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psnet.ahrq.gov/node/46515/psn-pdf
December 22, 2018 - A contemporary medicolegal analysis of outpatient
medication management in chronic pain.
December 22, 2018
Abrecht CR, Brovman EY, Greenberg P, et al. A Contemporary Medicolegal Analysis of Outpatient
Medication Management in Chronic Pain. Anesth Analg. 2017;125(5):1761-1768.
doi:10.1213/ANE.0000000000002499.
htt…
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psnet.ahrq.gov/node/46829/psn-pdf
July 23, 2018 - Quality and variability of patient directions in electronic
prescriptions in the ambulatory care setting.
July 23, 2018
Yang Y, Ward-Charlerie S, Dhavle AA, et al. Quality and Variability of Patient Directions in Electronic
Prescriptions in the Ambulatory Care Setting. J Manag Care Spec Pharm. 2018;24(7):691-699.
…
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psnet.ahrq.gov/node/47610/psn-pdf
March 13, 2019 - Patient safety outcomes under flexible and standard
resident duty-hour rules.
March 13, 2019
Silber JH, Bellini LM, Shea JA, et al; iCOMPARE Research Group. N Engl J Med. 2019;380:905-914.
https://psnet.ahrq.gov/issue/patient-safety-outcomes-under-flexible-and-standard-resident-duty-hour-rules
Duty hour reform for…
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psnet.ahrq.gov/node/44447/psn-pdf
September 02, 2015 - Community-, healthcare-, and hospital-acquired severe
sepsis hospitalizations in the University HealthSystem
Consortium.
September 2, 2015
Page DB, Donnelly JP, Wang HE. Community-, Healthcare-, and Hospital-Acquired Severe Sepsis
Hospitalizations in the University HealthSystem Consortium. Crit Care Med. 2015;43(9…
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psnet.ahrq.gov/node/43956/psn-pdf
January 01, 2016 - Monitoring the harm associated with use of
anticoagulants in pediatric populations through trigger-
based automated adverse-event detection.
June 21, 2015
Patregnani JT, Spaeder MC, Lemon V, et al. Monitoring the harm associated with use of anticoagulants in
pediatric populations through trigger-based automated ad…
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psnet.ahrq.gov/node/45419/psn-pdf
June 29, 2017 - Risk-adjusted survival for adults following in-hospital
cardiac arrest by day of week and time of day:
observational cohort study.
June 29, 2017
Robinson EJ, Smith GB, Power GS, et al. Risk-adjusted survival for adults following in-hospital cardiac
arrest by day of week and time of day: observational cohort study.…
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psnet.ahrq.gov/node/40074/psn-pdf
July 03, 2014 - Evaluation of consistency in dosing directions and
measuring devices for pediatric nonprescription liquid
medications.
July 3, 2014
Yin S, Wolf MS, Dreyer BP, et al. Evaluation of consistency in dosing directions and measuring devices for
pediatric nonprescription liquid medications. JAMA. 2010;304(23):2595-602. d…
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psnet.ahrq.gov/node/47666/psn-pdf
January 01, 2020 - A partially structured postoperative handoff protocol
improves communication in 2 mixed surgical intensive
care units: findings from the Handoffs and Transitions in
Critical Care (HATRICC) prospective cohort study.
February 6, 2019
Lane-Fall MB, Pascual JL, Peifer HG, et al. A Partially Structured Postoperative Ha…
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psnet.ahrq.gov/node/44571/psn-pdf
June 21, 2016 - One size fits all? Mixed methods evaluation of the impact
of 100% single-room accommodation on staff and patient
experience, safety and costs.
June 21, 2016
Maben J, Griffiths P, Penfold C, et al. One size fits all? Mixed methods evaluation of the impact of 100%
single-room accommodation on staff and patient exper…
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psnet.ahrq.gov/node/42454/psn-pdf
September 09, 2013 - A perinatal care quality and safety initiative: are there
financial rewards for improved quality?
