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  1. Microsoft PowerPoint - FINAL Feb 2021 Spotlight_Delay in Appropriate DX.pptx - Read-Only (pdf file)

    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…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867428/psn-pdf
    December 18, 2024 - In Conversation with Patricia Dykes about The Ongoing Journey to Prevent Patient Falls December 18, 2024 Dykes PC, Sousane Z, Mossburg SE. In Conversation with Patricia Dykes about The Ongoing Journey to Prevent Patient Falls. PSNet [internet]. 2024. https://psnet.ahrq.gov/perspective/conversation-patricia-dykes-a…

  3. AHRQ PSNet Webinar (pdf file)

    psnet.ahrq.gov/sites/default/files/2025-03/PSNet%20Webinar%20Feb%202025_0.pdf
    January 01, 2025 - AHRQ PSNet Webinar AHRQ PSNet Webinar Making Healthcare Safer (MHS) IV: Rapid Response Systems and Opioid Stewardship February 10, 2025 Agenda 2 • Logistics • Introduction to the Making Healthcare Safer (MHS) IV Reports • Report 1 – Rapid Response Systems ► Discussion ► PSNet Resources • Report 2 – Opioi…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853902/psn-pdf
    September 27, 2023 - A Missed Bowel Perforation - the Importance of Diagnostic Reasoning September 27, 2023 Timbag L, Sinigayan VR, Molla M. A Missed Bowel Perforation - the Importance of Diagnostic Reasoning. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/missed-bowel-perforation-importance-diagnostic-reasoning Disclosure of …

  5. Delayed Evaluation of Abdominal Pain in an Elderly Patient. | PSNet

    psnet.ahrq.gov/web-mm/delayed-evaluation-abdominal-pain-elderly-patient
    February 26, 2020 - Delayed Evaluation of Abdominal Pain in an Elderly Patient. Citation Text: Klimkiv L, Utter GH, Barnes DK. Delayed Evaluation of Abdominal Pain in an Elderly Patient.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citat…

  6. When the Meds Don’t Reach the Bed | PSNet

    psnet.ahrq.gov/web-mm/when-meds-dont-reach-bed
    May 16, 2022 - When the Meds Don’t Reach the Bed Citation Text: Molla M, Le K, Mendoza P. When the Meds Don’t Reach the Bed. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Format: Google Scholar BibTeX EndNote X3 X…

  7. Patient Safety Amid Nursing Workforce Challenges | PSNet

    psnet.ahrq.gov/perspective/patient-safety-amid-nursing-workforce-challenges
    April 24, 2024 - Patient Safety Amid Nursing Workforce Challenges Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, Merton Lee, PharmD, PhD, Sarah E. Mossburg, RN, PhD | April 24, 2024  Also Read the Conversation View more articles from the same authors. Citation Text: Leary KB, L…

  8. In Conversation with...Katie Boston-Leary about Patient Safety Amid Nursing Workforce Challenges | PSNet

    psnet.ahrq.gov/perspective/conversation-withkatie-boston-leary-about-patient-safety-amid-nursing-workforce
    April 24, 2024 - In Conversation with...Katie Boston-Leary about Patient Safety Amid Nursing Workforce Challenges Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, CCT | April 24, 2024  Also Read the Essay View more articles from the same authors. Citation Text: Leary KB. In Con…

  9. A Missed Bowel Perforation - the Importance of Diagnostic Reasoning | PSNet

    psnet.ahrq.gov/web-mm/missed-bowel-perforation-importance-diagnostic-reasoning
    January 29, 2021 - SPOTLIGHT CASE A Missed Bowel Perforation - the Importance of Diagnostic Reasoning Citation Text: Timbag L, Sinigayan VR, Molla M. A Missed Bowel Perforation - the Importance of Diagnostic Reasoning. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of He…

  10. In Conversation with Lucy Savitz about Learning Health Systems for Patient Safety | PSNet

    psnet.ahrq.gov/perspective/conversation-lucy-savitz-about-learning-health-systems-patient-safety
    February 26, 2025 - E-StaR) Centers to build a national learning health system infrastructure and work toward closing the gap

  11. Learning Health Systems for Patient Safety | PSNet

    psnet.ahrq.gov/perspective/learning-health-systems-patient-safety
    February 26, 2025 - E-StaR) Centers to build a national learning health system infrastructure and work toward closing the gap

  12. In Conversation With... Georgia Galanou Luchen, Pharm. D. | PSNet

    psnet.ahrq.gov/perspective/conversation-georgia-galanou-luchen-pharm-d
    October 24, 2021 - In Conversation With... Georgia Galanou Luchen, Pharm. D. October 24, 2021  Also Read the Essay Citation Text: In Conversation With.. Georgia Galanou Luchen, Pharm. D. PSNet [internet]. 2021.In Conversation With... Georgia Galanou Luchen, Pharm. D.. PSNet [interne…

  13. In Conversation With… David M. Gaba, MD | PSNet

    psnet.ahrq.gov/perspective/conversation-david-m-gaba-md
    March 01, 2013 - In Conversation With… David M. Gaba, MD March 1, 2013  Also Read an Essay Citation Text: In Conversation With… David M. Gaba, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy…

  14. In Conversation with...Eric Coleman, MD, MPH | PSNet

    psnet.ahrq.gov/perspective/conversation-witheric-coleman-md-mph
    December 01, 2007 - In Conversation with...Eric Coleman, MD, MPH December 1, 2007  Also Read an Essay Citation Text: In Conversation with..Eric Coleman, MD, MPH. PSNet [internet]. 2007.In Conversation with...Eric Coleman, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthca…

  15. Care Transitions | PSNet

    psnet.ahrq.gov/perspective/care-transitions
    December 01, 2007 - Care Transitions Sunil Kripalani, MD, MSc | December 1, 2007  Also Read a Conversation View more articles from the same authors. Citation Text: Kripalani S. Care Transitions. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Depart…

  16. In Conversation With... Cindy Brach | PSNet

    psnet.ahrq.gov/perspective/conversation-cindy-brach
    December 27, 2019 - In Conversation With... Cindy Brach December 27, 2019  Also Read the Essay Citation Text: In Conversation With.. Cindy Brach. PSNet [internet]. 2019.In Conversation With... Cindy Brach. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, …

  17. Zero Harm: Striving to Reduce Preventable Harms – Point, Counterpoint, and Areas of Agreement | PSNet

    psnet.ahrq.gov/perspective/zero-harm-striving-reduce-preventable-harms-point-counterpoint-and-areas-agreement
    September 24, 2024 - In a learning organization, an event of harm creates a zero harm gap that we yearn to close.

  18. In Conversation With…David C. Classen, MD, MS | PSNet

    psnet.ahrq.gov/perspective/conversation-withdavid-c-classen-md-ms
    May 01, 2012 - The gap between nurses and residents in a community hospital's error reporting system.

  19. The Emergence of the Trigger Tool as the Premier Measurement Strategy for Patient Safety | PSNet

    psnet.ahrq.gov/perspective/emergence-trigger-tool-premier-measurement-strategy-patient-safety
    May 01, 2012 - The gap between nurses and residents in a community hospital's error reporting system.

  20. In Conversation With… Rebecca Smith-Bindman, MD | PSNet

    psnet.ahrq.gov/perspective/conversation-rebecca-smith-bindman-md
    October 01, 2013 - In Conversation With… Rebecca Smith-Bindman, MD October 1, 2013  Also Read an Essay Citation Text: In Conversation With… Rebecca Smith-Bindman, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Serv…
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