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psnet.ahrq.gov/curated-library/nurse-wellbeing-and-patient-safety
August 30, 2023 - Classic
Effects of nurse staffing and nurse education on patient deaths
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psnet.ahrq.gov/web-mm/unfamiliar-catheter
November 01, 2006 - Medical device related deaths and injuries should be reported to the FDA .
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psnet.ahrq.gov/web-mm/limb-loss-after-vasopressor-use
March 14, 2012 - Limb Loss after Vasopressor Use
Citation Text:
Kwong M. Limb Loss after Vasopressor Use. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023.
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psnet.ahrq.gov/node/851971/psn-pdf
July 31, 2023 - Failure to Adhere to Dietary Restrictions Leading to
Complications and Poor Follow-up
July 31, 2023
Bohringer C, Bourgeois J, Xiong G, et al. Failure to adhere to dietary restrictions leading to complications
and poor follow-up. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/failure-adhere-dietary-restricti…
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psnet.ahrq.gov/perspective/diagnostic-errors-new-chapter-patient-safety-science-policy-and-practice
January 01, 2016 - The best estimate from autopsy studies is that there are 40,000 to 80,000 deaths a year from diagnostic … For example the 40,000 to 80,000 deaths a year was just a back-of-the-envelope calculation based on autopsy
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psnet.ahrq.gov/perspective/conversation-mark-l-graber-md
January 01, 2016 - The best estimate from autopsy studies is that there are 40,000 to 80,000 deaths a year from diagnostic … For example the 40,000 to 80,000 deaths a year was just a back-of-the-envelope calculation based on autopsy
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psnet.ahrq.gov/perspective/telemedicine-and-patient-safety
September 01, 2016 - One concerning study reviewed 32 cases that ended in catastrophic outcomes, including deaths and malpractice
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psnet.ahrq.gov/perspective/conversation-eric-thomas-about-zero-harm-striving-reduce-preventable-harms-point
September 24, 2024 - efforts are part of a larger challenge, many with “zero” as their goals, such as “Vision Zero” to reduce deaths
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psnet.ahrq.gov/issue/improving-safety-efficiencies-and-reducing-waste-ready-administer-iv-medications-roadmap
January 24, 2024 - International Meeting/Conference
Improving Safety, Efficiencies, and Reducing Waste with Ready-to-Administer IV Medications: A Roadmap to Success.
Citation Text:
Institute for Safe Medication Practices. February 6, 2024, 1:00-2:00 PM (eastern).
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psnet.ahrq.gov/issue/cpoe-not-first-step-toward-patient-safety
March 02, 2016 - Newspaper/Magazine Article
CPOE: not the first step toward patient safety.
Citation Text:
Kremsdorf R
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March 6, 2005
Kremsdo…
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psnet.ahrq.gov/issue/why-doctors-so-often-get-it-wrong
October 03, 2007 - Newspaper/Magazine Article
Why doctors so often get it wrong.
Citation Text:
Leonhardt D.
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March 8, 2006
Leonhardt D.
V…
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psnet.ahrq.gov/curated-library/world-patient-safety-day-2024-improving-diagnosis-patient-safety
August 30, 2023 - Breadcrumb
Home
The PSNet Collection
Curated Libraries
Subscribed
World Patient Safety Day 2024: Improving Diagnosis for Patient Safety
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Last Upda…
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psnet.ahrq.gov/node/49587/psn-pdf
May 01, 2009 - Missing Trauma
May 1, 2009
Jurkovich GJ. Missing Trauma. PSNet [internet]. 2009.
https://psnet.ahrq.gov/web-mm/missing-trauma
The Case
A 54-year-old woman collapsed behind the counter of a small neighborhood market. She was discovered a
few minutes later by a customer, who immediately called 911. On arrival, para…
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psnet.ahrq.gov/node/49838/psn-pdf
August 01, 2018 - An Untimely End Despite End-of-Life Care Planning
August 1, 2018
Elia G, Barbour S, Anderson WG. An Untimely End Despite End-of-Life Care Planning. PSNet [internet].
2018.
https://psnet.ahrq.gov/web-mm/untimely-end-despite-end-life-care-planning
The Case
A 76-year-old man was admitted to the intensive care unit (…
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psnet.ahrq.gov/node/73554/psn-pdf
July 28, 2021 - EMS Patient Safety in the Field
July 28, 2021
Augustine JJ, Fitall E, Hall KK, et al. EMS Patient Safety in the Field. PSNet [internet]. 2021.
https://psnet.ahrq.gov/perspective/ems-patient-safety-field
Introduction
Emergency medical services (EMS) personnel serve a critical role within the care continuum. They ar…
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psnet.ahrq.gov/web-mm/lethal-cap
December 19, 2018 - Lethal Cap
Citation Text:
Schillinger D. Lethal Cap. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004.
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Do…
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psnet.ahrq.gov/node/49757/psn-pdf
April 01, 2016 - Situational Awareness and Patient Safety
April 1, 2016
Farnan JE. Situational Awareness and Patient Safety. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/situational-awareness-and-patient-safety
The Case
A 40-year-old woman with a history of cirrhosis and known esophageal varices was admitted to the hospit…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.92_slideshow.ppt
April 01, 2005 - Spotlight Case [MONTH] 2003
Spotlight Case April 2005
Compare and Contrast
Source and Credits
This presentation is based on the April 2005
Spotlight Case in Emergency Medicine
See the full article at http://webmm.ahrq.gov
CME credit is available through the Web site
Commentary by: Kerry Cho, MD; Glenn Cher…
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psnet.ahrq.gov/node/49405/psn-pdf
June 01, 2003 - XL or Smaller?
June 1, 2003
Kozer E. XL or Smaller? PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/xl-or-smaller
The Case
With a history of hypertension and chronic renal failure secondary to hemolytic uremia syndrome at age 3,
a 14-year-old boy presented to the emergency department with dehydration second…
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psnet.ahrq.gov/node/33621/psn-pdf
November 01, 2005 - Rapid Response Teams: Lessons from the Early
Experience
November 1, 2005
Krimsky WS. Rapid Response Teams: Lessons from the Early Experience. PSNet [internet]. 2005.
https://psnet.ahrq.gov/perspective/rapid-response-teams-lessons-early-experience
Perspective
Health care organizations throughout the world have ide…