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psnet.ahrq.gov/Information/Panel
January 01, 2012 - Browse Author Resources
Technical Expert Panel The AHRQ PSNet Technical Expert Panel (TEP) is a distinguished group of healthcare professionals and subject matter experts dedicated to enhancing patient safety within the healthcare industry. They represent a diverse array of backgrounds, …
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psnet.ahrq.gov/perspective/conversation-amy-j-starmer-md-mph
May 31, 2023 - In Conversation With… Amy J. Starmer, MD, MPH
April 1, 2016
Citation Text:
In Conversation With… Amy J. Starmer, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
Copy Citation …
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psnet.ahrq.gov/node/865610/psn-pdf
April 24, 2024 - Suicide Prevention in an Emergency Department
Population: ED-SAFE
April 24, 2024
https://psnet.ahrq.gov/innovation/suicide-prevention-emergency-department-population-ed-safe
Summary
Suicide is the 12th leading cause of death in the United States, and the 3rd leading cause of death for
people ages 15-24.1 More tha…
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psnet.ahrq.gov/node/865455/psn-pdf
March 27, 2024 - Communication During Transitions of Care
March 27, 2024
Gurses AP, Sousane Z, Mossburg S. Communication During Transitions of Care. PSNet [internet]. 2024.
https://psnet.ahrq.gov/perspective/communication-during-transitions-care
Introduction
Inaccurate or untimely communication and ineffective teamwork in healthca…
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psnet.ahrq.gov/perspective/conversation-tejal-k-gandhi-md-mph
February 26, 2025 - the hospital, which is really important because there is evidence that many safety and quality issues occur
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psnet.ahrq.gov/node/33686/psn-pdf
August 01, 2009 - discovery—doing your work with a close eye toward what you don't understand, seeing problems as they
occur
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psnet.ahrq.gov/web-mm/fatal-error-neonate-does-just-culture-provide-answer
June 24, 2020 - SPOTLIGHT CASE
Fatal Error in Neonate: Does "Just Culture" Provide an Answer?
Citation Text:
Dekker SWA. Fatal Error in Neonate: Does "Just Culture" Provide an Answer?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2010. …
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psnet.ahrq.gov/perspective/conversation-vineet-arora-md-mapp
May 31, 2023 - But some complications also can occur with IT.
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psnet.ahrq.gov/perspective/conversation-withchristopher-p-landrigan-md
April 01, 2005 - strategies on David Bates' work, where the major goal is to try to tabulate the frequency with which errors occur
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psnet.ahrq.gov/perspective/conversation-mark-chassin-md-mpp-mph
April 26, 2023 - they're focused also on the human–electronic interfaces where a lot of the opportunities for error occur
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psnet.ahrq.gov/node/33791/psn-pdf
September 01, 2015 - But some
complications also can occur with IT.
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psnet.ahrq.gov/node/838222/psn-pdf
September 28, 2022 - The bulk of serious medical mistakes probably occur in acute settings where major
decisions have to
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psnet.ahrq.gov/perspective/introducing-new-ahrq-webmm-and-ahrq-patient-safety-network-psnet
April 01, 2005 - strategies on David Bates' work, where the major goal is to try to tabulate the frequency with which errors occur
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psnet.ahrq.gov/node/836850/psn-pdf
March 31, 2022 - Errors occur when pump users bypass
the programmed dosage or infusion rates or the drug library.
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psnet.ahrq.gov/web-mm/intubation-mishap
April 26, 2023 - Safety culture and priorities
Reactive culture (eg, address problems only when they occur
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psnet.ahrq.gov/web-mm/adolescent-diabetes-routine-visit
November 18, 2016 - T1DM are overweight or obese.( 13 ) Ketosis and ketoacidosis are more common in patients with T1DM but occur
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psnet.ahrq.gov/node/867651/psn-pdf
February 26, 2025 - it loses the opportunity to consider the majority of
cases in which expected and desired outcomes occur
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psnet.ahrq.gov/web-mm/need-eat
February 10, 2021 - acute care until overt symptoms, such a pressure ulcers, significant weight loss or failure to thrive occur
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psnet.ahrq.gov/node/50755/psn-pdf
December 18, 2019 - acute care until overt symptoms, such a pressure ulcers,
significant weight loss or failure to thrive occur
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psnet.ahrq.gov/innovation/hospital-homesm-care-reduces-costs-readmissions-and-complications-and-enhances
November 15, 2023 - 23 to 63percent depending on the age range in question (not surprisingly, larger declines tended to occur