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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50927/psn-pdf
    February 21, 2020 - Patient Safety in Primary Care February 21, 2020 Schiff G, Hall KK, Fitall E. Patient Safety in Primary Care. PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/patient-safety-primary-care Introduction A strong primary care system is foundational to achieving high-quality, accessible, efficient healthcare …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49818/psn-pdf
    January 01, 2018 - A Costly Colonoscopy Leads to a Delay in Diagnosis January 1, 2018 Moriates C. A Costly Colonoscopy Leads to a Delay in Diagnosis. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/costly-colonoscopy-leads-delay-diagnosis The Case A 50-year-old man presented to a primary care clinic to establish care, as he ha…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33646/psn-pdf
    February 01, 2007 - In Conversation with...Joseph Britto, MD February 1, 2007 In Conversation with..Joseph Britto, MD. PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/conversation-withjoseph-britto-md Editor's Note: Joseph Britto, MD, is CEO and Co-founder of Isabel Healthcare Inc. Isabel, a clinical decision support syste…
  4. www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/webinar02/spcslides.html
    July 01, 2013 - Advanced Methods in Delivery System Research - Planning, Executing, Analyzing, and Reporting Research on Delivery System Improvement Webinar #2: Statistical Process Control (Slide Presentation) This slide presentation was presented on May 14, 2013. Presenter: Jill Marsteller, PhD, MPP Discussant: Stephen Al…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49484/psn-pdf
    June 01, 2005 - Two Pills, Same Drug June 1, 2005 Horsky J, Patel VL. Two Pills, Same Drug. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/two-pills-same-drug The Case A 34-year-old woman with AIDS developed a fever and hypotension due to suspected pneumonia. Her past medical history included several AIDS-related complica…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49734/psn-pdf
    May 01, 2015 - Departure From Central Line Ritual May 1, 2015 Ballard DW, Vinson DR, Mark DG. Departure From Central Line Ritual. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/departure-central-line-ritual The Case A 55-year-old man with a history of poorly controlled diabetes mellitus, pancreatic insufficiency, and alco…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846125/psn-pdf
    March 15, 2023 - The I-READI Quality and Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical Protocols During a Time of Crisis March 15, 2023 https://psnet.ahrq.gov/innovation/i-readi-quality-and-safety-framework-strong-communications-channels- and-effective Summary …
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49523/psn-pdf
    November 01, 2006 - Urinary Retention Dilemma November 1, 2006 Joseph AC. Urinary Retention Dilemma. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/urinary-retention-dilemma The Case Following an elective thyroidectomy, a 56-year-old man with a history of benign prostatic hypertrophy (BPH) and urinary hesitancy returned to th…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33666/psn-pdf
    October 01, 2008 - Methicillin-Resistant Staphylococcus aureus April 1, 2008 Noskin GA. Methicillin-Resistant Staphylococcus aureus. PSNet [internet]. 2008. https://psnet.ahrq.gov/perspective/methicillin-resistant-staphylococcus-aureus Perspective Methicillin-resistant Staphylococcus aureus (MRSA) has received a great deal of media …
  10. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.347_slideshow.ppt
    May 01, 2015 - PowerPoint Presentation Spotlight Errors in Sepsis Management This presentation is based on the May 2015 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: David Shimabukuro, MD, University of California, San Francisco (UCSF) Editor, AHRQ WebM&M: Rober…
  11. www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/nashp-webinar-on-quality_measure-use.pdf
    September 21, 2015 - Title of Presentation: Using Quality Measures to Drive Improvement: Presentation for the National Academy of State Health Policy’s Vanguard Network and CHIP Directors Lessons from the CHIPRA Quality Demonstration Cindy Brach, MPP • Grace Anglin, MPH • Kyra Chamberlain, MS, RN • David Kelley, MD, MPA Se…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49592/psn-pdf
    October 01, 2009 - Danger in Disruption October 1, 2009 Fontaine DK. Danger in Disruption. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/danger-disruption The Case A 23-month-old toddler was severely dehydrated after vomiting due to gastric outlet obstruction. She had metabolic alkalosis (pH = 7.58), and her last peripheral…
  13. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/physician-staff-engagement-facguide.docx
    January 01, 2017 - Facilitator Guide: Build Your SSI Prevention Bundle Slide Title and Commentary Slide Number and Slide Title Slide Physician and Staff Engagement SAY: Today, we will give you an overview of physician and staff engagement. Slide 1 Learning Objectives SAY: After this session, you will be able to identify the imp…
  14. psnet.ahrq.gov/sites/default/files/2020-08/too_many_cooks_spotlight_pdf.pdf
    January 01, 2020 - Spotlight Too Many Cooks in the Kitchen Source and Credits • This presentation is based on the August 2020 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Richard P. Dutton, MD, MBA o AHRQ WebM&M Editors in Chief: Patrick Romano, MD…
  15. www.ahrq.gov/hai/tools/mvp/modules/vae/surveillance-fac-guide.html
    February 01, 2017 - Ventilator-Associated Event Surveillance: Facilitator Guide AHRQ Safety Program for Mechanically Ventilated Patients Slide 1: Ventilator-Associated Event Surveillance Say: This module will focus on ventilator-associated event surveillance and how it can be used in your unit. Slide 2: Learning Objectiv…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49670/psn-pdf
    November 01, 2012 - Missed Pneumonia November 1, 2012 Rohde JM, Flanders S. Missed Pneumonia. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/missed-pneumonia The Case A 32-year-old man presented to the emergency department (ED) with 3 days of fever and right pleuritic chest pain. Review of systems was negative for cough or dy…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49397/psn-pdf
    May 01, 2003 - The Dropped Lung May 1, 2003 Heffner JR. The Dropped Lung. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/dropped-lung The Case A 79-year-old woman was admitted for hypoxia and shortness of breath. Two weeks prior she had been hospitalized for dyspnea and was found to have multiple bilateral pulmonary nodu…
  18. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/sppcii-facilitator-guide.docx
    July 01, 2023 - Facilitator Guide for Hospital AIM Team Leads Facilitator Guide for Hospital AIM Team Leads What Is This Guide? This guide is intended as a complement to the online training modules of the Safety Program for Perinatal Care II (SPPC-II) Teamwork Toolkit. It provides helpful information about scheduling and conducting …
  19. www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/pf-engagement-fac-guide.html
    July 01, 2023 - Patient and Family Engagement for Perinatal Safety: Facilitator Guide AHRQ Safety Program for Perinatal Care Slide 1: Patient and Family Engagement for Perinatal Safety Say: The Patient and Family Engagement module focuses on an important topic: making sure patients and their family members understand w…
  20. www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-north-carolina-state-snapshot.pdf
    January 01, 2018 - Spotlight on North Carolina -- The National Evaluation of the CHIPRA Quality Demonstration Grant Program January 2018 This brief highlights the major strategies, lessons learned, and outcomes from North Carolina’s experience during the quality demonstration funded by the Centers for Medicare & Medicaid Services (…