September 9, 2013
Kozhimannil KB, Sommerness SA, Rauk P, et al. A perinatal care quality and safety initiative: are there
financial rewards for improved quality? Jt Comm J Qual Patient Saf. 2013;39(8):339-48.
https://…
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psnet.ahrq.gov/node/43987/psn-pdf
March 25, 2015 - Emergency physicians' views of direct notification of
laboratory and radiology results to patients using the
internet: a multisite survey.
March 25, 2015
Callen J, Giardina TD, Singh H, et al. Emergency physicians' views of direct notification of laboratory and
radiology results to patients using the Internet: a m…
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psnet.ahrq.gov/node/44427/psn-pdf
October 13, 2015 - Problem list completeness in electronic health records: a
multi-site study and assessment of success factors.
October 13, 2015
Wright A, McCoy AB, Hickman T-TT, et al. Problem list completeness in electronic health records: A multi-
site study and assessment of success factors. Int J Med Inform. 2015;84(10):784-90.…
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psnet.ahrq.gov/node/43590/psn-pdf
October 08, 2014 - Disentangling quality and safety indicator data: a
longitudinal, comparative study of hand hygiene
compliance and accreditation outcomes in 96 Australian
hospitals.
October 8, 2014
Mumford V, Greenfield D, Hogden A, et al. Disentangling quality and safety indicator data: a longitudinal,
comparative study of hand …
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psnet.ahrq.gov/node/45305/psn-pdf
February 14, 2017 - Sustaining reductions in central line-associated
bloodstream infections in Michigan intensive care units: a
10-year analysis.
February 14, 2017
Pronovost P, Watson S, Goeschel CA, et al. Sustaining Reductions in Central Line-Associated
Bloodstream Infections in Michigan Intensive Care Units: A 10-Year Analysis. Am…
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psnet.ahrq.gov/node/46338/psn-pdf
December 21, 2017 - Malpractice claims related to diagnostic errors in the
hospital.
December 21, 2017
Gupta A, Snyder A, Kachalia A, et al. Malpractice claims related to diagnostic errors in the hospital. BMJ
Qual Saf. 2017;27(1):53-60. doi:10.1136/bmjqs-2017-006774.
https://psnet.ahrq.gov/issue/malpractice-claims-related-diagnostic…
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psnet.ahrq.gov/node/852445/psn-pdf
August 16, 2023 - Systematic review of the impact of physician work
schedules on patient safety with meta-analyses of
mortality risk.
August 16, 2023
Weaver MD, Sullivan JP, Landrigan CP, et al. Systematic review of the impact of physician work schedules
on patient safety with meta-analyses of mortality risk. Jt Comm J Qual Patient…
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psnet.ahrq.gov/node/43629/psn-pdf
May 01, 2015 - Exposing physicians to reduced residency work hours
did not adversely affect patient outcomes after residency.
May 1, 2015
Jena AB, Schoemaker L, Bhattacharya J. Exposing physicians to reduced residency work hours did not
adversely affect patient outcomes after residency. Health Aff (Millwood). 2014;33(10):1832-40.…
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psnet.ahrq.gov/node/33859/psn-pdf
June 01, 2018 - Ultrasound is great for
getting us back to the bedside and physically examining the patient.
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psnet.ahrq.gov/node/49564/psn-pdf
July 01, 2008 - Dependence vs. Pain
July 1, 2008
Gordon AJ. Dependence vs. Pain . PSNet [internet]. 2008.
https://psnet.ahrq.gov/web-mm/dependence-vs-pain
Case Objectives
Define opioid dependence and opioid withdrawal syndrome.
Describe the treatment of opioid withdrawal syndrome including the use of the Clinical Opioid
Withdra…
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psnet.ahrq.gov/node/49849/psn-pdf
January 01, 2019 - Spotlight: Mistaken Attribution, Diagnostic Misstep
January 1, 2019
Kreider TR, Young JQ. Spotlight: Mistaken Attribution, Diagnostic Misstep. PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/spotlight-mistaken-attribution-diagnostic-misstep
Case Objectives
List the patient safety events that are unique to in…