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psnet.ahrq.gov/primer/triggers-and-trigger-tools
September 15, 2024 - Triggers and Trigger Tools
Citation Text:
Triggers and Trigger Tools. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/perspective/patient-safety-perspective-office-practice
May 01, 2009 - January 20, 2010
Pharmacy-driven performance improvement initiative to increase compliance
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psnet.ahrq.gov/web-mm/dont-wait-collect-accurate-weight-case-subtherapeutic-insulin-therapy
July 01, 2008 - February 16, 2022
An initiative to reduce insulin-related adverse drug events in a children's
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psnet.ahrq.gov/curated-library/value-and-patient-safety
October 30, 2019 - Gynecology and Reproductive Biology at Harvard Medical School and Director of the Delivery Decisions Initiative
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psnet.ahrq.gov/web-mm/direct-oral-anticoagulants-are-high-risk-medications-potentially-complex-dosing
August 21, 2005 - Direct Oral Anticoagulants are High-Risk Medications with Potentially Complex Dosing
Citation Text:
Giannini J, Wong M, Dager W, et al. Direct Oral Anticoagulants are High-Risk Medications with Potentially Complex Dosing. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Depar…
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psnet.ahrq.gov/node/49714/psn-pdf
August 21, 2014 - Pitfalls in Diagnosing Necrotizing Fasciitis
August 21, 2014
Goh T, Goh LG. Pitfalls in Diagnosing Necrotizing Fasciitis. PSNet [internet]. 2014.
https://psnet.ahrq.gov/web-mm/pitfalls-diagnosing-necrotizing-fasciitis
Case Objectives
State the epidemiology of necrotizing fasciitis.
Appreciate the high mortality a…
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psnet.ahrq.gov/web-mm/diagnostic-delay-emergency-department
September 18, 2024 - SPOTLIGHT CASE
Diagnostic Delay in the Emergency Department
Citation Text:
Marshall K, Singh H. Diagnostic Delay in the Emergency Department. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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psnet.ahrq.gov/node/49561/psn-pdf
May 01, 2008 - Diagnosing HIV-It Doesn't Take a Brain Surgeon
May 1, 2008
Chou R. Diagnosing HIV-It Doesn't Take a Brain Surgeon. PSNet [internet]. 2008.
https://psnet.ahrq.gov/web-mm/diagnosing-hiv-it-doesnt-take-brain-surgeon
Case Objectives
Describe the current epidemiology of HIV infection.
Identify the risk factors for HIV…
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psnet.ahrq.gov/node/73128/psn-pdf
July 01, 2022 - Hospital at Home? Care Reduces Costs, Readmissions,
and Complications and Enhances Satisfaction for Elderly
Patients.
April 7, 2021
https://psnet.ahrq.gov/innovation/hospital-homesm-care-reduces-costs-readmissions-and-complications-
and-enhances
Summary
The Hospital at Homesm program provides hospital-level care…
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psnet.ahrq.gov/node/49682/psn-pdf
April 01, 2013 - From Possible to Probable to Sure to Wrong—Premature
Closure and Anchoring in a Complicated Case
April 1, 2013
Newman-Toker DE. From Possible to Probable to Sure to Wrong—Premature Closure and Anchoring in a
Complicated Case. PSNet [internet]. 2013.
https://psnet.ahrq.gov/web-mm/possible-probable-sure-wrong-premat…
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psnet.ahrq.gov/node/33728/psn-pdf
May 01, 2012 - In Conversation With…David C. Classen, MD, MS
May 1, 2012
In Conversation With…David C. Classen, MD, MS. PSNet [internet]. 2012.
https://psnet.ahrq.gov/perspective/conversation-withdavid-c-classen-md-ms
Editor's note: David C. Classen, MD, MS, is Chief Medical Information Officer for Pascal Metrics and an
Associa…
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psnet.ahrq.gov/web-mm/despite-clues-failed-rescue
August 02, 2015 - SPOTLIGHT CASE
Despite Clues, Failed to Rescue
Citation Text:
Ghaferi AA. Despite Clues, Failed to Rescue. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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psnet.ahrq.gov/web-mm/pitfalls-diagnosing-necrotizing-fasciitis
March 24, 2021 - SPOTLIGHT CASE
Pitfalls in Diagnosing Necrotizing Fasciitis
Citation Text:
Goh T, Goh LG. Pitfalls in Diagnosing Necrotizing Fasciitis. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014.
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psnet.ahrq.gov/web-mm/what-happened-telemetry
January 18, 2012 - SPOTLIGHT CASE
What Happened on Telemetry?
Citation Text:
Sandau KE, Funk M. What Happened on Telemetry?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/web-mm/one-got-away-elopement-suicidal-patient-emergency-department
September 27, 2023 - The One That Got Away—Elopement of a Suicidal Patient in the Emergency Department.
Citation Text:
Bourgeois JA, Xiong G, Barnes DK, et al. The One That Got Away—Elopement of a Suicidal Patient in the Emergency Department.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Depa…
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psnet.ahrq.gov/issue/patient-safety-education-what-was-what-and-what-will-be
April 10, 2019 - Commentary
Patient safety education: what was, what is, and what will be?
Citation Text:
Klamen D, Sanserino K, Skolnik PJ. Patient Safety Education: What Was, What Is, and What Will Be? Teach Learn Med. 2013;25(sup1). doi:10.1080/10401334.2013.842906.
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psnet.ahrq.gov/issue/beyond-organisational-accident-need-error-wisdom-frontline
November 18, 2015 - Commentary
Beyond the organisational accident: the need for "error wisdom" on the frontline.
Citation Text:
Reason J. Beyond the organisational accident: the need for "error wisdom" on the frontline. Qual Saf Health Care. 2004;13 Suppl 2:ii28-33.
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Goo…
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psnet.ahrq.gov/issue/evolution-error-error-management-cognitive-constraints-and-adaptive-decision-making-biases
June 03, 2020 - Review
The evolution of error: error management, cognitive constraints, and adaptive decision-making biases.
Citation Text:
Johnson DDP, Blumstein DT, Fowler JH, et al. The evolution of error: error management, cognitive constraints, and adaptive decision-making biases. Trends Ecol Evo…
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psnet.ahrq.gov/issue/saving-without-compromising-teaching-trainees-safely-provide-high-value-care
August 02, 2015 - Commentary
Saving without compromising: teaching trainees to safely provide high value care.
Citation Text:
Judson TJ, Press MJ, Detsky AS. Saving without compromising: Teaching trainees to safely provide high value care. Healthc (Amst). 2019;7(1):4-6. doi:10.1016/j.hjdsi.2018.05.003.
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psnet.ahrq.gov/issue/essential-guide-patient-safety-officers-second-edition
February 15, 2017 - Book/Report
The Essential Guide for Patient Safety Officers, Second Edition.
Citation Text:
The Essential Guide for Patient Safety Officers, Second Edition. Leonard M, Frankel A, Federico F, et al, eds. Oakbrook Terrace, IL: Joint Commission Resources, Institute for Healthcare Improv…