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psnet.ahrq.gov/perspective/care-transitions
December 01, 2007 - developed 11 components for effective hospital discharge transitions, including the following ( 11 ):
Educate
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psnet.ahrq.gov/web-mm/ebola-are-we-ready
July 01, 2012 - Ebola: Are We Ready?
Citation Text:
Barsuk JH, Barnard C. Ebola: Are We Ready?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014.
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psnet.ahrq.gov/web-mm/cups-error
January 12, 2011 - Cups of Error
Citation Text:
Blegen MA, Pepper GA. Cups of Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006.
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psnet.ahrq.gov/issue/patient-safety-and-quality-improvement-0
September 27, 2017 - Special or Theme Issue
Patient Safety and Quality Improvement.
Citation Text:
Patient Safety and Quality Improvement. Shah RK, ed. Otolaryngol Clin North Am. 2019;52:1-194.
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psnet.ahrq.gov/web-mm/unfamiliar-catheter
November 01, 2006 - The Unfamiliar Catheter
Citation Text:
Swayze SC, James A. The Unfamiliar Catheter. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013.
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psnet.ahrq.gov/issue/healthcare-failure-mode-and-effect-analysis
May 24, 2017 - Toolkit
Healthcare Failure Mode and Effect Analysis.
Citation Text:
Healthcare Failure Mode and Effect Analysis. National Center for Patient Safety.
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psnet.ahrq.gov/issue/diagnostic-excellence-video-series
May 30, 2008 - Audiovisual Presentation
Diagnostic Excellence Video Series
Citation Text:
Diagnostic Excellence Video Series Oakland, CA: Kaiser Permanente; 2020.
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psnet.ahrq.gov/perspective/conversation-christopher-p-landrigan-md-mph
April 01, 2013 - In Conversation With… Christopher P. Landrigan, MD, MPH
April 1, 2013
Also Read an Essay
Citation Text:
In Conversation With… Christopher P. Landrigan, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health …
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psnet.ahrq.gov/web-mm/mismanagement-acute-decompensated-heart-failure-hypertensive-emergency
May 01, 2018 - SPOTLIGHT CASE
Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency
Citation Text:
Lee J, Fernilius J, Frick W. Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, U…
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psnet.ahrq.gov/web-mm/spotlight-mistaken-attribution-diagnostic-misstep
July 01, 2011 - SPOTLIGHT CASE
Spotlight: Mistaken Attribution, Diagnostic Misstep
Citation Text:
Kreider TR, Young JQ. Spotlight: Mistaken Attribution, Diagnostic Misstep. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/perspective/conversation-withatul-gawande-md-ma-mph
September 01, 2007 - In Conversation with...Atul Gawande, MD, MA, MPH
September 1, 2007
Also Read an Essay
Citation Text:
In Conversation with..Atul Gawande, MD, MA, MPH. PSNet [internet]. 2007.In Conversation with...Atul Gawande, MD, MA, MPH. PSNet [internet]. Rockville (MD): Agency…
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psnet.ahrq.gov/issue/teamstepps-core-curriculum
August 01, 2012 - Course Material/Curriculum
TeamSTEPPS Core Curriculum.
Citation Text:
TeamSTEPPS Core Curriculum. Rockville, MD: Agency for Healthcare Research and Quality; July 2023.
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psnet.ahrq.gov/issue/patient-safety-and-managing-risk-nursing
March 27, 2017 - Book/Report
Patient Safety and Managing Risk in Nursing.
Citation Text:
Patient Safety and Managing Risk in Nursing. Fisher MA, Scott M. London, UK: Sage Publishing; 2013. ISBN: 9781446266878.
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psnet.ahrq.gov/issue/mistakes-we-make-dialysis
April 04, 2018 - Special or Theme Issue
Mistakes We Make in Dialysis.
Citation Text:
Mistakes We Make in Dialysis. Rodby RA, Perazella MA, eds. Semin Dial. 2016;29(4):253-328.
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psnet.ahrq.gov/issue/case-shook-medicine
October 24, 2012 - Newspaper/Magazine Article
A case that shook medicine.
Citation Text:
A case that shook medicine. Lerner BH.
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psnet.ahrq.gov/issue/ahrq-challenge-innovative-solutions-update-or-re-create-teamstepps-videos
December 24, 2008 - Press Release/Announcement
AHRQ Challenge on Innovative Solutions To Update or Re-Create TeamSTEPPS Videos.
Citation Text:
AHRQ Challenge on Innovative Solutions To Update or Re-Create TeamSTEPPS Videos. Rockville, MD; Agency for Healthcare Research and Quality: April 2022.
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psnet.ahrq.gov/webmm/submit-case
Submit a Case
Note that your name will not be publicly associated with the case
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Submit a Case
Case Form
The content of case submissions is anonymous. Do not provide any personally identifiable (patient or provider) information, and do not use institution…
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psnet.ahrq.gov/issue/measure-dx-resource-identify-analyze-and-learn-diagnostic-safety-events
August 01, 2012 - Toolkit
Measure Dx: A Resource to Identify, Analyze, and Learn from Diagnostic Safety Events.
Citation Text:
Measure Dx: A Resource to Identify, Analyze, and Learn from Diagnostic Safety Events. Rockville, MD: Agency for Healthcare Research and Quality; July 2022. AHRQ Publication …
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psnet.ahrq.gov/issue/perceived-impact-duty-hours-limits-fragmentation-patient-care-results-academic-health-center
March 06, 2005 - Study
Perceived impact of duty hours limits on the fragmentation of patient care: results from an academic health center.
Citation Text:
Perceived impact of duty hours limits on the fragmentation of patient care: results from an academic health center. Keating RJ; LaRusso NF; Kolars …
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psnet.ahrq.gov/issue/work-design-drivers-organizational-learning-about-operational-failures-laboratory-experiment
September 05, 2012 - Book/Report
Work Design Drivers of Organizational Learning about Operational Failures: A Laboratory Experiment on Medication Administration.
Citation Text:
Work Design Drivers of Organizational Learning about Operational Failures: A Laboratory Experiment on Medication Administration. Tuc…