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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33835/psn-pdf
    June 01, 2017 - In Conversation With… Paul Aylin, MBChB June 1, 2017 In Conversation With… Paul Aylin, MBChB. PSNet [internet]. 2017. https://psnet.ahrq.gov/perspective/conversation-paul-aylin-mbchb Editor's note: Professor Aylin is Professor of Epidemiology and Public Health at Imperial College London, where he is also Co-Direc…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33741/psn-pdf
    November 01, 2012 - The Evidence-Based Physical Examination as a Patient Safety Practice November 1, 2012 McGee S. The Evidence-Based Physical Examination as a Patient Safety Practice. PSNet [internet]. 2012. https://psnet.ahrq.gov/perspective/evidence-based-physical-examination-patient-safety-practice Perspective Near the end of hi…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49659/psn-pdf
    July 01, 2012 - Sloppy and Paste July 1, 2012 Hirschtick RE. Sloppy and Paste. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/sloppy-and-paste The Case A 78-year-old man with hypertension and diabetes presented to an emergency department (ED) with new onset chest pain. The ED physician reviewed the patient's electronic me…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49748/psn-pdf
    December 01, 2015 - Managing Ascites: Hazards of Fluid Removal December 1, 2015 Moore K. Managing Ascites: Hazards of Fluid Removal. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/managing-ascites-hazards-fluid-removal The Case A 50-year-old man with longstanding alcoholic cirrhosis presented to the emergency department (ED) w…

  5. Organizational Change in the Face of Highly Public Errors—I. The Dana-Farber Cancer Institute Experience | PSNet

    psnet.ahrq.gov/perspective/organizational-change-face-highly-public-errors-i-dana-farber-cancer-institute
    December 23, 2020 - Organizational Change in the Face of Highly Public Errors—I. The Dana-Farber Cancer Institute Experience James B. Conway; Saul N. Weingart, MD, PhD | May 1, 2005  View more articles from the same authors. Citation Text: Conway JB, Weingart SN. Organizational Change…

  6. Spotlight Case July 2008 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.266_slideshow.ppt
    May 01, 2012 - Spotlight Case July 2008 Spotlight Case The Perils of Cross Coverage * * Source and Credits This presentation is based on the May 2012 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Jeanne M. Farnan, MD, MHPE, and Vineet M. Arora, MD, MAPP, …

  7. A Case of Mistaken Capacity: Why A Thorough Psychosocial History Can Improve Care. | PSNet

    psnet.ahrq.gov/web-mm/case-mistaken-capacity-why-thorough-psychosocial-history-can-improve-care
    July 08, 2022 - understanding of the situation due to young or old age, limited educational attainment, or significant cultural

  8. Overuse as a Patient Safety Problem | PSNet

    psnet.ahrq.gov/perspective/overuse-patient-safety-problem
    September 01, 2014 - RW : So the reasons for overuse include financial incentives, cultural beliefs, marketing, and production

  9. Patient Safety in Frail Older Patients | PSNet

    psnet.ahrq.gov/perspective/patient-safety-frail-older-patients
    November 26, 2019 - Ensuring Device Safety May 28, 2020 Perspective Cultural

  10. A Loss of Trust and a Missed Diagnosis | PSNet

    psnet.ahrq.gov/web-mm/loss-trust-and-missed-diagnosis
    October 31, 2023 - Delayed Diagnosis June 24, 2020 WebM&M Cases Cultural

  11. Making Healthcare Safer III Report | PSNet

    psnet.ahrq.gov/perspective/making-healthcare-safer-iii-report
    March 30, 2020 - safety culture; teamwork and team training; clinical decision support; person and family engagement; cultural

  12. In Conversation with...Peter J. Pronovost, MD, PhD | PSNet

    psnet.ahrq.gov/perspective/conversation-withpeter-j-pronovost-md-phd-0
    October 01, 2010 - In Conversation with...Peter J. Pronovost, MD, PhD October 1, 2010  Also Read an Essay Citation Text: In Conversation with..Peter J. Pronovost, MD, PhD. PSNet [internet]. 2010.In Conversation with...Peter J. Pronovost, MD, PhD. PSNet [internet]. Rockville (MD): Ag…

