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2001. Use of cascading A3s to drive systemwide improvement. | PSNet
      psnet.ahrq.gov/issue/use-cascading-a3s-drive-systemwide-improvement
      January 29, 2015 - Commentary Use of cascading A3s to drive systemwide improvement. Citation Text: Winner LE, Burroughs TJ, Cady-Reh JA, et al. Use of Cascading A3s to Drive Systemwide Improvement. Jt Comm J Qual Patient Saf. 2017;43(8):422-428. doi:10.1016/j.jcjq.2017.03.011. Copy Citation Format: …

2002. Diseases of medical progress. | PSNet
      psnet.ahrq.gov/issue/diseases-medical-progress
      June 27, 2018 - Review Classic Diseases of medical progress. Citation Text: MOSER RH. Diseases of medical progress. N Engl J Med. 1956;255(13):606-14. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

2003. Deprescribing as a clinical improvement focus. | PSNet
      psnet.ahrq.gov/issue/deprescribing-clinical-improvement-focus
      April 08, 2011 - Study Deprescribing as a clinical improvement focus. Citation Text: Dharmarajan TS, Choi H, Hossain N, et al. Deprescribing as a Clinical Improvement Focus. J Am Med Dir Assoc. 2020;21(3):355-360. doi:10.1016/j.jamda.2019.08.031. Copy Citation Format: DOI Google Scholar Pub…

2004. Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. | PSNet
      psnet.ahrq.gov/issue/use-beers-criteria-predict-adverse-drug-reactions-among-first-visit-elderly-outpatients
      October 27, 2016 - Study Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. Citation Text: Chang C-M, Liu P-YY, Yang Y-HK, et al. Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. Pharmacotherapy. 2005;25(6):…

2005. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49824/psn-pdf
      March 01, 2018 - Missing ECG and Missed Diagnosis Lead to Dangerous Delay March 1, 2018 O'Connor RE. Missing ECG and Missed Diagnosis Lead to Dangerous Delay. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/missing-ecg-and-missed-diagnosis-lead-dangerous-delay The Case A 35-year-old woman with no prior cardiac history calle…

2006. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49503/psn-pdf
      February 01, 2006 - Workaround Error February 1, 2006 Pape T. Workaround Error. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/workaround-error The Case A retired 81-year-old physician with metastatic colon cancer was admitted to an acute care hospital with pneumonia and congestive heart failure (CHF). After his acute hospita…

2007. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49420/psn-pdf
      October 01, 2003 - To LP or Not LP October 1, 2003 Landrigan CP. To LP or Not LP. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/lp-or-not-lp The Case A 4-month-old male infant was seen in the office setting of a large multisite practice. He presented with fever and irritability without an obvious source. He was referred to …

2008. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49635/psn-pdf
      September 01, 2011 - Central, not Epidural September 1, 2011 Simmons D. Central, not Epidural. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/central-not-epidural The Case A 55-year-old man with lung cancer recently had the lower lobe of his left lung removed. Post-operatively, he was awake, alert, and oriented to time, place,…

2009. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49387/psn-pdf
      February 01, 2003 - Patient Mix-Up February 1, 2003 Shojania KG. Patient Mix-Up. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/patient-mix The Case Joe Smith [not his real name], a 42-year-old man with nausea and vomiting for 4 days, was on the general medical service at an academic medical center. Overnight, another man wit…

2010. Spotlight Case July 2008 (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.287_slideshow.ppt
      December 01, 2012 - Spotlight Case July 2008 Spotlight Case The Lung Nodule That Refused To Grow * * Source and Credits This presentation is based on the December 2012 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Alex A. Balekian, MD, MSHS, Keck School of Med…

2011. In Conversation with...Atul Gawande, MD, MA, MPH | PSNet
      psnet.ahrq.gov/perspective/conversation-withatul-gawande-md-ma-mph
      September 01, 2007 - In Conversation with...Atul Gawande, MD, MA, MPH September 1, 2007  Also Read an Essay Citation Text: In Conversation with..Atul Gawande, MD, MA, MPH. PSNet [internet]. 2007.In Conversation with...Atul Gawande, MD, MA, MPH. PSNet [internet]. Rockville (MD): Agency…

