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  1. psnet.ahrq.gov/issue/assessment-incorrect-surgical-procedures-within-and-outside-operating-room-follow-study-us
    October 24, 2018 - Study Assessment of incorrect surgical procedures within and outside the operating room. A follow-up study from US Veterans Health Administration medical centers. Citation Text: Neily J, Soncrant C, Mills PD, et al. Assessment of Incorrect Surgical Procedures Within and Outside the Opera…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49528/psn-pdf
    January 01, 2015 - While the rash improved, the patient developed diarrhea and low-grade fever, prompting a visit to the … The resident physician's diagnosis was a "viral syndrome" causing the diarrhea and low-grade fever.
  3. psnet.ahrq.gov/web-mm/see-patient-first
    September 27, 2023 - On physical exam, he had grade 2 mucositis, as per the Common Terminology Criteria for Adverse Events … Low-grade oral mucositis can easily be diagnosed upon physical exam and managed with careful dental care
  4. psnet.ahrq.gov/issue/effect-increased-inpatient-attending-physician-supervision-medical-errors-patient-safety-and
    December 07, 2011 - Study Emerging Classic Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: a randomized clinical trial. Citation Text: Finn KM, Metlay JP, Chang Y, et al. Effect of Increased Inpatient Attendin…
  5. psnet.ahrq.gov/web-mm/customer-always-right
    January 22, 2014 - While the rash improved, the patient developed diarrhea and low-grade fever, prompting a visit to the … The resident physician's diagnosis was a "viral syndrome" causing the diarrhea and low-grade fever.
  6. psnet.ahrq.gov/primer/triggers-and-trigger-tools
    September 15, 2024 - identified, the entire chart is reviewed to determine whether an adverse event took place, and if so, to grade
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33664/psn-pdf
    March 01, 2008 - people are too quick to remove central lines if a line is in place and there is a concern about a low-grade … in a patient, and we don't like finding out on a Monday morning that, well, the patient had a low-grade
  8. psnet.ahrq.gov/perspective/conversation-linda-aiken-phd-rn
    March 01, 2018 - than 22,000 nurses in 577 hospitals, we found that 38% of nurses gave their hospitals an unfavorable grade … currently under review), about one third of nurses still gave their hospital an unfavorable patient safety grade
  9. psnet.ahrq.gov/perspective/missed-nursing-care-key-measure-patient-safety
    March 01, 2018 - than 22,000 nurses in 577 hospitals, we found that 38% of nurses gave their hospitals an unfavorable grade … currently under review), about one third of nurses still gave their hospital an unfavorable patient safety grade
  10. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.239_slideshow.ppt
    May 01, 2011 - Examination revealed a low-grade fever and some redness in his throat.
  11. psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery
    September 15, 2024 - Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery Citation Text: Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar Bib…
  12. psnet.ahrq.gov/primer/retained-surgical-items-definition-and-epidemiology
    September 15, 2024 - Drape Towels Drape towels are usually blue, green or an unbleached natural color, are made of coarser grade
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49846/psn-pdf
    November 01, 2018 - Supervision and Entrustment in Clinical Training: Protecting Patients, Protecting Trainees November 1, 2018 Cate O ten-. Supervision and Entrustment in Clinical Training: Protecting Patients, Protecting Trainees. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/supervision-and-entrustment-clinical-training-pr…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33799/psn-pdf
    January 01, 2015 - Burnout Among Health Professionals and Its Effect on Patient Safety January 1, 2015 Lyndon A. Burnout Among Health Professionals and Its Effect on Patient Safety. PSNet [internet]. 2015. https://psnet.ahrq.gov/perspective/burnout-among-health-professionals-and-its-effect-patient-safety Annual Perspective 2015 Bur…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867980/psn-pdf
    March 25, 2025 - the patient’s parents took him to the emergency department (ED), where he was found to have a low-grade
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33657/psn-pdf
    September 01, 2007 - Rediscovering the Power of the Surgical M&M Conference: The M+M Matrix September 1, 2007 Gordon LA. Rediscovering the Power of the Surgical M&M Conference: The M+M Matrix. PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/rediscovering-power-surgical-mm-conference-mm-matrix Perspective There is a slumbe…
  17. psnet.ahrq.gov/primer/never-events
    June 15, 2024 - Never Events Citation Text: Never Events. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download Cita…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49658/psn-pdf
    July 01, 2012 - A follow-up report card on computer-assisted diagnosis—the grade: C+.
  19. psnet.ahrq.gov/sites/default/files/2025-01/spotlight_case_misdiagnosis_of_small_bowel_obstruction_-_slides_-_final.pptx
    January 01, 2025 - Abdominal computed tomography (CT) demonstrated a high-grade small bowel obstruction with a small amount
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61080/psn-pdf
    October 28, 2020 - systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor (III-IV) Hunt-Hess grade

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