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psnet.ahrq.gov/node/853443/psn-pdf
September 13, 2023 - Complications and Errors in Periodontal and Implant
Therapy.
September 13, 2023
Zucchelli G, Stefanini M, eds. Periodontol 2000. 2023;92(1):1-398.
https://psnet.ahrq.gov/issue/complications-and-errors-periodontal-and-implant-therapy
Patient safety in dentistry shares common challenges with medicine and t…
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psnet.ahrq.gov/node/837862/psn-pdf
August 17, 2022 - A California man’s ‘painful and terrifying’ road to a
Monkeypox diagnosis.
August 17, 2022
Fortiér J. Kaiser Health News. August 4, 2022.
https://psnet.ahrq.gov/issue/california-mans-painful-and-terrifying-road-monkeypox-diagnosis
Lack of familiarity with disease is known to contribute to missed and delayed diagno…
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psnet.ahrq.gov/node/851365/psn-pdf
July 27, 2023 - Advancing Diagnostic Excellence in Maternal Health Care.
July 27, 2023
Board on Health Care Services, National Academies of Science, Engineering, and Medicine. Irvine,
CA: Arnold and Mabel Beckman Center: 2021-2023.
https://psnet.ahrq.gov/issue/advancing-diagnostic-excellence-maternal-health-care
These …
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psnet.ahrq.gov/node/34618/psn-pdf
July 28, 2013 - National Survey on Consumers' Experiences With Patient
Safety and Quality Information.
July 28, 2013
Washington DC: Kaiser Family Foundation, Agency for Healthcare Research and Quality, Harvard School
of Public Health; 2004.
https://psnet.ahrq.gov/issue/national-survey-consumers-experiences-patient-safety-and-qual…
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psnet.ahrq.gov/node/44978/psn-pdf
June 01, 2016 - Josie's Story: A Patient Safety Curriculum.
June 1, 2016
Kaprielian VS, Sullivan DT, eds. Chapel Hill, NC: Josie King Foundation; Duke University School of
Medicine; 2013.
https://psnet.ahrq.gov/issue/josies-story-patient-safety-curriculum
The experience of Sorrel King and the death of her daughter has motivated h…
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psnet.ahrq.gov/node/35858/psn-pdf
July 22, 2010 - How long and how much are nurses now working?
July 22, 2010
Trinkoff AM, Geiger-Brown J, Brady B, et al. How long and how much are nurses now working? Am J Nurs.
2006;106(4):60-72.
https://psnet.ahrq.gov/issue/how-long-and-how-much-are-nurses-now-working
The authors analyzed results from a national survey and foun…
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psnet.ahrq.gov/node/34785/psn-pdf
February 18, 2011 - Diseases of medical progress.
February 18, 2011
MOSER RH. Diseases of medical progress. N Engl J Med. 1956;255(13):606-14.
https://psnet.ahrq.gov/issue/diseases-medical-progress
This review shares a perspective that the history of medicine provides numerous examples of how
emerging illnesses develop from sound the…
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psnet.ahrq.gov/node/74733/psn-pdf
February 02, 2022 - Prep, Stop, Block.
February 2, 2022
RA-UK, the Faculty of Pain Medicine, RCoA Simulation and NHS Improvement
https://psnet.ahrq.gov/issue/prep-stop-block
Standardization is a common strategy for preventing practice deviations that can contribute to harm. This
tool outlines a three-step process for minimizing the o…
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psnet.ahrq.gov/perspective/university-texas-system-clinical-safety-and-effectiveness-course
February 01, 2011 - The University of Texas System Clinical Safety and Effectiveness Course
Eric J. Thomas, MD, MPH; Jan Patterson, MD, MS; Sherry Martin, MEd; Doris Quinn, PhD; Gary Reed, MD; Ken Shine, MD | February 1, 2011
View more articles from the same authors.
