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psnet.ahrq.gov/issue/team-time-out-and-surgical-safety-experiences-12390-neurosurgical-patients
November 21, 2018 - Related Resources From the Same Author(s)
Impact of interactions between drugs and laboratory … November 21, 2018
Diagnostic error as a result of drug-laboratory test interactions.
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psnet.ahrq.gov/issue/quality-improvement-healthcare-new-zealand-part-2-are-our-patients-safe-and-what-are-we-doing
April 01, 2015 - June 25, 2014
Impact of interactions between drugs and laboratory test results on diagnostic … November 21, 2018
Diagnostic error as a result of drug-laboratory test interactions.
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psnet.ahrq.gov/cme
February 26, 2025 - The commentary highlights how the misinterpretation of a common laboratory complication can lead to incorrect
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psnet.ahrq.gov/primer/clinical-decision-support-systems
December 15, 2024 - Clinical decision support systems use specific parameters (such as diagnoses, laboratory results, medication
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psnet.ahrq.gov/web-mm/strongyloides-hidden-traveler-and-potentially-lethal-missed-diagnosis
August 25, 2021 - Life cycle of Strongyloides stercoralis
Image from the CDC DPDx – Laboratory … Health departments can play a greater role in alerting clinicians and laboratories to the most recent
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psnet.ahrq.gov/web-mm/no-blood-please
January 14, 2011 - Many providers, such as emergency department, laboratory medicine, and anesthesia staff, will likely
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psnet.ahrq.gov/node/49764/psn-pdf
June 01, 2016 - Her laboratory studies were notable for a markedly elevated white blood cell count of 121,000
(normal
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psnet.ahrq.gov/node/49671/psn-pdf
November 01, 2012 - The patient then would have gone emergently to the catheterization laboratory for
reperfusion therapy
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.239_slideshow.ppt
May 01, 2011 - Laboratory tests were unremarkable, and a head CT was reported as normal by the radiologist.
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psnet.ahrq.gov/node/49603/psn-pdf
June 01, 2010 - Dekker, PhD Professor and Director
Leonardo da Vinci Laboratory for Complexity and Systems Thinking
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psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors
March 30, 2022 - with a follow-up visit with a cardiologist in 4 weeks but no instructions for earlier follow-up or laboratory
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psnet.ahrq.gov/web-mm/cognitive-overload-icu
June 01, 2005 - A new set of laboratory tests, an arterial blood gas, and a chest radiograph were performed. … Moreover, the clinician followed standard care when, following successful resuscitation, laboratory studies
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psnet.ahrq.gov/node/49525/psn-pdf
December 01, 2006 - oTher potential causes for thrombocytopenia (Figure 1)—may facilitate
assignment of a diagnosis.(4) Laboratory … Heparin-induced thrombocytopenia and
thrombosis: clinical and laboratory studies.
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psnet.ahrq.gov/web-mm/delayed-diagnosis-setting-virtual-care-remembering-physical-examination
April 29, 2020 - The physical examination, laboratory testing, imaging, and other investigations are meant to support … process does not result in adequate development of a differential diagnosis, the physical examination, laboratory
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psnet.ahrq.gov/web-mm/risks-absent-interoperability-medication-induced-hemolysis-patient-known-allergy
April 08, 2019 - language 7 Smoking status 8 Problems 9 Medications 10 Medication allergies 11 Laboratory … test(s) 12 Laboratory value(s)/result(s) 13 Vital signs: height, weight, blood pressure, BMI
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psnet.ahrq.gov/perspective/what-do-we-know-about-emergency-department-safety
June 01, 2010 - noise, repeated interruptions, 16 inadequate space to see patients, and delays or inaccuracies in laboratory … specific disease performance measures such as myocardial infarction (time to cardiac catheterization laboratory … An emergency department—which some people have described as a natural laboratory for error—is a chaotic
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psnet.ahrq.gov/sites/default/files/2024-12/spotlight_case_csf_leak_after_elective_spine_surgery_slides_-_final.pptx
January 01, 2024 - Detection of beta-2 transferrin in otorrhea and rhinorrhea in a routine clinical laboratory setting. … One should suspect a CSF leak if symptoms persist; imaging and laboratory testing should be considered … Detection of beta-2 transferrin in otorrhea and rhinorrhea in a routine clinical laboratory setting.
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psnet.ahrq.gov/perspective/conversation-jack-westfall-md-mph
September 28, 2022 - One of the projects that we did with AHRQ was developing and strengthening a patient safety laboratory … patient and clinician (1) had a shared decision about getting a test, (2) getting the blood test, (3) the laboratory … doing the test, (4) the laboratory reporting the test result back to the practice, (5) the result reported … events; inadequate communication, including problems with care transitions or reporting and follow-up of laboratory
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psnet.ahrq.gov/web-mm/hidden-heparins-hit-happens
March 27, 2024 - her potential causes for thrombocytopenia ( Figure 1 )—may facilitate assignment of a diagnosis.( 4 ) Laboratory … Heparin-induced thrombocytopenia and thrombosis: clinical and laboratory studies.
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psnet.ahrq.gov/node/865466/psn-pdf
March 27, 2024 - overestimates the kidney function of Black patients compared
to patients of other races with the same laboratory … A study
on laboratory and pharmacy data found that safety reporting did not identify issues in populations