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2561. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42840/psn-pdf
      January 08, 2014 - A system-wide approach to explaining variation in potentially avoidable emergency admissions: national ecological study. January 8, 2014 O'Cathain A, Knowles E, Maheswaran R, et al. A system-wide approach to explaining variation in potentially avoidable emergency admissions: national ecological study. BMJ Qual Saf…

2562. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60957/psn-pdf
      September 30, 2020 - A narrative review of strategies to increase patient safety event reporting by residents. September 30, 2020 Aaron M, Webb A, Luhanga U. A narrative review of strategies to increase patient safety event reporting by residents. J Grad Med Educ. 2020;12(4):415-424. doi:10.4300/jgme-d-19-00649.1. https://psnet.ahrq.g…

2563. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37790/psn-pdf
      April 11, 2011 - Adolescent use of insulin and patient-controlled analgesia pump technology: a 10-year Food and Drug Administration retrospective study of adverse events. April 11, 2011 Cope JU, Morrison AE, Samuels-Reid J. Adolescent use of insulin and patient-controlled analgesia pump technology: a 10-year Food and Drug Administ…

2564. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866168/psn-pdf
      January 02, 2000 - Missed diagnoses of acute cardiac ischemia in the emergency department. January 2, 2000 Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342(16):1163-1170. doi:10.1056/nejm200004203421603. https://psnet.ahrq.gov/issue/missed-diag…

2565. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34874/psn-pdf
      February 25, 2009 - Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery. February 25, 2009 Pronovost PJ, Dang D, Dorman T, et al. Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery. Eff Clin Pract. 2001;4(5):199-206. https://psnet.ahrq.gov/issu…

2566. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47941/psn-pdf
      January 01, 2020 - Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults. May 22, 2019 Holden RJ, Campbell NL, Abebe E, et al. Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults. Res Social Adm Pharm. 2020;16(1):54-61. doi:10.1016/…

2567. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47568/psn-pdf
      March 06, 2019 - Trends in anesthesia-related liability and lessons learned. March 6, 2019 Mora JC, Kaye AD, Romankowski ML, et al. Trends in Anesthesia-Related Liability and Lessons Learned. Adv Anesth. 2018;36(1):231-249. doi:10.1016/j.aan.2018.07.009. https://psnet.ahrq.gov/issue/trends-anesthesia-related-liability-and-lessons-l…

2568. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50536/psn-pdf
      October 16, 2019 - The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project October 16, 2019 Jones KJ, Crowe J, Allen JA, et al. The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-expe…

2569. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46898/psn-pdf
      April 16, 2019 - TeamSTEPPS: an evidence-based approach to reduce clinical errors threatening safety in outpatient settings: an integrative review. April 16, 2019 Parker AL, Forsythe LL, Kohlmorgen IK. TeamSTEPPS : An evidence-based approach to reduce clinical errors threatening safety in outpatient settings: An integrative review…

2570. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43077/psn-pdf
      April 02, 2014 - Am I right when I am sure? Data consistency influences the relationship between diagnostic accuracy and certainty. April 2, 2014 Cavalcanti RB, Sibbald M. Am I right when I am sure? Data consistency influences the relationship between diagnostic accuracy and certainty. Acad Med. 2014;89(1):107-13. doi:10.1097/ACM…

2571. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/853611/psn-pdf
      September 20, 2023 - Preventing potential patient harm through clinical content interventions during oncology clinical trial implementation. September 20, 2023 Loo VC, Kim S, Johnson LM, et al. Preventing potential patient harm through clinical content interventions during oncology clinical trial implementation. J Patient Saf. 2023;19…

2572. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60334/psn-pdf
      May 13, 2020 - Crisis Standards of Care: Ten Years of Successes and Challenges–Proceedings of a Workshop. May 13, 2020 National Academies of Sciences, Engineering, and Medicine. Washington, DC; The National Academies Press: 2020. ISBN 9780309676250. https://psnet.ahrq.gov/issue/crisis-standards-care-ten-years-successes-and-…

2573. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43208/psn-pdf
      July 18, 2014 - System-based interprofessional simulation-based training program increases awareness and use of rapid response teams. July 18, 2014 Wehbe-Janek H, Pliego J, Sheather S, et al. System-based interprofessional simulation-based training program increases awareness and use of rapid response teams. Jt Comm J Qual Patien…

2574. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/865722/psn-pdf
      May 01, 2024 - Patient death after inadvertent infusion of PRN medication hanging on bedside intravenous (IV) pole. May 1, 2024 ISMP Medication Safety Alert! Acute Care. 2024;29(8):1-4. https://psnet.ahrq.gov/issue/patient-death-after-inadvertent-infusion-prn-medication-hanging-bedside- intravenous-iv-pole A multitude of latent…

2575. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73610/psn-pdf
      January 01, 2022 - Patient factors and hospital outcomes associated with atypical presentation in hospitalized older adults with COVID-19 during the first surge of the pandemic. August 18, 2021 Marziliano A, Burns E, Chauhan L, et al. Patient factors and hospital outcomes associated with atypical presentation in hospitalized older a…

2576. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46153/psn-pdf
      May 31, 2017 - Adverse health events related to self-medication practices among elderly: a systematic review. May 31, 2017 Locquet M, Honvo G, Rabenda V, et al. Adverse health events related to self-medication practices among elderly: a systematic review. Drugs Aging. 2017;34(5):359-365. doi:10.1007/s40266-017-0445-y. https://ps…

2577. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/850173/psn-pdf
      June 07, 2023 - A national safety board made transportation safer and could do the same for health care, advocates say. June 7, 2023 Jaklevic MC. CNN. May 30, 2023. https://psnet.ahrq.gov/issue/national-safety-board-made-transportation-safer-and-could-do-same-health- care-advocates-say Patient safety has long drawn from aviation…

2578. The Dropped Lung | PSNet
      psnet.ahrq.gov/web-mm/dropped-lung
      February 06, 2012 - The Dropped Lung Citation Text: Heffner JR. The Dropped Lung. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

2579. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/840175/psn-pdf
      November 16, 2022 - Mechanical Prosthetic Valve Thrombosis with Thromboembolism. November 16, 2022 Hedayati N, White RO. Mechanical Prosthetic Valve Thrombosis with Thromboembolism. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/mechanical-prosthetic-valve-thrombosis-thromboembolism The Case A 61-year-old woman presented to …

2580. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/839820/psn-pdf
      November 09, 2022 - Patients who die by suicide: a study of treatment patterns and patient safety incidents in Norway. November 9, 2022 Krvavac S, Jansson B, Bukholm IRK, et al. Patients who die by suicide: a study of treatment patterns and patient safety incidents in Norway. Int J Environ Res Public Health. 2022;19(17):10686. doi:10…