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3921. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60167/psn-pdf
      April 12, 2024 - Discharge Planning and Transitions of Care March 25, 2020 Bajorek SA, McElroy V. Discharge Planning and Transitions of Care. PSNet [internet]. 2020. https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care Background Transitions of care refer to the movement of patients between different healthcare se…

3922. CE/MOC Quizzes | PSNet
      psnet.ahrq.gov/cme
      February 26, 2025 - Misdiagnosis of Small Bowel Obstruction in the Setting of Previous Abdominal Operations A man with a history of prior umbilical hernia repair presented to the emergency department (ED) with abdominal pain and was initially diagnosed with cholelithiasis before being discharged home. However, the next day he returned to …

3923. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/850450/psn-pdf
      June 14, 2023 - The One That Got Away—Elopement of a Suicidal Patient in the Emergency Department. June 14, 2023 Bourgeois JA, Xiong G, Barnes DK, et al. The One That Got Away—Elopement of a Suicidal Patient in the Emergency Department. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/one-got-away-elopement-suicidal-patient-…

3924. Annual Perspective: Psychological Safety of Healthcare Staff | PSNet
      psnet.ahrq.gov/perspective/annual-perspective-psychological-safety-healthcare-staff
      November 16, 2022 - Annual Perspective Annual Perspective: Psychological Safety of Healthcare Staff March 31, 2022  View more articles from the same authors. Citation Text: Kingston MB, Dowell P, Mossburg SE, et al. Annual Perspective: Psychological Safety of Healthcare Staff. P…

3925. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/846171/psn-pdf
      July 26, 2022 - Agitated Delirium Contributes to Missed Testing and Delayed Diagnosis of Gastric Perforation March 15, 2023 Trask J, Carlsen KM, Kuhn BT. Agitated Delirium Contributes to Missed Testing and Delayed Diagnosis of Gastric Perforation. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/agitated-delirium-contributes…

3926. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49688/psn-pdf
      August 21, 2013 - Discharge Instructions in the PACU: Who Remembers? August 21, 2013 Engel KG. Discharge Instructions in the PACU: Who Remembers? PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/discharge-instructions-pacu-who-remembers The Case A 42-year-old woman was diagnosed with a torn anterior cruciate ligament (ACL) in …

3927. Nonsustained Ventricular Tachycardia After Acute Coronary Syndromes: Recognizing High-Risk Patients | PSNet
      psnet.ahrq.gov/web-mm/nonsustained-ventricular-tachycardia-after-acute-coronary-syndromes-recognizing-high-risk
      September 20, 2011 - Nonsustained Ventricular Tachycardia After Acute Coronary Syndromes: Recognizing High-Risk Patients Citation Text: Piccini JP, Newby KL, Califf R. Nonsustained Ventricular Tachycardia After Acute Coronary Syndromes: Recognizing High-Risk Patients. PSNet [internet]. Rockville (MD): Agency for Healthcare Rese…

3928. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49711/psn-pdf
      June 01, 2014 - Wandering Off the Floors: Safety and Security Risks of Patient Wandering June 1, 2014 Smith TA. Wandering Off the Floors: Safety and Security Risks of Patient Wandering. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/wandering-floors-safety-and-security-risks-patient-wandering Case Objectives Define patie…

3929. Microsoft PowerPoint - FINAL Spotlight Case_Medication Error During Procedural Sedation in the Pediatric ED_03.27.2023.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2023-04/april_2023_spotlight_the_dose_makes_the_poison.pdf
      January 01, 2023 - Microsoft PowerPoint - FINAL Spotlight Case_Medication Error During Procedural Sedation in the Pediatric ED_03.27.2023.pptx Spotlight The Dose Makes the Poison: Medication Error During Procedural Sedation in the Pediatric Emergency Department Source and Credits • This presentation is based on the April 2023 AH…

