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  1. Opioids prescribed after low-risk surgical procedures in the United States, 2004–2012. | PSNet

    psnet.ahrq.gov/issue/opioids-prescribed-after-low-risk-surgical-procedures-united-states-2004-2012
    May 29, 2024 - Study Opioids prescribed after low-risk surgical procedures in the United States, 2004–2012. Citation Text: Wunsch H, Wijeysundera DN, Passarella MA, et al. Opioids Prescribed After Low-Risk Surgical Procedures in the United States, 2004-2012. JAMA. 2016;315(15):1654-7. doi:10.1001/jama.…

  2. Evaluation of near-miss wrong-patient events in radiology reports. | PSNet

    psnet.ahrq.gov/issue/evaluation-near-miss-wrong-patient-events-radiology-reports
    June 13, 2015 - Study Evaluation of near-miss wrong-patient events in radiology reports. Citation Text: Sadigh G, Loehfelm T, Applegate KE, et al. JOURNAL CLUB: Evaluation of Near-Miss Wrong-Patient Events in Radiology Reports. AJR Am J Roentgenol. 2015;205(2):337-43. doi:10.2214/AJR.14.13339. Copy Ci…

  3. Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU. | PSNet

    psnet.ahrq.gov/issue/simulator-based-crew-resource-management-training-interhospital-transfer-critically-ill
    February 14, 2024 - Study Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU. Citation Text: Droogh JM, Kruger HL, Ligtenberg JJM, et al. Simulator-Based Crew Resource Management Training for Interhospital Transfer of Critically Ill Pati…

  4. Workplace Safety in Health Care | PSNet

    psnet.ahrq.gov/perspective/workplace-safety-health-care
    January 01, 2017 - that produces immediate results, but after people get the rhythm of learning—ideally in real time, by identifying

  5. In Conversation With… Paul H. O'Neill, MPA | PSNet

    psnet.ahrq.gov/perspective/conversation-paul-h-oneill-mpa
    January 01, 2017 - that produces immediate results, but after people get the rhythm of learning—ideally in real time, by identifying

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49794/psn-pdf
    May 01, 2017 - Communication Error in a Closed ICU May 1, 2017 Haas B, Conn LG. Communication Error in a Closed ICU. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/communication-error-closed-icu The Case A 70-year-old man with a complex medical history including end-stage renal disease (status post kidney transplant), co…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838972/psn-pdf
    October 27, 2022 - The Unhappy Patient Leaves Against Medical Advice. October 27, 2022 Nichols A. The Unhappy Patient Leaves Against Medical Advice. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/unhappy-patient-leaves-against-medical-advice The Case A 61-year-old woman was placed on bedrest following major surgery. Her posto…

  8. Abnormal Volunteer Results | PSNet

    psnet.ahrq.gov/web-mm/abnormal-volunteer-results
    July 18, 2016 - Abnormal Volunteer Results Citation Text: Fernandez C. Abnormal Volunteer Results. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote ta…

  9. Finding Fault With the Default Alert | PSNet

    psnet.ahrq.gov/web-mm/finding-fault-default-alert
    August 28, 2024 - Finding Fault With the Default Alert Citation Text: Baysari M. Finding Fault With the Default Alert. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNot…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36683/psn-pdf
    March 28, 2011 - Adverse events following an emergency department visit. March 28, 2011 Forster AJ, Rose NGW, van Walraven C, et al. Adverse events following an emergency department visit. Qual Saf Health Care. 2007;16(1):17-22. https://psnet.ahrq.gov/issue/adverse-events-following-emergency-department-visit The investigators inte…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34099/psn-pdf
    March 02, 2016 - Findings from the ISMP Medication Safety Self- Assessment for hospitals. March 2, 2016 Smetzer JL, Vaida AJ, Cohen MR, et al. Findings from the ISMP Medication Safety Self-Assessment for hospitals. Jt Comm J Qual Patient Saf. 2003;29(11):586-597. https://psnet.ahrq.gov/issue/findings-ismp-medication-safety-self-as…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41160/psn-pdf
    February 22, 2012 - Surgical count practice variability and the potential for retained surgical items. February 22, 2012 Edel EM. Surgical count practice variability and the potential for retained surgical items. AORN J. 2012;95(2):228-38. doi:10.1016/j.aorn.2011.02.014. https://psnet.ahrq.gov/issue/surgical-count-practice-variabilit…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39317/psn-pdf
    November 02, 2010 - Exploring the causes of adverse events in hospitals and potential prevention strategies. November 2, 2010 Smits M, Zegers M, Groenewegen PP, et al. Exploring the causes of adverse events in hospitals and potential prevention strategies. BMJ Qual Saf. 2010;19(5). doi:10.1136/qshc.2008.030726. https://psnet.ahrq.gov…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35366/psn-pdf
    September 27, 2016 - Certified pharmacy technicians' views on their medication preparation errors and educational needs. September 27, 2016 Desselle SP. Certified pharmacy technicians' views on their medication preparation errors and educational needs. Am J Health Syst Pharm. 2005;62(19):1992-7. https://psnet.ahrq.gov/issue/certified-…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38130/psn-pdf
    January 02, 2017 - View the world through a different lens: shadowing another provider. January 2, 2017 Thompson DA, Holzmueller CG, Lubomski LH, et al. View the world through a different lens: shadowing another provider. Jt Comm J Qual Patient Saf. 2008;34(10):614-8, 561. https://psnet.ahrq.gov/issue/view-world-through-different-le…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50896/psn-pdf
    February 12, 2020 - Medical abbreviations that have contradictory or ambiguous meanings. February 12, 2020 Davis N. ISMP Medication Safety Alert! Acute care edition! January 30, 2020;25(2):1-5. https://psnet.ahrq.gov/issue/medical-abbreviations-have-contradictory-or-ambiguous-meanings Multiple organizations have identified using…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42712/psn-pdf
    October 02, 2017 - Improving patient safety through transparency. October 2, 2017 Kachalia A. Improving patient safety through transparency. N Engl J Med. 2013;369(18):1677-9. doi:10.1056/NEJMp1303960. https://psnet.ahrq.gov/issue/improving-patient-safety-through-transparency This commentary describes successful transparency initiat…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39196/psn-pdf
    January 16, 2010 - Detecting adverse events in dermatologic surgery. January 16, 2010 Pinney D, Pearce DJ, Feldman SR. Detecting adverse events in dermatologic surgery. Dermatol Surg. 2010;36(1):8-14. doi:10.1111/j.1524-4725.2009.01378.x. https://psnet.ahrq.gov/issue/detecting-adverse-events-dermatologic-surgery This review identifi…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37002/psn-pdf
    September 14, 2011 - Factors influencing nurses' decisions to raise concerns about care quality. September 14, 2011 Attree M. Factors influencing nurses' decisions to raise concerns about care quality. J Nurs Manag. 2007;15(4):392-402. https://psnet.ahrq.gov/issue/factors-influencing-nurses-decisions-raise-concerns-about-care-quality …

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41508/psn-pdf
    July 11, 2012 - Complications in surgery: root cause analysis and preventive measures. July 11, 2012 Chung KC, Kotsis S. Complications in surgery: root cause analysis and preventive measures. Plast Reconstr Surg. 2012;129(6):1421-1427. doi:10.1097/PRS.0b013e31824ecda0. https://psnet.ahrq.gov/issue/complications-surgery-root-cause…
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