2012. Potentially inappropriate prescribing in elderly veterans: are we using the wrong drug, wrong dose, or wrong duration? | PSNet
      psnet.ahrq.gov/issue/potentially-inappropriate-prescribing-elderly-veterans-are-we-using-wrong-drug-wrong-dose-or
      August 15, 2012 - Study Potentially inappropriate prescribing in elderly veterans: are we using the wrong drug, wrong dose, or wrong duration? Citation Text: Pugh MJV, Fincke BG, Bierman AS, et al. Potentially Inappropriate Prescribing in Elderly Veterans: Are We Using the Wrong Drug, Wrong Dose, or Wro…

2013. Developing and pilot testing practical measures of preanalytic surgical specimen identification defects. | PSNet
      psnet.ahrq.gov/issue/developing-and-pilot-testing-practical-measures-preanalytic-surgical-specimen-identification
      June 16, 2011 - Study Developing and pilot testing practical measures of preanalytic surgical specimen identification defects. Citation Text: Bixenstine PJ, Zarbo RJ, Holzmueller CG, et al. Developing and pilot testing practical measures of preanalytic surgical specimen identification defects. Am J M…

2014. Identifying the 'right patient': nurse and consumer perspectives on verifying patient identity during medication administration. | PSNet
      psnet.ahrq.gov/issue/identifying-right-patient-nurse-and-consumer-perspectives-verifying-patient-identity-during
      September 03, 2011 - Study Identifying the 'right patient': nurse and consumer perspectives on verifying patient identity during medication administration. Citation Text: Kelly T, Roper C, Elsom S, et al. Identifying the 'right patient': nurse and consumer perspectives on verifying patient identity during …

2015. In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission. | PSNet
      psnet.ahrq.gov/issue/hospital-mortality-associated-misdiagnosis-or-unidentified-site-infection-admission
      June 27, 2011 - Review In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission. Citation Text: Abe T, Tokuda Y, Shiraishi A, et al. In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission. Crit Care. 2019;23(1):2…

2016. Barriers to staff adoption of a surgical safety checklist. | PSNet
      psnet.ahrq.gov/issue/barriers-staff-adoption-surgical-safety-checklist
      February 25, 2015 - Study Barriers to staff adoption of a surgical safety checklist. Citation Text: Fourcade A, Blache J-L, Grenier C, et al. Barriers to staff adoption of a surgical safety checklist. BMJ Qual Saf. 2012;21(3):191-7. doi:10.1136/bmjqs-2011-000094. Copy Citation Format: DOI Go…

2017. The Charter on Professionalism for Health Care Organizations. | PSNet
      psnet.ahrq.gov/issue/charter-professionalism-health-care-organizations
      May 25, 2016 - Commentary The Charter on Professionalism for Health Care Organizations. Citation Text: Egener BE, Mason DJ, McDonald WJ, et al. The Charter on Professionalism for Health Care Organizations. Acad Med. 2017;92(8):1091-1099. doi:10.1097/ACM.0000000000001561. Copy Citation Format: …

2018. Dementia and risk of adverse warfarin-related events in the nursing home setting. | PSNet
      psnet.ahrq.gov/issue/dementia-and-risk-adverse-warfarin-related-events-nursing-home-setting
      February 23, 2011 - Study Dementia and risk of adverse warfarin-related events in the nursing home setting. Citation Text: Tjia J, Field T, Mazor KM, et al. Dementia and risk of adverse warfarin-related events in the nursing home setting. Am J Geriatr Pharmacother. 2012;10(5):323-30. doi:10.1016/j.amjopha…

2019. Accuracy of radiographic readings in the emergency department. | PSNet
      psnet.ahrq.gov/issue/accuracy-radiographic-readings-emergency-department
      November 18, 2016 - Study Accuracy of radiographic readings in the emergency department. Citation Text: Petinaux B, Bhat R, Boniface K, et al. Accuracy of radiographic readings in the emergency department. Am J Emerg Med. 2011;29(1):18-25. doi:10.1016/j.ajem.2009.07.011. Copy Citation Format: …

2020. Clinical handover of the critically ill postoperative patient: an integrative review. | PSNet
      psnet.ahrq.gov/issue/clinical-handover-critically-ill-postoperative-patient-integrative-review
      March 23, 2016 - Review Clinical handover of the critically ill postoperative patient: an integrative review. Citation Text: Gardiner TM, Marshall AP, Gillespie BM. Clinical handover of the critically ill postoperative patient: an integrative review. Aust Crit Care. 2015;28(4):226-34. doi:10.1016/j.aucc.…