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  1. psnet.ahrq.gov/web-mm/danger-disruption
    July 29, 2020 - Danger in Disruption Citation Text: Fontaine DK. Danger in Disruption. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedI…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/857260/psn-pdf
    November 30, 2023 - When Taking an SGLT2 inhibitor, Remember To SSTOP (Stop SGLT2 Inhibitor Three days bef-O-re Procedures)! November 30, 2023 Bagley B, Tan CL, Plante D. When Taking an SGLT2 inhibitor, Remember To SSTOP (Stop SGLT2 Inhibitor Three days bef-O-re Procedures)!. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/when…
  3. psnet.ahrq.gov/web-mm/cyp450-drugs-expect-unexpected
    October 19, 2022 - CYP450 Drugs: Expect the Unexpected Citation Text: Gonzalez CJ. CYP450 Drugs: Expect the Unexpected. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNot…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865984/psn-pdf
    May 29, 2024 - Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D-dimer. May 29, 2024 Agusala V, Deen J, Schaefer S. Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D- dimer. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/fatal-oversight-misdiagnosis-nocturnal-chest-pain-elevated-d-d…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49475/psn-pdf
    March 01, 2005 - Techno Trip March 1, 2005 Cook RI. Techno Trip. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/techno-trip The Case A 70-year-old woman was admitted to a community hospital after developing confusion and right-sided weakness. A CT scan of her brain showed an acute subdural hematoma. The hospital arranged a…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49664/psn-pdf
    January 01, 2013 - Empty Handoff September 1, 2012 Goldman A, Catchpole K. Empty Handoff. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/empty-handoff The Case A 29-year-old man with "brittle diabetes" was admitted to the surgery service for incision and drainage of a leg wound. The patient's medical history included chronic…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49806/psn-pdf
    September 01, 2017 - Failed Interpretation of Screening Tool: Delayed Treatment September 1, 2017 Cable CA, Murphy DJ, Martin GS. Failed Interpretation of Screening Tool: Delayed Treatment. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/failed-interpretation-screening-tool-delayed-treatment The Case An 88-year-old man present…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49795/psn-pdf
    June 01, 2017 - The Perils of Contrast Media June 1, 2017 Sadat U, Solomon R. The Perils of Contrast Media. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/perils-contrast-media Case Objectives Recognize that contrast media are potentially nephrotoxic. Identify key risk factors for the development of contrast-induced kidne…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49621/psn-pdf
    March 01, 2011 - Volume Too Low: In and Out March 1, 2011 Miller MR. Volume Too Low: In and Out . PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/volume-too-low-and-out Case Objectives Appreciate that because of multiple factors, children are at high risk for medical errors. Describe the importance of weight-based dosing of…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33596/psn-pdf
    June 01, 2025 - Failure to Rescue January 29, 2025 Tokareva I, Romano P. Failure to Rescue. PSNet [internet]. 2025. https://psnet.ahrq.gov/primer/failure-rescue Updated in January 2025 by Irina Tokareva RN, BSN, MAS, CPHQ and Patrick Romano, MD, MPH. PSNet primers are regularly reviewed and updated to ensure that they reflect cur…
  11. psnet.ahrq.gov/perspective/american-view-uks-patient-safety-enterprise-top-down-vs-bottom
    December 01, 2005 - An American View of the UK's Patient Safety Enterprise: Top Down vs. Bottom Up Robert M. Wachter, MD | June 1, 2012  View more articles from the same authors. Citation Text: Wachter R. An American View of the UK's Patient Safety Enterprise: Top Down vs. Bottom Up. …
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49747/psn-pdf
    December 01, 2015 - Harm From Alarm Fatigue December 1, 2015 Pelter MM, Drew BJ. Harm From Alarm Fatigue. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/harm-alarm-fatigue Case Objectives Define alarm fatigue and describe potential errors that can occur due to alarm fatigue. Identify federal and national agencies focusing on …
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49582/psn-pdf
    April 01, 2009 - Breakage of a PICC Line April 1, 2009 Dimov V. Breakage of a PICC Line. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/breakage-picc-line Case Objectives Appreciate the incidence and consequences of PICC line breakage. Understand the risk factors for PICC line breakage. Understand the treatment options in…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33693/psn-pdf
    February 01, 2010 - The Role of Graduate Medical Education (GME) in Improving Patient Safety February 1, 2010 Baron RB, Vidyarthi A. The Role of Graduate Medical Education (GME) in Improving Patient Safety. PSNet [internet]. 2010. https://psnet.ahrq.gov/perspective/role-graduate-medical-education-gme-improving-patient-safety Perspec…
  15. psnet.ahrq.gov/web-mm/too-much-too-fast
    June 14, 2019 - Too Much, Too Fast Citation Text: Tuot D. Too Much, Too Fast. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
  16. psnet.ahrq.gov/primer/patient-safety-indicators
    June 15, 2024 - Patient Safety Indicators Citation Text: Tokareva I, Romano P. Patient Safety Indicators.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML En…
  17. psnet.ahrq.gov/web-mm/fatal-oversight-misdiagnosis-nocturnal-chest-pain-elevated-d-dimer
    May 01, 2005 - Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D-dimer. Citation Text: Agusala V, Deen J, Schaefer S. Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D-dimer.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and H…
  18. psnet.ahrq.gov/web-mm/language-barrier
    February 28, 2024 - Language Barrier Citation Text: Flores G. Language Barrier. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
  19. psnet.ahrq.gov/web-mm/breakage-picc-line
    June 21, 2023 - SPOTLIGHT CASE Breakage of a PICC Line Citation Text: Dimov V. Breakage of a PICC Line. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote …
  20. Spotlight Nstemi (pdf file)

    psnet.ahrq.gov/sites/default/files/2020-07/spotlight_nstemi.pdf
    January 01, 2020 - Spotlight The NSTEMI Curbside Consultation Source and Credits • This presentation is based on the July 2020 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Amparo C. Villablanca, MD and Gordon Wong, MD MBA o AHRQ WebM&M Editors …

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