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  1. Timely diagnosis of esophageal perforation | PSNet

    psnet.ahrq.gov/web-mm/timely-diagnosis-esophageal-perforation
    September 27, 2023 - Successful implementation of standardized multidisciplinary bedside rounds, including daily goals, in a pediatric

  2. EMS Patient Safety in the Field | PSNet

    psnet.ahrq.gov/perspective/ems-patient-safety-field
    July 28, 2021 - this country, we have seen the development of excellent regional programs for strokes, trauma, burns, pediatric … 26, 2021 Ambulance personnel perceptions of near misses and adverse events in pediatric

  3. PowerPoint Presentation (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.434_slideshow.ppt
    February 01, 2018 - PowerPoint Presentation Spotlight Signout Fallout 1 Source and Credits This presentation is based on the February 2018 AHRQ WebM&M Spotlight Case See the full article at https://psnet.ahrq.gov/webmm CME credit is available Commentary by: Amy J. Starmer, MD, MPH, and Christopher P. Landrigan, MD, MPH, Harvard M…

  4. Spotlight Case July 2008 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.290_slideshow.ppt
    February 01, 2013 - Spotlight Case July 2008 Spotlight Case Delay in Treatment: Failure to Contact Patient Leads to Significant Complications * * Source and Credits This presentation is based on the February 2013 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: …

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836812/psn-pdf
    March 30, 2022 - Strategies and Approaches for Investigating Patient Safety Events March 30, 2022 Shaikh U. Strategies and Approaches for Investigating Patient Safety Events. PSNet [internet]. 2022. https://psnet.ahrq.gov/primer/strategies-and-approaches-investigating-patient-safety-events Background This primer provides a broad …

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33852/psn-pdf
    January 01, 2017 - Patient Engagement in Safety January 1, 2017 Stern RJ, Sarkar U. Patient Engagement in Safety. PSNet [internet]. 2017. https://psnet.ahrq.gov/perspective/patient-engagement-safety Annual Perspective 2017 Background In the past 2 decades, patient engagement in safety has evolved from obscurity to maturity. The Ins…

  7. Diagnostic Errors | PSNet

    psnet.ahrq.gov/primer/diagnostic-errors
    June 15, 2024 - Diagnostic Errors Citation Text: Diagnostic Errors. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Dow…

  8. Suicidal Ideation in the Family Medicine Clinic | PSNet

    psnet.ahrq.gov/web-mm/suicidal-ideation-family-medicine-clinic
    October 01, 2007 - SPOTLIGHT CASE Suicidal Ideation in the Family Medicine Clinic Citation Text: Moutier C. Suicidal Ideation in the Family Medicine Clinic. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: …

  9. Microsoft PowerPoint - Spotlight Case_The Risks of a Malpositioned Gastrostomy Tube_FINAL.pptx (pdf file)

    psnet.ahrq.gov/sites/default/files/2023-11/spotlight_case_the_risk_of_malpositioned.pdf
    January 01, 2023 - Microsoft PowerPoint - Spotlight Case_The Risks of a Malpositioned Gastrostomy Tube_FINAL.pptx Spotlight The Risks of a Malpositioned Gastrostomy Tube and Poor Communication Source and Credits • This presentation is based on the November 2023 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahr…

  10. The Risks of a Malpositioned Gastrostomy Tube and Poor Communication | PSNet

    psnet.ahrq.gov/web-mm/risks-malpositioned-gastrostomy-tube-and-poor-communication
    August 01, 2012 - SPOTLIGHT CASE The Risks of a Malpositioned Gastrostomy Tube and Poor Communication Citation Text: Hight RA. The Risks of a Malpositioned Gastrostomy Tube and Poor Communication. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Servic…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867672/psn-pdf
    February 26, 2025 - increased from 3.9% to 37.8% between 1997 and 2016.3 There are circumstances, such as those involving pediatric

  12. Spotlight Case September 2003 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.29_slideshow.ppt
    September 01, 2003 - Spotlight Case September 2003 Spotlight Case September 2003 Infant Paralyzed for Intubation Before Airway Materials Ready Source and Credits This presentation is based on the Sept. 2003 AHRQ WebM&M Spotlight Case in Pediatrics See the full article at http://webmm.ahrq.gov CME credit is available through the …

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49410/psn-pdf
    July 01, 2003 - A Little Shuteye July 1, 2003 Farion KJ. A Little Shuteye. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/little-shuteye The Case A 3-year-old boy was seen in urgent care for a superficial laceration above the left eyebrow. The pediatrician had heard of the availability of topical skin adhesive that can be…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49412/psn-pdf
    September 01, 2003 - Shake Well September 1, 2003 Flynn EA. Shake Well. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/shake-well The Case A 35-year-old patient on the neurology service was receiving carbamazepine for a seizure disorder. Daily serum drug levels consistently fell below the therapeutic range, which led the physi…

  15. Spotlight Case [MONTH] 2003 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.64_slideshow.ppt
    June 01, 2004 - Spotlight Case [MONTH] 2003 Spotlight Case June 2004 The Wrong Shot: Error Disclosure Source and Credits This presentation is based on the June 2004 AHRQ WebM&M Spotlight Case in Pediatrics CME credit is available through the Web site See the full article at http://webmm.ahrq.gov Commentary by: Thomas H. …

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73106/psn-pdf
    April 01, 2021 - Strategies and Approaches for Tracking Improvements in Patient Safety April 1, 2021 Shaikh U. Strategies and Approaches for Tracking Improvements in Patient Safety . PSNet [internet]. 2021. https://psnet.ahrq.gov/primer/strategies-and-approaches-tracking-improvements-patient-safety Background An essential aspect …

  17. Critical Opportunity Lost | PSNet

    psnet.ahrq.gov/web-mm/critical-opportunity-lost
    February 17, 2017 - September 23, 2020 Discrepancies between prescribed and actual pediatric home parenteral

  18. Think Like a Surgeon | PSNet

    psnet.ahrq.gov/web-mm/think-surgeon
    December 04, 2024 - June 12, 2019 Optimizing Pediatric Patient Safety in the Emergency Care Setting.

  19. Spotlight Case July 2008 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.296_slideshow.ppt
    April 01, 2013 - dedicate pharmacist time to review or clarify PN orders When knowledgeable pharmacists are involved, pediatric

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49776/psn-pdf
    November 01, 2016 - recently performed site visits and a qualitative analysis of 23 family medicine, internal medicine, and pediatric
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