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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33657/psn-pdf
    September 01, 2007 - Rediscovering the Power of the Surgical M&M Conference: The M+M Matrix September 1, 2007 Gordon LA. Rediscovering the Power of the Surgical M&M Conference: The M+M Matrix. PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/rediscovering-power-surgical-mm-conference-mm-matrix Perspective There is a slumbe…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49496/psn-pdf
    December 01, 2005 - Discharged Blindly December 1, 2005 Iezzoni LI. Discharged Blindly. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/discharged-blindly The Case An elderly blind man developed a deep vein thrombosis during his hospital stay. At discharge, he was to receive enoxaparin (Lovenox) for self-administration at home…
  3. psnet.ahrq.gov/primer/leadership-role-improving-safety
    September 15, 2024 - Leadership Role in Improving Safety Citation Text: Leadership Role in Improving Safety. 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 Endno…
  4. psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors
    March 30, 2022 - Adverse Events, Near Misses, and Errors Citation Text: Adverse Events, Near Misses, and 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 X…
  5. psnet.ahrq.gov/primer/falls
    October 27, 2021 - Falls Citation Text: Falls. 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 Download Citation …
  6. psnet.ahrq.gov/web-mm/consequences-medical-overuse
    May 05, 2021 - SPOTLIGHT CASE Consequences of Medical Overuse Citation Text: Morgan DJ, Foy AJ. Consequences of Medical Overuse. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibT…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49801/psn-pdf
    August 01, 2017 - Despite Clues, Failed to Rescue August 1, 2017 Ghaferi AA. Despite Clues, Failed to Rescue. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/despite-clues-failed-rescue Case Objectives Define failure to rescue. Identify the main contributors to failure-to-rescue events. Appreciate the ongoing areas of scien…
  8. psnet.ahrq.gov/web-mm/spotlight-overdiagnosis-and-delay-challenges-sepsis-diagnosis
    October 28, 2020 - SPOTLIGHT CASE Spotlight: Overdiagnosis and Delay: Challenges in Sepsis Diagnosis Citation Text: Kuye I, Rhee C. Spotlight: Overdiagnosis and Delay: Challenges in Sepsis Diagnosis. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Serv…
  9. 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 …
  10. 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…
  11. 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…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49737/psn-pdf
    June 01, 2015 - Unseen Perils of Urinary Catheters June 1, 2015 Newman DK, Strauss R, Abraham L, et al. Unseen Perils of Urinary Catheters. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/unseen-perils-urinary-catheters The Case A 68-year-old man with a history of hypothyroidism, hypertension, seizures, cerebral vascular at…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49723/psn-pdf
    January 01, 2015 - Monitoring Fetal Health January 1, 2015 Scerbo MW, Abuhamad AZ. Monitoring Fetal Health . PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/monitoring-fetal-health Case Objectives Define fetal heart rate monitoring. Describe the current state of evidence regarding fetal heart rate monitoring. List the known …
  14. psnet.ahrq.gov/web-mm/do-not-disturb
    February 03, 2011 - SPOTLIGHT CASE Do Not Disturb! Citation Text: Duffy DF, Cassel C. Do Not Disturb!. 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…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33748/psn-pdf
    April 01, 2013 - In Conversation With… Christopher P. Landrigan, MD, MPH April 1, 2013 In Conversation With… Christopher P. Landrigan, MD, MPH. PSNet [internet]. 2013. https://psnet.ahrq.gov/perspective/conversation-christopher-p-landrigan-md-mph Editor's note: Christopher P. Landrigan, MD, is Associate Professor of Medicine and …
  16. psnet.ahrq.gov/sites/default/files/2024-10/spotlight_case_delayed_symptomatic_subdural_hematoma_slides.pptx
    January 01, 2024 - Spotlight Spotlight Delayed Symptomatic Subdural Hematoma Following an Initially Normal CT Head 1 Source and Credits This presentation is based on the October 2024 AHRQ WebM&M Spotlight Case See the full article at https://psnet.ahrq.gov/webmm  CME credit is available  Commentary by: Ryan Martin, MD, FCNS and …
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60242/psn-pdf
    March 01, 2021 - Team-Developed Care Plan and Ongoing Care Management by Social Workers and Nurse Practitioners Result in Better Outcomes and Reduced Acute Care Utilization in Low-Income Seniors and other High-Risk Populations Originally published on June 12, 2020 Last updated on January 11, 2021 https://psnet.ahrq.gov/innovatio…
  18. psnet.ahrq.gov/perspective/patient-safety-and-health-information-technology-learning-our-mistakes
    July 01, 2012 - Patient Safety and Health Information Technology: Learning from Our Mistakes Ross Koppel, PhD | July 1, 2012  Also Read a Conversation View more articles from the same authors. Citation Text: Koppel R. Patient Safety and Health Information Technology: Learning f…
  19. psnet.ahrq.gov/perspective/conversation-david-blumenthal-md-mpp
    July 01, 2012 - In Conversation With… David Blumenthal, MD, MPP July 1, 2012  Also Read an Essay Citation Text: In Conversation With… David Blumenthal, MD, MPP. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Service…
  20. psnet.ahrq.gov/perspective/implementing-patient-safety-program-large-national-health-system
    January 01, 2008 - Implementing a Patient Safety Program at a Large National Health System Loran Hauck, MD, and Jan Jacob, MBA, RN | January 1, 2008  Also Read a Conversation View more articles from the same authors. Citation Text: Hauck LD, Jacob J. Implementing a Patient Safety …

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