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psnet.ahrq.gov/issue/good-catch-campaign-improving-perioperative-culture-safety
April 24, 2018 - June 9, 2021
WebM&M Cases
Lack of Sepsis Recognition Leads
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psnet.ahrq.gov/issue/alternative-perspectives-safety-home-delivered-health-care-sequential-exploratory-mixed
February 17, 2016 - Cases
Be Picky about your PICCs—Fragmented Care and Poor Communication at Discharge Leads
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psnet.ahrq.gov/issue/when-systems-fail
February 10, 2011 - April 14, 2021
Error in body weight estimation leads to inadequate parenteral anticoagulation
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psnet.ahrq.gov/issue/using-multidisciplinary-rounds-improve-patient-safety-through-venous-thromboembolism
April 20, 2016 - Cases
Be Picky about your PICCs—Fragmented Care and Poor Communication at Discharge Leads
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psnet.ahrq.gov/issue/medication-administration-process-assessment-applying-lessons-learned-commercial-aviation
May 25, 2011 - March 23, 2011
An anesthesiology department leads culture change at a hospital system
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psnet.ahrq.gov/issue/understanding-safer-practices-health-care-prologue-role-indicators
May 07, 2008 - November 21, 2012
Learning through simulated independent practice leads to better future
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psnet.ahrq.gov/issue/measuring-errors-surgical-pathology-real-life-practice-defining-what-does-and-does-not-matter
January 14, 2011 - September 27, 2017
When diagnostic testing leads to harm: a new outcomes-based approach
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psnet.ahrq.gov/issue/always-having-say-youre-sorry-ethical-response-making-mistakes-professional-practice
September 09, 2011 - February 22, 2017
A medical error leads to tragedy: how do we inform the patient?
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psnet.ahrq.gov/issue/leadership-initiative-improve-communication-and-enhance-safety
March 11, 2009 - June 13, 2011
An anesthesiology department leads culture change at a hospital system
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psnet.ahrq.gov/issue/novel-approach-implementation-quality-and-safety-programmes-anaesthesiology
January 15, 2014 - March 1, 2011
An anesthesiology department leads culture change at a hospital system
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psnet.ahrq.gov/issue/conditions-influence-impact-malpractice-litigation-risk-physicians-behavior-regarding-patient
January 07, 2015 - January 7, 2015
How health care complexity leads to cooperation and affects the autonomy
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psnet.ahrq.gov/issue/cost-poor-blood-specimen-quality-and-errors-preanalytical-processes
April 22, 2009 - March 26, 2014
When diagnostic testing leads to harm: a new outcomes-based approach for
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psnet.ahrq.gov/issue/near-misses-paradoxical-realities-everyday-clinical-practice
May 04, 2012 - Implementing an interprofessional patient safety learning initiative: insights from participants, project leads
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psnet.ahrq.gov/issue/sentinel-events-serious-reportable-events-and-root-cause-analysis
February 26, 2014 - Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads
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psnet.ahrq.gov/issue/rate-occult-specimen-provenance-complications-routine-clinical-practice
January 05, 2012 - March 12, 2014
When diagnostic testing leads to harm: a new outcomes-based approach for
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psnet.ahrq.gov/issue/anesthesia-medication-handling-needs-new-vision
July 10, 2017 - Radiology Reads in the Digital Era
January 1, 2017
An anesthesiology department leads
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psnet.ahrq.gov/issue/e-prescribing-first-step-improved-safety
February 16, 2011 - October 10, 2018
Electronic prescribing vulnerabilities: height and weight mix-up leads
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psnet.ahrq.gov/issue/hospital-credentialing-and-privileging-surgeons-potential-safety-blind-spot
September 24, 2017 - Summary
July 23, 2024
WebM&M Cases
Saline Flush Leads
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psnet.ahrq.gov/issue/what-just-culture-doesnt-understand-about-just-punishment
December 30, 2014 - July 14, 2010
Error in body weight estimation leads to inadequate parenteral anticoagulation
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psnet.ahrq.gov/issue/explaining-unexplainable-impact-physicians-attitude-towards-litigation-their-incident
March 26, 2014 - March 26, 2014
How health care complexity leads to cooperation and affects the autonomy