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psnet.ahrq.gov/node/865413/psn-pdf
March 27, 2024 - In Conversation with...Barbara Pelletreau and John Riggi
about Cybersecurity
March 27, 2024
Pelletreau B, Riggi J. In Conversation with..Barbara Pelletreau and John Riggi about Cybersecurity. PSNet
[internet]. 2024.
https://psnet.ahrq.gov/perspective/conversation-withbarbara-pelletreau-and-john-riggi-about-cyberse…
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psnet.ahrq.gov/sites/default/files/2023-06/hurried_huddle_0.pdf
January 01, 2023 - Microsoft PowerPoint - Spotlight Case_Anesthesia Error During Cesarean_06.22.2023 - Final.pptx
Spotlight
Hurried Team Huddle and Poor Communication: Unsafe
Practice During Anesthesia for Emergency Cesarean
Delivery
Source and Credits
• This presentation is based on the June 2023 AHRQ WebM&M
Spotlight Case
o See…
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psnet.ahrq.gov/perspective/conversation-eric-j-topol-md
February 26, 2025 - The fourth leading cause of death in this country is medication errors. We can do better than that.
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psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia
March 31, 2021 - SPOTLIGHT CASE
Delayed Diagnosis of Mesenteric Ischemia
Citation Text:
Robles A, Utter GH. Delayed Diagnosis of Mesenteric Ischemia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022.
Copy Citation
Format:
…
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psnet.ahrq.gov/perspective/conversation-jack-westfall-md-mph
September 28, 2022 - Leading Causes of Death – Males – by Race and Hispanic Origin – United States, 2017.
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psnet.ahrq.gov/sites/default/files/2024-04/spotlight_case_hindsight_is_2020_slides_final.pdf
January 01, 2024 - for 1.2% of annual visits to emergency departments and is the
eighth leading cause of preventable death
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psnet.ahrq.gov/perspective/conversation-withjohn-banja-phd
February 01, 2006 - conduct the initial disclosure of an adverse event.( 10 ) It opens with one mother describing the tragic death
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psnet.ahrq.gov/perspective/removing-insult-injury-disclosing-adverse-events
February 01, 2006 - conduct the initial disclosure of an adverse event.( 10 ) It opens with one mother describing the tragic death
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psnet.ahrq.gov/node/846975/psn-pdf
March 28, 2023 - The MMRC data that are collected after the death of people who have been pregnant or were pregnant
shows
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psnet.ahrq.gov/node/33859/psn-pdf
June 01, 2018 - RW: The transition zone is partly because you have this death spiral where people no longer learn very
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psnet.ahrq.gov/node/33728/psn-pdf
May 01, 2012 - About 2% of them were associated with death, about 3.5% of them were associated with the
requirement
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psnet.ahrq.gov/web-mm/failure-ensure-patient-safety-leads-patient-falls-nursing-homes
August 14, 2024 - The cause of death was documented as hip trauma from the fall at the nursing home.
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psnet.ahrq.gov/perspective/conversation-jennifer-schulz-moore-llb-ma-phd
February 26, 2025 - the family can also go to the Coroner's Court , and the coroner will investigate what the cause of death
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psnet.ahrq.gov/periodic-issue/periodic-issue-447
July 10, 2024 - Of the 89 nutrition-related problems, 20% were very severe, including one that resulted in patient death
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psnet.ahrq.gov/web-mm/agitated-delirium-contributes-missed-testing-and-delayed-diagnosis-gastric-perforation
June 28, 2023 - timeliness of device removal. 22
Conclusion
Several issues contributed to the decompensation and death
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psnet.ahrq.gov/perspective/overuse-patient-safety-problem
September 01, 2014 - Influence of patient preferences and local health system characteristics on the place of death.
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psnet.ahrq.gov/perspective/conversation-rosemary-gibson-msc
September 01, 2014 - Influence of patient preferences and local health system characteristics on the place of death.
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psnet.ahrq.gov/node/867035/psn-pdf
October 30, 2024 - consecutive falls and is associated with longer hospital
stays, increased frequency of in-hospital death
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psnet.ahrq.gov/web-mm/adolescent-diabetes-routine-visit
November 18, 2016 - with physical, emotional, and social adversity during adolescence and with premature disability and death
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psnet.ahrq.gov/sites/default/files/2024-05/spotlight_case_hindsight_is_2020_slides_final_revised_05.03.2024.pdf
January 01, 2024 - for 1.2% of annual visits to emergency departments and is the
eighth leading cause of preventable death