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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60348/psn-pdf
    May 20, 2020 - High-priority drug-drug interaction clinical decision support overrides in a newly implemented commercial computerized provider order-entry system: override appropriateness and adverse drug events. May 20, 2020 Edrees H, Amato MG, Wong A, et al. High-priority drug-drug interaction clinical decision support overrid…

  2. Introduction to the Case Studies | Agency for Healthcare Research and Quality

    www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-intro.html
    November 01, 2014 - in more rational organizational theories, visions of and goals for something like Lean are viewed as occurring

  3. ParentLink: Better and Safer Emergency Care for Children (pdf file)

    digital.ahrq.gov/sites/default/files/docs/publication/r01hs014947-porter-final-report-2007.pdf
    January 01, 2007 - oral liquid” are all displayed as “oral liquid or suspension” with further product differentiation occurring

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49601/psn-pdf
    April 01, 2010 - Nosy Business April 1, 2010 Orlandi RR. Nosy Business. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/nosy-business The Case   A 59-year-old man with a history of idiopathic thrombocytopenic purpura (ITP) presented to the emergency department (ED) with epistaxis (a "nose bleed"). He reported no previous h…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61080/psn-pdf
    October 28, 2020 - Preventing Complications during Aneurysm Clipping – the Role of Neuromonitoring. October 28, 2020 DeLemos C. Preventing Complications during Aneurysm Clipping – the Role of Neuromonitoring. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/preventing-complications-during-aneurysm-clipping-role-neuromonitoring …

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73549/psn-pdf
    July 28, 2021 - Local Anesthesia-Induced Coma During Total Knee Arthroplasty. July 28, 2021 Aldwinckle R. Local Anesthesia-Induced Coma During Total Knee Arthroplasty. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/local-anesthesia-induced-coma-during-total-knee-arthroplasty The Case A 61-year-old male patient weighing 57…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49851/psn-pdf
    January 01, 2019 - One Bronchoscopy, Two Errors January 1, 2019 Leiten E, Nielsen R. One Bronchoscopy, Two Errors. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/one-bronchoscopy-two-errors The Case A 67-year-old man with a history of hypertension was admitted to the intensive care unit (ICU) with hypoxic respiratory failure…

  8. Section 2: Explanation of Key Concepts and Tools | Agency for Healthcare Research and Quality

    www.ahrq.gov/teamstepps-program/curriculum/communication/tools/index.html
    July 01, 2023 - Section 2: Explanation of Key Concepts and Tools This section contains explanations and illustrations to help you better understand and appreciate the importance of TeamSTEPPS communication concepts and tools. If you teach this content or want additional insights into how the material can be more fully learned,…

  9. Past Research on Patient Perceptions of Safety and Diagnostic Mishaps | Agency for Healthcare Research and Quality

    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol1-3.html
    June 01, 2023 - Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors Past Research on Patient Perceptions of Safety and Diagnostic Mishaps Previous Page Next Page Table of Contents Patient Experience as a Source for Understanding the Origins, Impact, and Remedia…

  10. PowerPoint Presentation (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.338_slideshow.ppt
    January 01, 2015 - PowerPoint Presentation Spotlight Monitoring Fetal Health 1 This presentation is based on the January 2015 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Mark W. Scerbo, PhD, Department of Psychology, Old Dominion University, and Alfred Z. Abuham…

  11. Toxic Tachycardia | PSNet

    psnet.ahrq.gov/web-mm/toxic-tachycardia
    March 01, 2005 - Toxic Tachycardia Citation Text: Wartofsky L. Toxic Tachycardia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49560/psn-pdf
    April 01, 2008 - The Wrongful Resuscitation April 1, 2008 Teno JM. The Wrongful Resuscitation. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/wrongful-resuscitation The Case   An 80-year-old man with diabetes, peripheral vascular disease, bilateral below-the-knee amputations, and poor quality of life had previously been r…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33658/psn-pdf
    October 01, 2007 - In Conversation with...David Marx, JD October 1, 2007 In Conversation with..David Marx, JD. PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/conversation-withdavid-marx-jd Editor's Note: An engineer and an attorney by training, David Marx, JD, is president of Outcome Engineering, a risk management firm. …

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49616/psn-pdf
    December 01, 2010 - Milliliters vs. Milligrams December 1, 2010 Poole RL, Dixon T. Milliliters vs. Milligrams. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/milliliters-vs-milligrams The Case   A 32-year-old man was admitted to the hospital after a vehicle collision and multiple traumatic injuries. His evaluation showed acu…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49575/psn-pdf
    November 01, 2008 - Sick and Pregnant November 1, 2008 El-Ibiary S. Sick and Pregnant. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/sick-and-pregnant The Case A 35-year-old woman with chronic asthma presented to the emergency department (ED) with difficulty breathing. The patient informed the staff that she was 17 weeks pre…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49396/psn-pdf
    April 01, 2003 - The 2-Week Itch April 1, 2003 Cohen MR. The 2-Week Itch. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/2-week-itch The Case A 40-year-old woman with bipolar disorder (on trazodone) came to her primary care physician with new urticaria. She received a handwritten prescription for Zyrtec and Atarax. The ha…

  17. Periodic Issue | PSNet

    psnet.ahrq.gov/periodic-issue/periodic-issue-473
    March 25, 2025 - March 5, 2025 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, reports, …

  18. AHRQ Webinar: Transforming Guidelines Into Action: Clinical Decision Support at the Point of Care - Q&As (pdf file)

    digital.ahrq.gov/sites/default/files/docs/transforming-guidelines-action-qas-06152023.pdf
    June 15, 2023 - AHRQ Webinar: Transforming Guidelines Into Action: Clinical Decision Support at the Point of Care - Q&As AHRQ National Webin…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/864868/psn-pdf
    March 27, 2024 - Inpatient Transitions of Care: Challenges and Safety Practices March 27, 2024 Satake A, McElroy V. Inpatient Transitions of Care: Challenges and Safety Practices. PSNet [internet]. 2024. https://psnet.ahrq.gov/primer/inpatient-transitions-care-challenges-and-safety-practices Background Transitions of care occur …

  20. Timely diagnosis of esophageal perforation | PSNet

    psnet.ahrq.gov/web-mm/timely-diagnosis-esophageal-perforation
    September 27, 2023 - Timely diagnosis of esophageal perforation Citation Text: Utter GH, Cooke DT. Timely diagnosis of esophageal perforation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Format: Google Scholar BibTeX …
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