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psnet.ahrq.gov/issue/patient-safety-indicators-during-initial-covid-19-pandemic-surge-united-states
August 03, 2022 - Study
Patient safety indicators during the initial COVID-19 pandemic surge in the United States.
Citation Text:
Rodriguez JA, Samal L, Ganesan S, et al. Patient safety indicators during the initial COVID-19 pandemic surge in the United States. J Patient Saf. 2024;20(4):247-251. doi:10.10…
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psnet.ahrq.gov/issue/association-current-opioid-use-serious-adverse-events-among-older-adult-survivors-breast
February 15, 2023 - Study
Association of current opioid use with serious adverse events among older adult survivors of breast cancer.
Citation Text:
Winn AN, Check DK, Farkas A, et al. Association of current opioid use with serious adverse events among older adult survivors of breast cancer. JAMA Netw Open.…
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psnet.ahrq.gov/issue/diagnostic-error-emergency-department-follow-patients-minor-trauma-outpatient-clinic
November 15, 2023 - Study
Diagnostic error in the emergency department: follow up of patients with minor trauma in the outpatient clinic.
Citation Text:
Moonen P-J, Mercelina L, Boer W, et al. Diagnostic error in the Emergency Department: follow up of patients with minor trauma in the outpatient clinic. Sca…
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psnet.ahrq.gov/issue/how-often-are-potential-patient-safety-events-present-admission
January 26, 2022 - Study
Classic
How often are potential patient safety events present on admission?
Citation Text:
Houchens RL, Elixhauser A, Romano PS. How often are potential patient safety events present on admission? Jt Comm J Qual Patient Saf. 2008;34(3):154-63.
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psnet.ahrq.gov/sites/default/files/2024-10/spotlight_case_delayed_symptomatic_subdural_hematoma_slides.pptx
January 01, 2024 - signs are present:
GCS <15 after two hours from injury;
Suspected open, depressed, or basilar skull fracture … not consider the mechanism of injury, focusing only on findings absent in this case:
Suspected skull fracture
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psnet.ahrq.gov/issue/green-cross-method-postanaesthesia-care-unit-qualitative-study-healthcare-professionals
September 04, 2024 - Study
Green Cross method in a postanaesthesia care unit: a qualitative study of the healthcare professionals' experiences after 3 years, including the COVID-19 pandemic period.
Citation Text:
Birkeli GH, Ballangrud R, Jacobsen HK, et al. Green Cross method in a postanaesthesia care unit:…
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psnet.ahrq.gov/web-mm/good-catch-operating-room
August 27, 2017 - Good Catch in the Operating Room
Citation Text:
Day J, Paige JT. Good Catch in the Operating Room. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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Google Scholar BibTeX EndNote X3 XML EndNote …
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psnet.ahrq.gov/web-mm/transfusion-overload
September 23, 2020 - Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture … Repair (FOCUS).( 4 ) This study randomized 2016 patients undergoing surgical repair for hip fracture
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psnet.ahrq.gov/node/837748/psn-pdf
August 05, 2022 - The patient was readmitted 10 days later with another episode of severe
hypoglycemia and a humeral fracture … failure to obtain an accurate PAML resulted in a downstream ADE with significant harm
(i.e., humeral fracture
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psnet.ahrq.gov/node/50754/psn-pdf
December 18, 2019 - clearly a palliative intervention that
would avoid severe pain with movement for weeks or months post-fracture
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psnet.ahrq.gov/node/49654/psn-pdf
June 01, 2012 - orthopedic surgeon briefly
described a 92-year-old woman with a history of dementia who had a left hip fracture … Early the next day, the patient was taken to the operating room for surgical repair of her hip fracture
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psnet.ahrq.gov/node/49711/psn-pdf
June 01, 2014 - He was treated for his fracture and the institution began to consider a policy regarding patients leaving
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psnet.ahrq.gov/issue/just-what-doctor-ordered-missed-ordering-venous-thromboembolism-chemoprophylaxis-associated
September 07, 2022 - Study
Just what the doctor ordered: missed ordering of venous thromboembolism chemoprophylaxis is associated with increased VTE events in high-risk general surgery patients.
Citation Text:
Baimas-George MR, Ross SW, Yang H, et al. Just what the doctor ordered: missed ordering of venous t…
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psnet.ahrq.gov/issue/clinical-impact-and-economic-burden-hospital-acquired-conditions-following-common-surgical
October 21, 2020 - Study
Clinical impact and economic burden of hospital-acquired conditions following common surgical procedures.
Citation Text:
Horn SR, Liu TC, Horowitz JA, et al. Clinical impact and economic burden of hospital-acquired conditions following common surgical procedures. Spine (Phila Pa 19…
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psnet.ahrq.gov/issue/association-low-dose-whole-body-computed-tomography-missed-injury-diagnoses-and-radiation
February 12, 2020 - Study
Association of low-dose whole-body computed tomography with missed injury diagnoses and radiation exposure in patients with blunt multiple trauma.
Citation Text:
Stengel D, Mutze S, Güthoff C, et al. Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnose…
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psnet.ahrq.gov/issue/impact-drug-shortages-children-cancer-example-mechlorethamine
February 15, 2023 - Study
The impact of drug shortages on children with cancer—the example of mechlorethamine.
Citation Text:
Metzger ML, Billett A, Link MP. The impact of drug shortages on children with cancer--the example of mechlorethamine. N Engl J Med. 2012;367(26):2461-2463. doi:10.1056/NEJMp1212468. …
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psnet.ahrq.gov/issue/patient-safety-culture-effects-errors-incident-reporting-and-patient-safety-grade
August 26, 2020 - Study
Patient safety culture: effects on errors, incident reporting, and patient safety grade.
Citation Text:
Kaya S, Banaz Goncuoglu M, Mete B, et al. Patient safety culture: effects on errors, incident reporting, and patient safety grade. J Patient Saf. 2023;19(7):439-446. doi:10.1097/…
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psnet.ahrq.gov/issue/adverse-events-and-emergency-department-opioid-prescriptions-adolescents
December 21, 2022 - Study
Adverse events and emergency department opioid prescriptions in adolescents.
Citation Text:
Worsham CM, Woo J, Jena AB, et al. Adverse events and emergency department opioid prescriptions in adolescents. Health Aff (Millwood). 2021;40(6):970-978. doi:10.1377/hlthaff.2020.01762.
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psnet.ahrq.gov/issue/team-based-approach-reducing-cardiac-monitor-alarms
October 19, 2022 - Study
A team-based approach to reducing cardiac monitor alarms.
Citation Text:
Dandoy CE, Davies SM, Flesch L, et al. A team-based approach to reducing cardiac monitor alarms. Pediatrics. 2014;134(6):e1686-e1694. doi:10.1542/peds.2014-1162.
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psnet.ahrq.gov/issue/relationship-between-physician-burnout-and-quality-and-cost-care-medicare-beneficiaries
August 12, 2020 - Study
Relationship between physician burnout and the quality and cost of care for Medicare beneficiaries is complex.
Citation Text:
Casalino LP, Li J, Peterson LE, et al. Relationship between physician burnout and the quality and cost of care for Medicare beneficiaries is complex. Health…