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psnet.ahrq.gov/web-mm/which-line-ordering-provider-or-proceduralist
September 16, 2015 - SPOTLIGHT CASE
Which Line: Ordering Provider or Proceduralist?
Citation Text:
Blackmore CC. Which Line: Ordering Provider or Proceduralist?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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Format: …
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psnet.ahrq.gov/web-mm/dissecting-presentation
May 05, 2021 - SPOTLIGHT CASE
Dissecting the Presentation
Citation Text:
Suat-Ooi SB. Dissecting the Presentation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015.
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Format:
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psnet.ahrq.gov/node/49445/psn-pdf
May 01, 2004 - No Blood, Please
May 1, 2004
Liang BA. No Blood, Please. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/no-blood-please
The Case
A young woman, about 30 years of age, was injured in an automobile collision. She was brought to the
emergency department (ED) via ambulance, where she was found to be suffering …
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psnet.ahrq.gov/node/866839/psn-pdf
September 25, 2024 - Errors in Managing an Open Wound of the Elbow Leading
to Multiple Complications and Operations
September 25, 2024
Barnes DK, Utter GH. Errors in Managing an Open Wound of the Elbow Leading to Multiple Complications
and Operations. PSNet [internet]. 2024.
https://psnet.ahrq.gov/web-mm/errors-managing-open-wound-elb…
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psnet.ahrq.gov/sites/default/files/2024-09/final_spotlight_case_open_wound_of_the_elbow_slides_09.19.2024.pptx
January 01, 2024 - Spotlight
Spotlight
Errors in Managing an Open Wound of the Elbow Leading to Multiple Complications and Operations
1
Source and Credits
This presentation is based on the September 2024 AHRQ WebM&M Spotlight Case
See the full article at https://psnet.ahrq.gov/webmm
CME credit is available
Commentary by: David…
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psnet.ahrq.gov/node/61110/psn-pdf
November 11, 2020 - Association between parent comfort with English and
adverse events among hospitalized children.
November 11, 2020
Khan A, Yin HS, Brach C, et al. Association between parent comfort with English and adverse events
among hospitalized children. JAMA Pediatr. 2020;174(12):e203215.
doi:10.1001/jamapediatrics.2020.3215.…
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psnet.ahrq.gov/node/40982/psn-pdf
March 23, 2012 - Emergency hospitalizations for adverse drug events in
older Americans.
March 23, 2012
Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older
Americans. New Engl J Med. 2011;365(21):2002-2012. doi:10.1056/NEJMsa1103053.
https://psnet.ahrq.gov/issue/emergency-hospitali…
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psnet.ahrq.gov/node/38691/psn-pdf
June 10, 2009 - Effects of shift length on quality of patient care and health
provider outcomes: systematic review.
June 10, 2009
Estabrooks CA, Cummings GG, Olivo SA, et al. Effects of shift length on quality of patient care and health
provider outcomes: systematic review. Qual Saf Health Care. 2009;18(3):181-188.
doi:10.1136/qs…
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psnet.ahrq.gov/node/43262/psn-pdf
April 06, 2015 - Escalation of care in surgery: a systematic risk
assessment to prevent avoidable harm in hospitalized
patients.
April 6, 2015
Johnston MJ, Arora S, Anderson O, et al. Escalation of care in surgery: a systematic risk assessment to
prevent avoidable harm in hospitalized patients. Ann Surg. 2015;261(5):831-838.
doi:…
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psnet.ahrq.gov/node/48083/psn-pdf
August 07, 2019 - Missed diagnosis of cancer in primary care: insights from
malpractice claims data.
August 7, 2019
Aaronson E, Quinn GR, Wong CI, et al. Missed diagnosis of cancer in primary care: Insights from
malpractice claims data. J Healthc Risk Manag. 2019;39(2):19-29. doi:10.1002/jhrm.21385.
https://psnet.ahrq.gov/issue/mis…
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psnet.ahrq.gov/node/36979/psn-pdf
February 28, 2011 - Changes in outcomes for internal medicine inpatients
after work-hour regulations.