3930. Healthcare failure mode and effect analysis (HFMEA) as an effective mechanism in preventing infection caused by accompanying caregivers during COVID-19-experience of a city medical center in Taiwan. | PSNet
      psnet.ahrq.gov/issue/healthcare-failure-mode-and-effect-analysis-hfmea-effective-mechanism-preventing-infection
      April 05, 2023 - October 14, 2020 Expanding frontiers of risk management: care safety in nursing home

3931. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866217/psn-pdf
      July 10, 2024 - In Conversation With...Amy Helwig about Health Plan Patient Safety Initiatives July 10, 2024 Helwig A, Sousane Z, Mossburg S. In Conversation With..Amy Helwig about Health Plan Patient Safety Initiatives. PSNet [internet]. 2024. https://psnet.ahrq.gov/perspective/conversation-withamy-helwig-about-health-plan-patie…

3932. When the Meds Don’t Reach the Bed | PSNet
      psnet.ahrq.gov/web-mm/when-meds-dont-reach-bed
      May 16, 2022 - When the Meds Don’t Reach the Bed Citation Text: Molla M, Le K, Mendoza P. When the Meds Don’t Reach the Bed. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Format: Google Scholar BibTeX EndNote X3 X…

3933. Empty Handoff | PSNet
      psnet.ahrq.gov/web-mm/empty-handoff
      August 01, 2017 - Empty Handoff Citation Text: Goldman A, Catchpole K. Empty Handoff. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId R…

3934. Eptifibatide Epilogue | PSNet
      psnet.ahrq.gov/web-mm/eptifibatide-epilogue
      March 04, 2011 - Eptifibatide Epilogue Citation Text: Churchill WW, Fiumara K. Eptifibatide Epilogue. 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 …

3935. An Ounce of Prevention | PSNet
      psnet.ahrq.gov/web-mm/ounce-prevention
      February 17, 2011 - SPOTLIGHT CASE An Ounce of Prevention Citation Text: Kucher N. An Ounce of Prevention. 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…

3936. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49482/psn-pdf
      May 01, 2005 - Pregnant With Danger May 1, 2005 Pearlman MD, Desmond JS. Pregnant With Danger. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/pregnant-danger The Case A 35-year-old woman, 38 weeks pregnant, presented to the emergency department (ED) in the middle of the night complaining of left leg pain. She also had so…

3937. Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care. | PSNet
      psnet.ahrq.gov/issue/safety-implications-remote-assessments-suspected-covid-19-qualitative-study-uk-primary-care
      July 08, 2020 - Study Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care. Citation Text: Wieringa S, Neves AL, Rushforth A, et al. Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care. BMJ Qual Saf. 202…

3938. Handling polypharmacy--a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. | PSNet
      psnet.ahrq.gov/issue/handling-polypharmacy-qualitative-study-using-focus-group-interviews-older-patients-their
      August 03, 2022 - Study Handling polypharmacy--a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. Citation Text: Mikkelsen TH, Søndergaard J, Kjaer NK, et al. Handling polypharmacy –a qualitative study using focus group interviews with olde…

3939. Influence of the Comprehensive Unit-based Safety Program in ICUs: evidence from the Keystone ICU project. | PSNet
      psnet.ahrq.gov/issue/influence-comprehensive-unit-based-safety-program-icus-evidence-keystone-icu-project
      January 22, 2016 - Study Influence of the Comprehensive Unit-based Safety Program in ICUs: evidence from the Keystone ICU project. Citation Text: Hsu Y-J, Marsteller JA. Influence of the Comprehensive Unit-based Safety Program in ICUs: Evidence From the Keystone ICU Project. Am J Med Qual. 2016;31(4):349-3…

3940. Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review. | PSNet
      psnet.ahrq.gov/issue/effectiveness-and-safety-pulse-oximetry-remote-patient-monitoring-patients-covid-19
      October 05, 2022 - Review Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review. Citation Text: Alboksmaty A, Beaney T, Elkin S, et al. Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a syste…