  13. A blinded, prospective study of error detection during physician chart rounds in radiation oncology. | PSNet

    psnet.ahrq.gov/issue/blinded-prospective-study-error-detection-during-physician-chart-rounds-radiation-oncology
    November 16, 2022 - Study A blinded, prospective study of error detection during physician chart rounds in radiation oncology. Citation Text: Talcott WJ, Lincoln H, Kelly JR, et al. A blinded, prospective study of error detection during physician chart rounds in radiation oncology. Pract Radiat Oncol. 2020;…

  14. Impact of simulation-based closed-loop communication training on medical errors in a pediatric emergency department. | PSNet

    psnet.ahrq.gov/issue/impact-simulation-based-closed-loop-communication-training-medical-errors-pediatric-emergency
    July 22, 2020 - Study Impact of simulation-based closed-loop communication training on medical errors in a pediatric emergency department. Citation Text: Diaz MCG, Dawson K. Impact of Simulation-Based Closed-Loop Communication Training on Medical Errors in a Pediatric Emergency Department. Am J Med Qual…

  15. Investigating racial and ethnic disparities in maternal care at the system level using patient safety incident reports. | PSNet

    psnet.ahrq.gov/issue/investigating-racial-and-ethnic-disparities-maternal-care-system-level-using-patient-safety
    March 29, 2023 - Study Investigating racial and ethnic disparities in maternal care at the system level using patient safety incident reports. Citation Text: Alfred MC, Wilson D, DeForest E, et al. Investigating racial and ethnic disparities in maternal care at the system level using patient safety incid…

  16. Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study. | PSNet

    psnet.ahrq.gov/issue/nursing-implications-early-warning-system-implemented-reduce-adverse-events-qualitative-study
    October 27, 2021 - Study Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study. Citation Text: Braun EJ, Singh S, Penlesky AC, et al. Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study. BMJ Qual Saf. …

  17. I-PASS handoff program: use of a campaign to effect transformational change. | PSNet

    psnet.ahrq.gov/issue/i-pass-handoff-program-use-campaign-effect-transformational-change
    April 24, 2018 - Study I-PASS handoff program: use of a campaign to effect transformational change. Citation Text: Rosenbluth G, Destino LA, Starmer AJ, et al. I-PASS Handoff Program: Use of a Campaign to Effect Transformational Change. Ped Qual Saf. 2018;3(4):e088. doi:10.1097/pq9.0000000000000088. Co…

  18. Large-scale implementation of the I-PASS handover system at an academic medical centre. | PSNet

    psnet.ahrq.gov/issue/large-scale-implementation-i-pass-handover-system-academic-medical-centre
    March 27, 2018 - Study Large-scale implementation of the I-PASS handover system at an academic medical centre. Citation Text: Shahian DM, McEachern K, Rossi L, et al. Large-scale implementation of the I-PASS handover system at an academic medical centre. BMJ Qual Saf. 2017;26(9):760-770. doi:10.1136/bmjq…

  19. Characteristics and unexpected COVID-19 diagnoses in resuscitation room patients during the COVID-19 outbreak - a retrospective case series. | PSNet

    psnet.ahrq.gov/issue/characteristics-and-unexpected-covid-19-diagnoses-resuscitation-room-patients-during-covid-19
    September 02, 2020 - Commentary Characteristics and unexpected COVID-19 diagnoses in resuscitation room patients during the COVID-19 outbreak - a retrospective case series. Citation Text: Bergrath S, Aretz O, Haake H, et al. Characteristics and unexpected COVID-19 diagnoses in resuscitation room patients dur…

  20. Embracing the future-is artificial intelligence already better? A comparative study of artificial intelligence performance in diagnostic accuracy and decision-making. | PSNet

    psnet.ahrq.gov/issue/embracing-future-artificial-intelligence-already-better-comparative-study-artificial
    January 31, 2024 - Study Embracing the future-is artificial intelligence already better? A comparative study of artificial intelligence performance in diagnostic accuracy and decision-making. Citation Text: Fonseca Â, Ferreira A, Ribeiro L, et al. Embracing the future—is artificial intelligence already bet…
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