February 28, 2011
Horwitz LI, Kosiborod M, Lin Z, et al. Changes in outcomes for internal medicine inpatients after work-hour
regulations. Ann Intern Med. 2007;147(2):97-103.
https://psnet.ahrq.gov/issue/changes-outcomes-internal-med…
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psnet.ahrq.gov/node/46339/psn-pdf
August 20, 2018 - Association of the Hospital Readmissions Reduction
Program implementation with readmission and mortality
outcomes in heart failure.
August 20, 2018
Gupta A, Allen LA, Bhatt DL, et al. Association of the Hospital Readmissions Reduction Program
Implementation With Readmission and Mortality Outcomes in Heart Failure.…
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psnet.ahrq.gov/node/43346/psn-pdf
August 02, 2015 - Diffusion of surgical innovations, patient safety, and
minimally invasive radical prostatectomy.
August 2, 2015
Parsons K, Messer K, Palazzi K, et al. Diffusion of surgical innovations, patient safety, and minimally
invasive radical prostatectomy. JAMA Surg. 2014;149(8):845-51. doi:10.1001/jamasurg.2014.31.
https:…
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psnet.ahrq.gov/node/43766/psn-pdf
September 26, 2016 - Driven to distraction: a prospective controlled study of a
simulated ward round experience to improve patient
safety teaching for medical students.
September 26, 2016
Thomas I, Nicol L, Regan L, et al. Driven to distraction: a prospective controlled study of a simulated ward
round experience to improve patient saf…
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psnet.ahrq.gov/node/47010/psn-pdf
March 13, 2019 - Comparative accuracy of diagnosis by collective
intelligence of multiple physicians vs individual
physicians.
March 13, 2019
Barnett ML, Boddupalli D, Nundy S, et al. Comparative Accuracy of Diagnosis by Collective Intelligence of
Multiple Physicians vs Individual Physicians. JAMA Netw Open. 2019;2(3):e190096.
do…
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psnet.ahrq.gov/node/46191/psn-pdf
July 19, 2017 - Performance of a trigger tool for identifying adverse
events in oncology.
July 19, 2017
Lipitz-Snyderman A, Classen D, Pfister D, et al. Performance of a Trigger Tool for Identifying Adverse
Events in Oncology. J Oncol Pract. 2017;13(3). doi:10.1200/jop.2016.016634.
https://psnet.ahrq.gov/issue/performance-trigger…
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psnet.ahrq.gov/node/39210/psn-pdf
January 12, 2010 - Can aviation-based team training elicit sustainable
behavioral change?
January 12, 2010
Sax HC, Browne P, Mayewski RJ, et al. Can aviation-based team training elicit sustainable behavioral
change? Arch Surg. 2009;144(12):1133-1137. doi:10.1001/archsurg.2009.207.
https://psnet.ahrq.gov/issue/can-aviation-based-team…
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psnet.ahrq.gov/node/853427/psn-pdf
January 01, 2024 - Patient and family contributions to improve the diagnostic
process through the OurDX electronic health record tool:
a mixed method analysis.
September 13, 2023
Bell SK, Harcourt K, Dong J, et al. Patient and family contributions to improve the diagnostic process
through the OurDX electronic health record tool: a m…
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psnet.ahrq.gov/node/856584/psn-pdf
January 01, 2024 - Patient safety incidents in endoscopy: a human factors
analysis of non-procedural significant harm incidents
from the National Reporting and Learning System (NRLS).
November 29, 2023
Ravindran S, Matharoo M, Rutter MD, et al. Patient safety incidents in endoscopy: a human factors
analysis of nonprocedural signific…
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psnet.ahrq.gov/node/44683/psn-pdf
June 21, 2016 - Physician spending and subsequent risk of malpractice
claims: observational study.
June 21, 2016
Jena AB, Schoemaker L, Bhattacharya J, et al. Physician spending and subsequent risk of malpractice
claims: observational study. BMJ. 2015;351:h5516. doi:10.1136/bmj.h5516.
https://psnet.ahrq.gov/issue/physician-spendi…