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psnet.ahrq.gov/node/35170/psn-pdf
October 07, 2016 - Center for Patient Safety.
October 7, 2016
Missouri State Medical Association; Missouri Hospital Association; Primaris
https://psnet.ahrq.gov/issue/center-patient-safety
The Missouri Center for Patient Safety is dedicated to improving patient safety in Missouri by applying
evidence-based methods and best practices…
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psnet.ahrq.gov/node/39906/psn-pdf
July 08, 2013 - Safe Site Invasive Procedure—Non-Operating Room.
July 8, 2013
Institute for Clinical Systems Improvement.
https://psnet.ahrq.gov/issue/safe-site-invasive-procedure-non-operating-room
This protocol is designed to protect against wrong-site incidents in ambulatory care and to improve team
communication and patient e…
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psnet.ahrq.gov/perspective/conversation-wanda-pratt-phd
November 01, 2017 - In Conversation With… Wanda Pratt, PhD
November 1, 2017
Also Read an Essay
Citation Text:
In Conversation With… Wanda Pratt, PhD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
Cop…
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psnet.ahrq.gov/perspective/conversation-withwilliam-b-weeks-md-mba
May 01, 2009 - In Conversation with…William B. Weeks, MD, MBA
May 1, 2009
Also Read an Essay
Citation Text:
In Conversation with…William B. Weeks, MD, MBA. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. …
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psnet.ahrq.gov/sites/default/files/2024-06/spotlight_case_hemorrhagic_shock_slides_final.pptx
January 01, 2024 - Spotlight
Spotlight
Hemorrhagic Shock after Elective Spine Surgery: Failure to Rescue after Limited Response to Nursing Concerns
1
Source and Credits
This presentation is based on the July 2024 AHRQ WebM&M Spotlight Case
See the full article at https://psnet.ahrq.gov/webmm
CME credit is available
Commentary …
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psnet.ahrq.gov/node/60952/psn-pdf
September 30, 2020 - When the Lytes Go Out: A Case of Inpatient Cardiac
Arrest
September 30, 2020
Stripe B, Zuidema D. When the Lytes Go Out: A Case of Inpatient Cardiac Arrest . PSNet [internet]. 2020.
https://psnet.ahrq.gov/web-mm/when-lytes-go-out-case-inpatient-cardiac-arrest
Disclosure of Relevant Financial Relationships: As a pr…
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psnet.ahrq.gov/web-mm/seasonal-care-transition-failure
June 01, 2016 - A Seasonal Care Transition Failure
Citation Text:
Young JQ. A Seasonal Care Transition Failure. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 X…
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psnet.ahrq.gov/node/35447/psn-pdf
November 02, 2005 - Training health care professionals for patient safety.
November 2, 2005
Clancy CM.
https://psnet.ahrq.gov/issue/training-health-care-professionals-patient-safety
Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy summarizes the Agency's
research and training activities in teamwork, medical e…
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psnet.ahrq.gov/node/42871/psn-pdf
September 13, 2016 - Diagnosis.
September 13, 2016
Graber ML, Plebani M, eds. Berlin, Germany: Society to Improve Diagnosis in Medicine and DeGruyter.
ISSN: 2194-802X.
https://psnet.ahrq.gov/issue/diagnosis
This journal offers multidisciplinary research and commentary covering such topics as diagnostic error,
clinical reasoning, and …
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psnet.ahrq.gov/node/40669/psn-pdf
August 27, 2013 - STate Action on Avoidable Rehospitalizations.
August 27, 2013
Institute for Healthcare Improvement. 2009 -2013.
https://psnet.ahrq.gov/issue/state-action-avoidable-rehospitalizations
This Web site supports an initiative to reduce avoidable rehospitalizations by improving transitions in care
and communication betwe…
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psnet.ahrq.gov/node/39940/psn-pdf
December 14, 2016 - Quality and Safety in Women's Health Care. Second
Edition.
