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psnet.ahrq.gov/issue/perfect-possible
March 06, 2005 - May 13, 2021
Hospitals look to computers to predict patient emergencies before they happen
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psnet.ahrq.gov/web-mm/dangerous-shift
July 24, 2013 - SPOTLIGHT CASE
Dangerous Shift
Citation Text:
Patterson ES. Dangerous Shift. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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psnet.ahrq.gov/perspective/conversation-withbarbara-blakeney-ms-rn
August 01, 2005 - RW: What can make these changes happen?
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psnet.ahrq.gov/web-mm/pre-analytical-pitfalls-missing-and-mislabeled-specimens
April 18, 2018 - under-reported. 6-8 The busy nature of the ED environment increases the likelihood for mislabel events to happen
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psnet.ahrq.gov/node/33771/psn-pdf
August 22, 2014 - Beyond the Hospital: the New Frontier of Patient Safety
August 22, 2014
Plews-Ogan M. Beyond the Hospital: the New Frontier of Patient Safety. PSNet [internet]. 2014.
https://psnet.ahrq.gov/perspective/beyond-hospital-new-frontier-patient-safety
Perspective
The frontier of patient safety outside the hospital has y…
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psnet.ahrq.gov/perspective/conversation-karl-bilimoria-md-ms
April 19, 2023 - Wachter : How did the FIRST trial happen?
Dr.
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psnet.ahrq.gov/node/73642/psn-pdf
August 25, 2021 - Sudden Collapse During Upper Gastrointestinal
Endoscopy: Expect the Unexpected
August 25, 2021
Wieck M. Sudden Collapse During Upper Gastrointestinal Endoscopy: Expect the Unexpected. PSNet
[internet]. 2021.
https://psnet.ahrq.gov/web-mm/sudden-collapse-during-upper-gastrointestinal-endoscopy-expect-
unexpected
…
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psnet.ahrq.gov/node/33785/psn-pdf
May 01, 2015 - In Conversation With… John D. Birkmeyer, MD
May 1, 2015
In Conversation With… John D. Birkmeyer, MD. PSNet [internet]. 2015.
https://psnet.ahrq.gov/perspective/conversation-john-d-birkmeyer-md
Editor's note: John D. Birkmeyer, MD, is an internationally recognized health services researcher with
expertise in perfo…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/156-what-are-4es.pptx
October 01, 2024 - AHRQ Safety Program for MRSA Prevention
AHRQ Safety Program for MRSA Prevention
What Are the 4 Es?
ICU/Non-ICU
AHRQ Pub. No. 25-0007
October 2024
AHRQ Safety Program for MRSA Prevention | ICU & Non-ICU
What Are The Four Es
1
Educational Objectives
Define the 4 Es framework—Engage, Educate, Execute, Evaluate—and ex…
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psnet.ahrq.gov/node/49618/psn-pdf
February 01, 2011 - One Toxic Drug Is Not Like Another
February 1, 2011
Holmboe ES. One Toxic Drug Is Not Like Another. PSNet [internet]. 2011.
https://psnet.ahrq.gov/web-mm/one-toxic-drug-not-another
Case Objectives
Distinguish between the three distinct regulatory processes of board certification, medical licensure,
and credential…
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psnet.ahrq.gov/node/74252/psn-pdf
January 12, 2022 - They
made things happen.
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psnet.ahrq.gov/node/49388/psn-pdf
February 01, 2003 - Unexplained Apnea Under Anesthesia
February 1, 2003
Barach P. Unexplained Apnea Under Anesthesia. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/unexplained-apnea-under-anesthesia
Case Objectives
Clinical Objectives
List the causes of prolonged apnea in the operating room
Describe the steps in management …
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/allergies-guide.docx
September 01, 2022 - Remember, type 1 reactions usually happen soon after the first dose of antibiotics, whereas other reactions
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psnet.ahrq.gov/node/33877/psn-pdf
April 01, 2019 - It has
moved to include supporting physicians when mistakes happen but way beyond that.
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digital.ahrq.gov/sites/default/files/docs/medicaid/contracting-guidelines-for-ehr-vendors.pdf
June 16, 2021 - Contracting Guidelines
Doctors’ Office Quality - Information Technology (DOQ-IT) Project
Contracting Guidelines with EHR Vendors
In general, if a contract is presented to your group from a software company, it will be written from
the perspective of the software company. You can request language changes t…
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psnet.ahrq.gov/perspective/conversation-vineet-arora-md-mapp
May 31, 2023 - You have this great EHR, you should be harnessing it for safety, but these transcription errors still happen
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psnet.ahrq.gov/issue/recognizing-excellence-diagnosis
November 03, 2023 - Multi-use Website
Recognizing Excellence in Diagnosis.
Citation Text:
Recognizing Excellence in Diagnosis. The Leapfrog Group.
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psnet.ahrq.gov/node/33849/psn-pdf
January 01, 2018 - We are testifying to things
that didn't actually happen, physical exam findings that we didn't do, or
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psnet.ahrq.gov/node/33791/psn-pdf
September 01, 2015 - have
this great EHR, you should be harnessing it for safety, but these transcription errors still happen
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psnet.ahrq.gov/node/33855/psn-pdf
April 01, 2018 - Every patient
is different and things happen in the hospitalization, so to get the acute situation under