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psnet.ahrq.gov/node/33792/psn-pdf
September 01, 2015 - In Conversation With… Eric J. Topol, MD
September 1, 2015
In Conversation With… Eric J. Topol, MD. PSNet [internet]. 2015.
https://psnet.ahrq.gov/perspective/conversation-eric-j-topol-md
Editor's note: Eric J. Topol, MD, is Director of Scripps Translational Science Institute, Professor of
Genomics at The Scripps …
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psnet.ahrq.gov/primer/retained-surgical-items-definition-and-epidemiology
September 15, 2024 - Retained Surgical Items: Definition and Epidemiology.
Citation Text:
Romano PS, Gibbs VC. Retained Surgical Items: Definition and Epidemiology.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024.
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psnet.ahrq.gov/web-mm/verbal-orders-and-medication-overrides-dangerous-combination
September 27, 2023 - Verbal Orders and Medication Overrides: A Dangerous Combination
Citation Text:
Mueller C, MacDowell P, Bourgeois JA. Verbal Orders and Medication Overrides: A Dangerous Combination. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024…
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psnet.ahrq.gov/node/866343/psn-pdf
December 31, 2024 - Mismanagement of Acute Decompensated Heart Failure
with Hypertensive Emergency
December 31, 2024
Lee J, Fernilius J, Frick W. Mismanagement of Acute Decompensated Heart Failure with Hypertensive
Emergency. PSNet [internet]. 2024.
https://psnet.ahrq.gov/web-mm/mismanagement-acute-decompensated-heart-failure-hyperte…
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psnet.ahrq.gov/web-mm/inadequate-anesthesia-preparation-leading-difficult-intubation-and-severe-hypoxemia
January 29, 2021 - Inadequate Anesthesia Preparation Leading to Difficult Intubation and Severe Hypoxemia
Citation Text:
Bohringer C. Inadequate Anesthesia Preparation Leading to Difficult Intubation and Severe Hypoxemia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and…
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psnet.ahrq.gov/innovation/algorithm-based-decision-support-system-guides-trauma-staff-during-initial-treatment
May 31, 2023 - Algorithm-Based Decision Support System Guides Trauma Staff During Initial Treatment, Leading to Fewer Medical Errors
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March 3, 2021
Innovation…
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psnet.ahrq.gov/node/33577/psn-pdf
September 15, 2024 - Duty Hours and Patient Safety
September 15, 2024
Duty Hours and Patient Safety. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/duty-hours-and-patient-safety
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the …
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psnet.ahrq.gov/perspective/conversation-withj-bryan-sexton-phd-ma
December 01, 2006 - In Conversation with...J. Bryan Sexton, PhD, MA
December 1, 2006
Also Read an Essay
Citation Text:
In Conversation with..J. Bryan Sexton, PhD, MA. PSNet [internet]. 2006.In Conversation with...J. Bryan Sexton, PhD, MA. PSNet [internet]. Rockville (MD): Agency for…
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psnet.ahrq.gov/node/837958/psn-pdf
December 01, 2021 - EMS Perils from Hospital Overcrowding
August 31, 2022
Brown S, Rose JS, Barnes DK. EMS Perils from Hospital Overcrowding. PSNet [internet]. 2022.
https://psnet.ahrq.gov/web-mm/ems-perils-hospital-overcrowding
The Case
A 71-year-old man with a history of postoperative septic knee arthritis (status: post-intravenous…
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psnet.ahrq.gov/node/73902/psn-pdf
September 29, 2021 - Dangers of Missing an Epidural Abscess: Multiple Visits
and Delayed Diagnosis with a Severely Negative Outcome
September 29, 2021
Lantz L, Yoon J, Barnes DK. Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed
Diagnosis with a Severely Negative Outcome. PSNet [internet]. 2021.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/837324/psn-pdf
July 08, 2022 - A Statewide Collaborative to Support Vaginal Birth and
Reduce Unnecessary Cesarean Deliveries
July 8, 2022
https://psnet.ahrq.gov/innovation/statewide-collaborative-support-vaginal-birth-and-reduce-unnecessary-
cesarean-deliveries
Summary
Started in response to rising maternal morbidity and mortality rates in …
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psnet.ahrq.gov/web-mm/total-parenteral-nutrition-multifarious-errors
January 23, 2017 - On rounds, the resident caring for the patient examined the TPN bag to see how much sodium the boy was
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psnet.ahrq.gov/node/865413/psn-pdf
March 27, 2024 - A study by the
University of Minnesota also examined data from the Centers for Medicare & Medicaid Services
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psnet.ahrq.gov/node/863649/psn-pdf
February 28, 2024 - Stephen Hines: Multiple studies have examined TeamSTEPPS in a variety of settings.
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psnet.ahrq.gov/perspective/equity-patient-safety
September 24, 2024 - address disparities and improve equity. 9 To further advance health equity, AHRQ has critically examined
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psnet.ahrq.gov/perspective/annual-perspective-topics-medication-safety
April 27, 2022 - A recent report on nursing education curricula examined the safety and medication administration practice
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psnet.ahrq.gov/node/49764/psn-pdf
June 01, 2016 - Communication With Consultants
June 1, 2016
Cohn SL. Communication With Consultants. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/communication-consultants
The Case
A 30-year-old pregnant woman presented to the emergency department (ED) with nausea, headaches, and
fevers. Her laboratory studies were nota…
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psnet.ahrq.gov/node/33612/psn-pdf
May 01, 2005 - Organizational Change in the Face of Highly Public
Errors—I. The Dana-Farber Cancer Institute Experience
May 1, 2005
Conway JB, Weingart SN. Organizational Change in the Face of Highly Public Errors—I. The Dana-Farber
Cancer Institute Experience. PSNet [internet]. 2005.
https://psnet.ahrq.gov/perspective/organizat…
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psnet.ahrq.gov/node/49464/psn-pdf
December 27, 2020 - Lap Burn
October 1, 2004
Ball K. Lap Burn. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/lap-burn
The Case
A woman was scheduled for an elective diagnostic laparoscopy for dysfunctional uterine bleeding. After
accessing the abdomen with the trocar without complication, the surgeon inserted the laparoscope…
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psnet.ahrq.gov/node/50858/psn-pdf
January 31, 2020 - Artificial Intelligence and Diagnostic Errors
January 31, 2020
Hall KK, Fitall E. Artificial Intelligence and Diagnostic Errors. PSNet [internet]. 2020.
https://psnet.ahrq.gov/perspective/artificial-intelligence-and-diagnostic-errors
Definition of Artificial Intelligence
The definition of artificial intelligence (…