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  1. Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong. | PSNet

    psnet.ahrq.gov/web-mm/fecal-contamination-peritoneum-laparoscopic-trocar-injury-routine-operation-goes-wrong
    March 03, 2021 - December 14, 2022 Factors causing variation in World Health Organization surgical

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33728/psn-pdf
    May 01, 2012 - And, we found voluntary reporting picked up no adverse events at that organization.

  3. Back Again | PSNet

    psnet.ahrq.gov/web-mm/back-again
    November 18, 2016 - SPOTLIGHT CASE Back Again Citation Text: Lurie JD. Back Again. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubM…

  4. Hospital-Acquired Diabetic Ketoacidosis. | PSNet

    psnet.ahrq.gov/web-mm/hospital-acquired-diabetic-ketoacidosis
    October 28, 2020 - Hospital-Acquired Diabetic Ketoacidosis. Citation Text: Zuidema D, Bagley B, Tan CL. Hospital-Acquired Diabetic Ketoacidosis.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: Google Scholar Bi…

  5. Palliative Care: Comfort vs. Harm | PSNet

    psnet.ahrq.gov/web-mm/palliative-care-comfort-vs-harm
    December 04, 2016 - SPOTLIGHT CASE Palliative Care: Comfort vs. Harm Citation Text: Jox RJ. Palliative Care: Comfort vs. Harm. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibTeX EndN…

  6. Dissecting the Presentation | PSNet

    psnet.ahrq.gov/web-mm/dissecting-presentation
    May 05, 2021 - SPOTLIGHT CASE Dissecting the Presentation Citation Text: Suat-Ooi SB. Dissecting the Presentation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3 …

  7. Delayed Diagnosis of Mesenteric Ischemia | PSNet

    psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia
    March 31, 2021 - SPOTLIGHT CASE Delayed Diagnosis of Mesenteric Ischemia Citation Text: Robles A, Utter GH. Delayed Diagnosis of Mesenteric Ischemia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022. Copy Citation Format: …

  8. All in the History | PSNet

    psnet.ahrq.gov/web-mm/all-history
    February 28, 2011 - SPOTLIGHT CASE All in the History Citation Text: Fee C. All in the History. 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 Endnot…

  9. A Cognitive and Communication Blind Spot Contributes to Permanent Paralysis | PSNet

    psnet.ahrq.gov/web-mm/cognitive-and-communication-blind-spot-contributes-permanent-paralysis
    January 13, 2010 - SPOTLIGHT CASE A Cognitive and Communication Blind Spot Contributes to Permanent Paralysis Citation Text: Utter GH. A Cognitive and Communication Blind Spot Contributes to Permanent Paralysis. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health an…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837963/psn-pdf
    August 31, 2022 - Delayed Diagnosis of Mesenteric Ischemia August 31, 2022 Robles A, Utter GH. Delayed Diagnosis of Mesenteric Ischemia. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia Disclosure of Relevant Financial Relationships: As a provider accredited by the Accreditation Council for…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49721/psn-pdf
    December 01, 2014 - Ebola: Are We Ready? December 1, 2014 Barsuk JH, Barnard C. Ebola: Are We Ready? PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/ebola-are-we-ready The Case A 28-year-old man, well-appearing but pale, walked into the emergency department (ED) on a Wednesday afternoon at 3 PM complaining of nausea, vomiting,…

  12. 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-…

  13. Microsoft PowerPoint - Spotlight Case_Agitated Delirium_FINAL.pptx (pdf file)

    psnet.ahrq.gov/sites/default/files/2023-03/march_2023_spotlight_agitated_delirium.pdf
    January 01, 2023 - Microsoft PowerPoint - Spotlight Case_Agitated Delirium_FINAL.pptx Spotlight Agitated Delirium Contributes to Missed Testing and Delayed Diagnosis of Gastric Perforation Source and Credits • This presentation is based on the March 2023 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33855/psn-pdf
    April 01, 2018 - In Conversation With… Harlan Krumholz, MD, SM April 1, 2018 In Conversation With… Harlan Krumholz, MD, SM. PSNet [internet]. 2018. https://psnet.ahrq.gov/perspective/conversation-harlan-krumholz-md-sm Editor's note: Dr. Krumholz, Harold H. Hines, Jr. Professor of Medicine at the Yale School of Medicine and Directo…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33708/psn-pdf
    March 01, 2011 - In Conversation with…Vineet Arora, MD, MA March 1, 2011 In Conversation with…Vineet Arora, MD, MA . PSNet [internet]. 2011. https://psnet.ahrq.gov/perspective/conversation-withvineet-arora-md-ma Editor's note: Vineet Arora, MD, MA, is Associate Program Director for the Internal Medicine Residency and Assistant Dea…

  16. CA-MRSA Skin Infections: An Ounce of Prevention is Worth a Pound of Cure | PSNet

    psnet.ahrq.gov/web-mm/ca-mrsa-skin-infections-ounce-prevention-worth-pound-cure
    March 01, 2005 - SPOTLIGHT CASE CA-MRSA Skin Infections: An Ounce of Prevention is Worth a Pound of Cure Citation Text: Liu C. CA-MRSA Skin Infections: An Ounce of Prevention is Worth a Pound of Cure. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human S…

  17. Delayed Diagnosis of Endocrinologic Emergencies | PSNet

    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. Copy Citation Format: Google …

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60856/psn-pdf
    August 26, 2020 - Too Many Cooks in the Kitchen August 26, 2020 Dutton RP. Too Many Cooks in the Kitchen. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/too-many-cooks-kitchen Disclosure of Relevant Financial Relationships: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Un…

  19. Patient Safety in Frail Older Patients | PSNet

    psnet.ahrq.gov/perspective/patient-safety-frail-older-patients
    November 26, 2019 - Related Resources Perspective High Reliability Organization

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60858/psn-pdf
    August 26, 2020 - days, and over two-thirds of those readmissions were medication-related.6 In 2017, the World Health Organization
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