Citation Text:
T…
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psnet.ahrq.gov/web-mm/cognitive-overload-icu
June 01, 2005 - SPOTLIGHT CASE
Cognitive Overload in the ICU
Citation Text:
Patel VL, Buchman TG. Cognitive Overload in the ICU. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
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psnet.ahrq.gov/web-mm/delayed-diagnosis-endocrinologic-emergencies
November 13, 2024 - Delayed Diagnosis of Endocrinologic Emergencies
Citation Text:
Gomes-Lima C, Burman KD. Delayed Diagnosis of Endocrinologic Emergencies. 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/33862/psn-pdf
July 01, 2018 - In Conversation With… Shantanu Nundy, MD
July 1, 2018
In Conversation With… Shantanu Nundy, MD. PSNet [internet]. 2018.
https://psnet.ahrq.gov/perspective/conversation-shantanu-nundy-md
Editor's note: Dr. Nundy is the Director of the nonprofit organization called the Human Diagnosis Project, a
unique effort to cro…
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psnet.ahrq.gov/node/60329/psn-pdf
May 14, 2020 - In Conversation With... Joel Willis, DO, PA, MA, MPhiL
and Neal Sikka, MD
May 14, 2020
In Conversation With.. Joel Willis, DO, PA, MA, MPhiL and Neal Sikka, MD. PSNet [internet]. 2020.
https://psnet.ahrq.gov/perspective/conversation-joel-willis-do-pa-ma-mphil-and-neal-sikka-md
Editor’s note: Joel Willis, DO, PA, M…
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psnet.ahrq.gov/perspective/conversation-jeffrey-starke-md
September 11, 2023 - In Conversation With… Jeffrey Starke, MD
October 1, 2017
Citation Text:
In Conversation With… Jeffrey Starke, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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February 01, 2010 - In Conversation with…Thomas J. Nasca, MD
February 1, 2010
In Conversation with…Thomas J. Nasca, MD. PSNet [internet]. 2010.
https://psnet.ahrq.gov/perspective/conversation-withthomas-j-nasca-md
Editor's note: Thomas J. Nasca, MD, is the executive director and chief executive officer of the
Accreditation Council fo…
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psnet.ahrq.gov/node/33783/psn-pdf
April 01, 2015 - In Conversation With… Lucian Leape, MD
April 1, 2015
In Conversation With… Lucian Leape, MD. PSNet [internet]. 2015.
https://psnet.ahrq.gov/perspective/conversation-lucian-leape-md
Editor's note: Dr. Lucian Leape is Adjunct Professor of Health Policy at the Harvard School of Public
Health, Chairman of the Lucian …
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psnet.ahrq.gov/print/pdf/node/865308
January 01, 2024 - PSNet
Curated Library
AHRQ: Agency for Healthcare Research and Quality
Organizational Learning
Curated Library
Foundations
Organizational learning: health care leaders need to design structures and processes that enhance
collective learning.
Bohmer RM, Edmondson AC. Health Forum J. 2001;44:32-35.
This comment…
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psnet.ahrq.gov/web-mm/which-line-ordering-provider-or-proceduralist
September 16, 2015 - SPOTLIGHT CASE
Which Line: Ordering Provider or Proceduralist?
Citation Text:
Blackmore CC. Which Line: Ordering Provider or Proceduralist?. 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/webmm-case-studies
March 25, 2025 - WebM&M: Case Studies
WebM&M (Morbidity & Mortality Rounds on the Web) features expert analysis of medical errors reported anonymously by our readers. Spotlight Cases include interactive learning modules available for CME/CPE . Commentaries are written by patient safety experts and published monthly. Have you encou…
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psnet.ahrq.gov/primer/safety-i-safety-ii-and-new-views-safety
October 02, 2024 - Safety I, Safety II, and the New Views of Safety
Citation Text:
Scanlon M, Jacobson N. Safety I, Safety II, and the New Views of Safety. PSNet [internet]. Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025.
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