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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49709/psn-pdf
    May 01, 2014 - Raise the Bar May 1, 2014 Stotts J, Lyndon A. Raise the Bar. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/raise-bar The Case A 57-year-old man presented to an ambulatory surgery center for excision of a right groin lipoma. The patient was seen and evaluated by an anesthesiologist who was new to the cente…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49756/psn-pdf
    April 01, 2016 - Lost in Sign Out and Documentation April 1, 2016 Detsky ME. Lost in Sign Out and Documentation. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/lost-sign-out-and-documentation The Case A 71-year-old man presented to the emergency department with chest pain. While being evaluated by the emergency physician, …
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49616/psn-pdf
    December 01, 2010 - Milliliters vs. Milligrams December 1, 2010 Poole RL, Dixon T. Milliliters vs. Milligrams. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/milliliters-vs-milligrams The Case   A 32-year-old man was admitted to the hospital after a vehicle collision and multiple traumatic injuries. His evaluation showed acu…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49851/psn-pdf
    January 01, 2019 - One Bronchoscopy, Two Errors January 1, 2019 Leiten E, Nielsen R. One Bronchoscopy, Two Errors. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/one-bronchoscopy-two-errors The Case A 67-year-old man with a history of hypertension was admitted to the intensive care unit (ICU) with hypoxic respiratory failure…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49808/psn-pdf
    October 01, 2017 - High-Risk Medications, High-Risk Transfers October 1, 2017 Staggers N. High-Risk Medications, High-Risk Transfers. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/high-risk-medications-high-risk-transfers The Case A 47-year-old woman with history of primary pulmonary arterial hypertension (PAH) was admitted …
  6. psnet.ahrq.gov/web-mm/timely-diagnosis-esophageal-perforation
    September 27, 2023 - Timely diagnosis of esophageal perforation Citation Text: Utter GH, Cooke DT. Timely diagnosis of esophageal perforation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Format: Google Scholar BibTeX …
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43643/psn-pdf
    November 04, 2014 - Out-of-hospital medication errors among young children in the United States, 2002–2012. November 4, 2014 Smith MD, Spiller HA, Casavant MJ, et al. Out-of-hospital medication errors among young children in the United States, 2002-2012. Pediatrics. 2014;134(5):867-76. doi:10.1542/peds.2014-0309. https://psnet.ahrq.g…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41223/psn-pdf
    March 21, 2012 - High-profile investigations into hospital safety problems in England did not prompt patients to switch providers. March 21, 2012 Laverty AA, Smith PC, Pape UJ, et al. High-profile investigations into hospital safety problems in England did not prompt patients to switch providers. Health Aff (Millwood). 2012;31(3):5…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47082/psn-pdf
    July 02, 2019 - Effect of systematic physician cross-checking on reducing adverse events in the emergency department: the CHARMED cluster randomized trial. July 2, 2019 Freund Y, Goulet H, Leblanc J, et al. Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department: The CHARMED Cluster Ra…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38612/psn-pdf
    May 06, 2009 - Assessing controlled substance prescribing errors in a pediatric teaching hospital: an analysis of the safety of analgesic prescription practice in the transition from the hospital to home. May 6, 2009 Lee BH, Lehmann CU, Jackson E, et al. Assessing controlled substance prescribing errors in a pediatric teaching …
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46424/psn-pdf
    March 20, 2018 - Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care. March 20, 2018 Murphy DR, Meyer AND, Vaghani V, et al. Electronic Triggers to Identify Delays in Follow-Up of Mammography: Harnessing the Power of Big Data in Health Care. J Am Coll Radiol. 2018;15(…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41458/psn-pdf
    June 19, 2012 - What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service. June 19, 2012 Shearer B, Marshall S, Buist MD, et al. What stops ho…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39463/psn-pdf
    February 10, 2015 - Mixed results in the safety performance of computerized physician order entry. February 10, 2015 Metzger J, Welebob E, Bates DW, et al. Mixed results in the safety performance of computerized physician order entry. Health Aff (Millwood). 2010;29(4):655-663. doi:10.1377/hlthaff.2010.0160. https://psnet.ahrq.gov/iss…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47307/psn-pdf
    December 12, 2018 - Are teaching hospitals treated fairly in the Hospital- Acquired Condition Reduction Program? December 12, 2018 Mohajer MA, Joiner KA, Nix DE. Are Teaching Hospitals Treated Fairly in the Hospital-Acquired Condition Reduction Program? Acad Med. 2018;93(12):1827-1832. doi:10.1097/ACM.0000000000002399. https://psnet.…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44976/psn-pdf
    February 14, 2017 - Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment. February 14, 2017 Schmidt HG, Van Gog T, Schuit SC, et al. Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment. BMJ Qual Saf. 2017;26(1):19-23. doi:10.11…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44643/psn-pdf
    July 21, 2016 - Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medical Office Survey on Patient Safety Culture. July 21, 2016 Hickner J, Smith SA, Yount N, et al. Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medic…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39604/psn-pdf
    November 23, 2016 - Improving the patient, family, and clinician experience after harmful events: the "When Things Go Wrong" curriculum. November 23, 2016 Bell SK, Moorman D, Delbanco T. Improving the patient, family, and clinician experience after harmful events: the "when things go wrong" curriculum. Acad Med. 2010;85(6):1010-1017.…
  18. psnet.ahrq.gov/issue/lessons-event-reports
    January 16, 2025 - Multi-use Website Lessons from Event Reports. Citation Text: Lessons from Event Reports. Patient Safety Authority. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download Citation Save Sav…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45220/psn-pdf
    June 08, 2016 - Medical Office Survey on Patient Safety Culture: 2016 User Comparative Database Report. June 8, 2016 Famolaro T, Yount ND, Hare R, Thornton S, Sorra J. Rockville, MD: Agency for Healthcare Research and Quality; May 2016. AHRQ Publication No. 16-0028-EF. https://psnet.ahrq.gov/issue/medical-office-survey-patient-sa…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43865/psn-pdf
    May 01, 2015 - Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems. May 1, 2015 Schiff GD, Amato MG, Eguale T, et al. Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current sy…

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