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psnet.ahrq.gov/node/846127/psn-pdf
March 15, 2023 - Sepsis Resulting from Delays in Treatment and
Miscommunication among Specialists
March 15, 2023
Shi L, Noren E. Sepsis Resulting from Delays in Treatment and Miscommunication among Specialists.
PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/sepsis-resulting-delays-treatment-and-miscommunication-among-
spec…
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psnet.ahrq.gov/node/49398/psn-pdf
May 01, 2003 - Bloody BP Cuff
May 1, 2003
Madan AK. Bloody BP Cuff. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/bloody-bp-cuff
The Case
Patient #1, a 28-year-old male, was a trauma patient following a motor vehicle collision into a cement pillar.
Patient #1 was in the trauma bay with massive injuries and profuse bleed…
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psnet.ahrq.gov/node/49620/psn-pdf
February 01, 2011 - Silent Pain in the Neck
February 1, 2011
Bittner EA. Silent Pain in the Neck. PSNet [internet]. 2011.
https://psnet.ahrq.gov/web-mm/silent-pain-neck
The Case
A 60-year-old man with no significant past medical history underwent an elective anterior cervical
discectomy for persistent right arm weakness due to cervi…
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psnet.ahrq.gov/web-mm/mistaken-identity
December 18, 2014 - Mistaken Identity
Citation Text:
Hall LW. Mistaken Identity. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
…
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psnet.ahrq.gov/innovation/risk-mitigation-using-anesthesia-risk-alert-program-applying-proactive-approach-data
February 26, 2025 - Risk Mitigation Using the Anesthesia Risk Alert Program: Applying a Proactive Approach With Data Review & Collaborating With a Second Practitioner
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A…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.296_slideshow.ppt
April 01, 2013 - Spotlight Case July 2008
Spotlight Case
Total Parenteral Nutrition, Multifarious Errors
*
*
Source and Credits
This presentation is based on the April 2013
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Joseph I. Boullata, PharmD, RPh, BCNSP…
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psnet.ahrq.gov/node/33675/psn-pdf
October 01, 2008 - Identifying Adverse Events Not Present on Admission:
Can We Do It?
October 1, 2008
Naessens JM. Identifying Adverse Events Not Present on Admission: Can We Do It? PSNet [internet].
2008.
https://psnet.ahrq.gov/perspective/identifying-adverse-events-not-present-admission-can-we-do-it
Perspective
Interest is growi…
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psnet.ahrq.gov/node/49562/psn-pdf
May 01, 2008 - The Inside of a Time Out
May 1, 2008
Feldman DL. The Inside of a Time Out. PSNet [internet]. 2008.
https://psnet.ahrq.gov/web-mm/inside-time-out
The Case
A 65-year-old man was scheduled for an elective endovascular repair of an abdominal aortic aneurysm.
The patient had an allergy to "IV contrast dye" that was no…
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psnet.ahrq.gov/web-mm/new-patient-mistakenly-checked-another
October 01, 2013 - New Patient Mistakenly Checked in as Another
Citation Text:
Green RA, Adelman JS. New Patient Mistakenly Checked in as Another. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
Copy Citation
Format:
Google Scholar B…
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psnet.ahrq.gov/node/33697/psn-pdf
June 01, 2010 - What Do We Know About Emergency Department Safety?
June 1, 2010
Sklar DP, Crandall CS. What Do We Know About Emergency Department Safety? PSNet [internet]. 2010.
https://psnet.ahrq.gov/perspective/what-do-we-know-about-emergency-department-safety
Perspective
Emergency medicine has evolved from a location, with var…
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psnet.ahrq.gov/node/49458/psn-pdf
September 01, 2004 - Poor Prognosis
September 1, 2004
Lamont EB. Poor Prognosis. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/poor-prognosis
Case Objectives
Understand the current limitations of physicians' ability to provide prognoses.
List the variables that can be used to guide treatment decisions and prognostication in e…
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psnet.ahrq.gov/node/50756/psn-pdf
December 18, 2019 - A Mistaken Dose of Naloxone?
December 18, 2019
Cutler E, Gunawardena D. A Mistaken Dose of Naloxone?. PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/mistaken-dose-naloxone
The Case
A 55-year-old man with widely metastatic gastric cancer presented to his oncologist's office for a follow-up
appointment. He h…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/fallspximpl-ig.pdf
June 02, 2025 - AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention Facilitator Training
AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention 1
On-Time Falls
Prevention:
Implementation
AHRQ’s Safety Program for Nursing
Homes: On-Time Falls Prevention
Facilitator Training
Implementatio…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/ontimefallspxselfassessment.pdf
June 02, 2025 - Falls Prevention Self-Assessment Worksheet - AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention
Agency for Healthcare Research and Quality Safety Program for Nursing Homes: On-Time Prevention
AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention
Falls Prevention Self-Assessment Workshee…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/valueresourcelist.pdf
January 01, 2019 - Improving Value and Efficiency in Hospitals and Medical Offices: A Resource List for Users of the AHRQ SOPS Value and Efficiency Supplemental Items
Improving Value and Efficiency in Hospitals and
Medical Offices: A Resource List for Users of the
AHRQ SOPSTM Value and Efficiency Supplemental
Items
I. Purpose
Thi…
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www.ahrq.gov/data/apcd/envscan/context.html
June 01, 2017 - All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices and Evidence
Project Context
Previous Page Next Page
Table of Contents
All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices and Evide…
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www.ahrq.gov/data/apcd/envscan/app-c.html
May 01, 2025 - All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices and Evidence
Appendix C. Environmental Scan Resources Included
Previous Page
Table of Contents
All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of C…
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www.ahrq.gov/research/findings/final-reports/ssi/ssiapd.html
April 01, 2018 - Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection
Appendix D. Mapping ICD9 and CPT Codes
Previous Page Next Page
Table of Contents
Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection
Executive Summary
Chapter 1. Admi…
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/module5-presenters-notes.pdf
January 10, 2022 - TeamSTEPPS® Diagnosis Improvement: Module 5 Situation Monitoring To Improve Diagnosis - Facilitator’s Notes
Slide 1
TeamSTEPPS® for Diagnosis
Improvement
…
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/module5-situation-monitoring.pptx
January 10, 2022 - Module 5: Situation Monitoring
Module 5
Situation Monitoring To Improve Diagnosis
TeamSTEPPS® for Diagnosis Improvement
Welcome to the TeamSTEPPS for Diagnosis Improvement Course. This presentation will cover Module 5, Situation Monitoring To Improve Diagnosis, that you will review as the facilitator.
Individual…