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psnet.ahrq.gov/node/74188/psn-pdf
December 15, 2021 - addition to creating challenges for trainee
comprehension of surgical instruction, ambiguous language can lead
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psnet.ahrq.gov/node/840477/psn-pdf
November 30, 2022 - common-and-consequential-fractures-should-not-be-missed-children
Diagnostic errors involving pediatric musculoskeletal radiographs can lead
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psnet.ahrq.gov/node/865977/psn-pdf
May 29, 2024 - complication-rates-central-venous-catheters-systematic-review-and-meta-
analysis
The use of central venous catheters (CVC) can lead
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psnet.ahrq.gov/node/866162/psn-pdf
June 19, 2024 - surgeon-and-surgical-trainee-experiences-after-adverse-patient-events
Adverse events in surgery can lead
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psnet.ahrq.gov/node/60722/psn-pdf
February 06, 2023 - global pandemic, delayed diagnosis of infection with SARS-CoV-2, the virus that causes COVID-19, may
lead … However, these same heuristics that support “fast
and frugal” decision-making can lead to diagnostic … To avoid such errors, it is useful to understand
why these heuristics potentially lead to biases in … In current circumstances, this cognitive (anchoring) bias may lead clinicians to miss the diagnosis of … Premature closure may also lead clinicians to make a presumptive diagnosis of COVID-19 (allowing the
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psnet.ahrq.gov/node/854818/psn-pdf
October 25, 2023 - The nature, causes, and clinical impact of errors in the
clinical laboratory testing process leading to diagnostic
error: a voluntary incident report analysis.
October 25, 2023
van Moll C, Egberts TCG, Wagner C, et al. The nature, causes, and clinical impact of errors in the clinical
laboratory testing process lea…
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psnet.ahrq.gov/node/838222/psn-pdf
September 28, 2022 - them out to do things they don’t need to do, and avoid unnecessary tests or
treatments that might lead … So, I think we’re well positioned to lead patient
safety efforts. … I think primary care has an opportunity to
lead the patient safety effort or to claim it as part of … We need to lead the charge in making sure that those organizations have the
information they need to … Those transitions are important, and I think
primary care can lead by example and demand from our
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psnet.ahrq.gov/node/38938/psn-pdf
July 26, 2023 - Drug name confusion can easily lead to medication errors, and the ISMP has
recommended interventions
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psnet.ahrq.gov/node/854982/psn-pdf
November 01, 2023 - medicine-self-administration-errors-older-adult-population-systematic-review
https://psnet.ahrq.gov/issue/polypharmacy-elderly-when-good-drugs-lead-bad-outcomes-teachable-moment
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psnet.ahrq.gov/node/855430/psn-pdf
November 15, 2023 - BMJ Lead. 2023;7(3):196-202. doi:10.1136/leader-2022-000626.
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psnet.ahrq.gov/node/73922/psn-pdf
October 06, 2021 - Leading causes of anesthesia-related liability claims in
ambulatory surgery centers.
October 6, 2021
Ranum D, Beverly A, Shapiro FE, et al. Leading causes of anesthesia-related liability claims in ambulatory
surgery centers. J Patient Saf. 2021;17(7):513-521. doi:10.1097/pts.0000000000000431.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/47953/psn-pdf
January 01, 2021 - impact-medication-reviews-delivered-community-pharmacist-elderly-patients-polypharmacy-meta
https://psnet.ahrq.gov/issue/polypharmacy-elderly-when-good-drugs-lead-bad-outcomes-teachable-moment
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psnet.ahrq.gov/node/72761/psn-pdf
February 17, 2021 - joint-statement-multiple-patients-ventilator
https://psnet.ahrq.gov/issue/drawn-curtains-muted-alarms-and-diverted-attention-lead-tragedy-postanesthesia-care-unit
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psnet.ahrq.gov/node/74104/psn-pdf
November 24, 2021 - examining-meaning-language-used-communicate-nursing-hand
During handoffs, nurses are exposed to a variety of interruptions and distractions which may lead
-
psnet.ahrq.gov/node/73885/psn-pdf
September 29, 2021 - reporting-unsafe-conditions-academic-women-and-childrens-hospital
Incident reporting and analysis can lead
-
psnet.ahrq.gov/node/72534/psn-pdf
December 02, 2020 - patients-perceptions-safety-emergency-medical-services-interview-study
Safety problems in prehospital care can lead
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psnet.ahrq.gov/node/73189/psn-pdf
April 28, 2021 - suggests that safety initiatives taking a systems-oriented approach and organizational buy-
in can lead
-
psnet.ahrq.gov/node/851194/psn-pdf
July 05, 2023 - psnet.ahrq.gov/issue/additional-cost-perioperative-medication-errors
Preventable adverse events can lead
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psnet.ahrq.gov/node/853233/psn-pdf
September 06, 2023 - weight-estimation-drug-dose-calculations-prehospital-setting-systematic-review
Inaccurate estimations of patient weight can lead
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psnet.ahrq.gov/node/853245/psn-pdf
September 06, 2023 - intraoperative-communications-between-pathologists-and-surgeons-do-we-
understand-each-other
Miscommunication between pathologists and surgeons can lead