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psnet.ahrq.gov/issue/audit-handover-ent-unit
October 28, 2020 - Study
Audit of handover in an ENT unit.
Citation Text:
Ellul D, Robson AK. Audit of handover in an ENT unit. J Laryngol Otol. 2011;125(9):924-7. doi:10.1017/S0022215111000880.
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psnet.ahrq.gov/issue/interview-peter-pronovost
July 01, 2017 - Award Recipient
An interview with Peter Pronovost
Citation Text:
Pronovost P. An interview with Peter Pronovost. Jt Comm J Qual Saf. 2004;30(12):659-64.
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Dow…
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psnet.ahrq.gov/web-mm/failure-latch
November 27, 2012 - , while the face-to-face visit provided for an assessment of the latching process, which was key in identifying
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psnet.ahrq.gov/perspective/conversation-ann-l-hendrich-rn-phd
February 26, 2025 - RW : What about identifying the patient with strategies around different colored shoes or signs on the
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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…
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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 …
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psnet.ahrq.gov/node/49711/psn-pdf
June 01, 2014 - search procedures
including assigning one individual to be responsible for coordinating the search; identifying
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psnet.ahrq.gov/submit-case
November 03, 2025 - The Submit a Case Process
PSNet’s Submit a Case feature allows health care professionals to submit de-identified cases that feature patient safety and health care quality issues to PSNet’s WebM&M educational journal. Watch the video below to learn more about the Submit a Case process.
Submit Your Case
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psnet.ahrq.gov/node/37560/psn-pdf
March 28, 2018 - Learning from Investigations.
March 28, 2018
Commission for Healthcare Audit and Inspection. London, England; Healthcare Commission: 2008. ISBN
9781845621636.
https://psnet.ahrq.gov/issue/learning-investigations
Analyzing health care failures from 2004-2007 in the United Kingdom, this report identifies common them…
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psnet.ahrq.gov/node/36584/psn-pdf
January 12, 2011 - Will my patient fall?
January 12, 2011
Ganz DA, Bao Y, Shekelle PG, et al. Will my patient fall? JAMA. 2007;297(1):77-86.
https://psnet.ahrq.gov/issue/will-my-patient-fall
The authors assessed the literature to determine risk factors for falls that can be identified to help prevent
such injuries.
https://psnet.ah…
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psnet.ahrq.gov/primer/electronic-health-records
March 15, 2025 - August 2, 2023
Identifying electronic health record contributions to diagnostic error in ambulatory
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psnet.ahrq.gov/node/33600/psn-pdf
June 16, 2024 - Care Safer report, issued
in 2001, was the first effort to use evidence-based medicine principles in identifying
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psnet.ahrq.gov/node/33581/psn-pdf
December 15, 2024 - posthospital-medication-discrepancies-prevalence-and-contributing-factors
https://psnet.ahrq.gov/issue/defining-identifying-and-addressing-problematic-polypharmacy-within-multimorbidity-primary
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psnet.ahrq.gov/perspective/weekend-effect
April 01, 2008 - February 18, 2011
Identifying and classifying diagnostic errors in acute care across
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psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
June 15, 2024 - not understand the reasons or mechanism for doing so, and therefore do not make the appointment. 6 Identifying
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psnet.ahrq.gov/web-mm/fatal-error-neonate-does-just-culture-provide-answer
June 24, 2020 - April 29, 2018
NICU medication errors: identifying a risk profile for medication errors
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psnet.ahrq.gov/perspective/patient-safety-primary-care
January 31, 2020 - impacting numerous safety targets, such as accuracy of diagnosis and medication adherence. 9
Identifying
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psnet.ahrq.gov/primer/telehealth-and-patient-safety
July 27, 2022 - such as COVID-19, at-home daily assessments of pulse oximetry and home monitoring were effective in identifying
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psnet.ahrq.gov/web-mm/wrong-route-nutrients
September 04, 2010 - , and an educationally diverse workforce.( 3 ) The goal is to move from casting blame to carefully identifying
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psnet.ahrq.gov/web-mm/timely-diagnosis-esophageal-perforation
September 27, 2023 - it is hypertonic and can cause aspiration pneumonitis, and thin barium has greater sensitivity for identifying