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  1. psnet.ahrq.gov/web-mm/two-cases-retained-vaginal-packing-when-writing-order-not-enough
    September 01, 2003 - SPOTLIGHT CASE Two Cases of Retained Vaginal Packing: When Writing an Order is Not Enough Citation Text: Gibbs VC. Two Cases of Retained Vaginal Packing: When Writing an Order is Not Enough. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and …
  2. psnet.ahrq.gov/web-mm/impact-communication-medication-errors
    August 01, 2009 - The Impact of Communication on Medication Errors Citation Text: Branch J, Hiner D, Jackson V. The Impact of Communication on Medication Errors. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021. Copy Citation Format: …
  3. psnet.ahrq.gov/perspective/conversation-sigall-k-bell-md
    February 26, 2025 - In Conversation With… Sigall K. Bell, MD September 1, 2018  Citation Text: In Conversation With… Sigall K. Bell, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Fo…
  4. psnet.ahrq.gov/web-mm/life-threatening-infant-overdose-sodium-chloride
    December 23, 2020 - Life-Threatening Infant Overdose of Sodium Chloride Citation Text: Hamline M, McGlynn G, Lee A, et al. Life-Threatening Infant Overdose of Sodium Chloride. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Form…
  5. psnet.ahrq.gov/perspective/artificial-intelligence-and-diagnostic-errors
    January 31, 2020 - Artificial Intelligence and Diagnostic Errors January 31, 2020  Also Read the Conversation View more articles from the same authors. Citation Text: Hall KK, Fitall E. Artificial Intelligence and Diagnostic Errors. PSNet [internet]. Rockville (MD): Agency for Hea…
  6. psnet.ahrq.gov/perspective/conversation-david-gruen-md
    January 31, 2020 - In Conversation With... David Gruen, MD January 31, 2020  Also Read the Essay Citation Text: In Conversation With.. David Gruen, MD. PSNet [internet]. 2020.In Conversation With... David Gruen, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research an…
  7. psnet.ahrq.gov/perspective/where-does-risk-adjusted-mortality-fit-safety-measurement-program
    March 01, 2015 - Where Does Risk-Adjusted Mortality Fit Into a Safety Measurement Program? Ian Scott, MBBS, MHA, MEd | March 1, 2015  Also Read a Conversation View more articles from the same authors. Citation Text: Scott IA. Where Does Risk-Adjusted Mortality Fit Into a Safety …
  8. psnet.ahrq.gov/sites/default/files/2021-02/final_feb_2021_spotlight_delay_in_appropriate_dx.pdf
    January 01, 2021 - Microsoft PowerPoint - FINAL Feb 2021 Spotlight_Delay in Appropriate DX.pptx - Read-Only Spotlight Delay in Appropriate Diagnosis and Treatment Leading to Death from Pulmonary Embolism Source and Credits • This presentation is based on the February 2021 AHRQ WebM&M Spotlight Case o See the full article at ht…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74149/psn-pdf
    January 07, 2022 - Multiple Missed Opportunities for Suicide Risk Assessment in Emergency and Primary Care Settings January 7, 2022 Erb JL, Shah SB, Schiff G. Multiple Missed Opportunities for Suicide Risk Assessment in Emergency and Primary Care Settings. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/multiple-missed-opportu…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865419/psn-pdf
    March 27, 2024 - Do Not Miss Sepsis Needles in Viral Haystacks! March 27, 2024 Hamline M, Shaikh U. Do Not Miss Sepsis Needles in Viral Haystacks!. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/do-not-miss-sepsis-needles-viral-haystacks Disclosure of Relevant Financial Relationships: As a provider accredited by the Accredit…
  11. psnet.ahrq.gov/perspective/safety-medical-devices
    June 01, 2011 - The Safety of Medical Devices Christopher Nemeth, PhD | June 1, 2011  Also Read a Conversation View more articles from the same authors. Citation Text: Nemeth CP. The Safety of Medical Devices. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/841467/psn-pdf
    December 14, 2022 - A framework for assessing reasoning about controversial end-of-life clinical decisions. December 14, 2022 Fedyk M, Fairman N, Romano PS, et al. A framework for assessing reasoning about controversial end-of- life clinical decisions. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/framework-assessing-reasonin…
  13. psnet.ahrq.gov/web-mm/overdose-gabapentin-and-oxycodone-patient-end-stage-renal-disease-case-appropriate
    October 31, 2023 - SPOTLIGHT CASE Overdose of Gabapentin and Oxycodone in a Patient with End-Stage Renal Disease: A Case for Appropriate Interruptive Drug-Disease Alerts. Citation Text: Keenan CR, MacDonald S, Takeshita A, et al. Overdose of Gabapentin and Oxycodone in a Patient with End-Stage Renal Disease: A Case…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60611/psn-pdf
    June 24, 2020 - Direct Oral Anticoagulants are High-Risk Medications with Potentially Complex Dosing June 24, 2020 Giannini J, Wong M, Dager W, et al. Direct Oral Anticoagulants are High-Risk Medications with Potentially Complex Dosing. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/direct-oral-anticoagulants-are-high-risk…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865655/psn-pdf
    April 24, 2024 - Under Pressure: Delayed Diagnosis of Compartment Syndrome after Lower Leg Fracture. April 24, 2024 Barnes DK, Randhawa SDS, Fitzpatrick EP. Under Pressure: Delayed Diagnosis of Compartment Syndrome after Lower Leg Fracture. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/under-pressure-delayed-diagnosis-comp…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60066/psn-pdf
    March 25, 2020 - Some Patients Can't Wait: Improving Timeliness of Emergency Department Care March 25, 2020 Chang R, Barnes DK. Some Patients Can't Wait: Improving Timeliness of Emergency Department Care. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/some-patients-cant-wait-improving-timeliness-emergency-department-care D…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/843234/psn-pdf
    January 01, 2013 - Overdose of Gabapentin and Oxycodone in a Patient with End-Stage Renal Disease: A Case for Appropriate Interruptive Drug-Disease Alerts. February 1, 2023 Keenan CR, MacDonald S, Takeshita A, et al. Overdose of Gabapentin and Oxycodone in a Patient with End-Stage Renal Disease: A Case for Appropriate Interruptive D…
  18. psnet.ahrq.gov/perspective/conversation-withdonald-m-berwick-md-mpp
    November 01, 2005 - In Conversation with…Donald M. Berwick, MD, MPP November 1, 2005  Also Read an Essay Citation Text: In Conversation with…Donald M. Berwick, MD, MPP. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Ser…
  19. psnet.ahrq.gov/web-mm/postpartum-woman-erroneous-sars-cov-2-test
    December 23, 2020 - A Postpartum Woman with an Erroneous SARS-CoV-2 Test Citation Text: Martin SA, Kanjilal S, Schiff G. A Postpartum Woman with an Erroneous SARS-CoV-2 Test. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021. Copy Citation Forma…
  20. psnet.ahrq.gov/web-mm/multiple-missed-opportunities-suicide-risk-assessment-emergency-and-primary-care-settings
    May 26, 2021 - Multiple Missed Opportunities for Suicide Risk Assessment in Emergency and Primary Care Settings Citation Text: Erb JL, Shah SB, Schiff G. Multiple Missed Opportunities for Suicide Risk Assessment in Emergency and Primary Care Settings. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qu…

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