December 14, 2016
Women's Health Care Physicians; Committee on Patient Safety and Quality Improvement. Washington,
DC: American College of Obstetricians and Gynecologists; 2010. ISBN: 9781934946930.
https://psnet.ahrq.gov/issue/quality-and-safety-womens-he…
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psnet.ahrq.gov/issue/parent-perceptions-childrens-hospital-safety-climate
December 22, 2018 - Study
Parent perceptions of children's hospital safety climate.
Citation Text:
Cox E, Carayon P, Hansen KW, et al. Parent perceptions of children's hospital safety climate. BMJ Qual Saf. 2013;22(8):664-71. doi:10.1136/bmjqs-2012-001727.
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Format:
DOI Google Sc…
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psnet.ahrq.gov/issue/patient-and-health-care-professional-perspectives-stigma-integrated-behavioral-health
January 12, 2022 - Study
Patient and health care professional perspectives on stigma in integrated behavioral health: barriers and recommendations.
Citation Text:
Phelan SM, Salinas M, Pankey T, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: barriers and…
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psnet.ahrq.gov/issue/using-health-care-failure-mode-and-effect-analysis-va-national-center-patient-safetys
January 17, 2012 - Study
Classic
Using Health Care Failure Mode and Effect Analysis: the VA National Center for Patient Safety's prospective risk analysis system.
Citation Text:
DeRosier JM, Stalhandske E, Bagian JP, et al. Using health care Failure Mode and Effect Analysis: the V…
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psnet.ahrq.gov/issue/impact-closed-loop-electronic-prescribing-and-administration-system-prescribing-errors
November 13, 2009 - Study
The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.
Citation Text:
Franklin BD, O'Grady K, Donyai P, et al. The impact of a closed-loop electronic prescribing and admin…
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psnet.ahrq.gov/issue/literature-review-training-offered-qualified-prescribers-use-electronic-prescribing-systems
December 21, 2022 - Review
A literature review of the training offered to qualified prescribers to use electronic prescribing systems: why is it so important?
Citation Text:
Brown CL, Reygate K, Slee A, et al. A literature review of the training offered to qualified prescribers to use electronic prescribing…
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psnet.ahrq.gov/issue/comparative-accuracy-diagnosis-collective-intelligence-multiple-physicians-vs-individual
January 23, 2017 - Study
Emerging Classic
Comparative accuracy of diagnosis by collective intelligence of multiple physicians vs individual physicians.
Citation Text:
Barnett ML, Boddupalli D, Nundy S, et al. Comparative Accuracy of Diagnosis by Collective Intelligence of Multiple…
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psnet.ahrq.gov/issue/medication-related-clinical-decision-support-alert-overrides-inpatients
July 16, 2019 - Study
Medication-related clinical decision support alert overrides in inpatients.
Citation Text:
Nanji KC, Seger DL, Slight SP, et al. Medication-related clinical decision support alert overrides in inpatients. J Am Med Inform Assoc. 2018;25(5):476-481. doi:10.1093/jamia/ocx115.
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psnet.ahrq.gov/issue/delays-diagnosis-treatment-and-surgery-root-causes-actions-taken-and-recommendations
March 25, 2020 - Study
Delays in diagnosis, treatment, and surgery: root causes, actions taken, and recommendations for healthcare improvement.
Citation Text:
Politi RE, Mills PD, Zubkoff L, et al. Delays in diagnosis, treatment, and surgery: root causes, actions taken, and recommendations for healthcare…
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psnet.ahrq.gov/issue/engineering-care-transitions-clinician-perceptions-barriers-safe-medication-management-during
July 20, 2022 - Study
Engineering care transitions: clinician perceptions of barriers to safe medication management during transitions of patient care.
Citation Text:
Hannum SM, Abebe E, Xiao Y, et al. Engineering care transitions: clinician perceptions of barriers to safe medication management during t…