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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61120/psn-pdf
    November 11, 2020 - Application of human factors methods to understand missed follow-up of abnormal test results. November 11, 2020 Rogith D, Satterly T, Singh H, et al. Application of human factors methods to understand missed follow-up of abnormal test results. Appl Clin Inform. 2020;11(05):692-698. doi:10.1055/s-0040-1716537. http…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866733/psn-pdf
    September 18, 2024 - A coproduced family reporting intervention to improve safety surveillance and reduce disparities. September 18, 2024 Khan A, Baird JD, Mauskar S, et al. A coproduced family reporting intervention to improve safety surveillance and reduce disparities. Pediatrics. 2024;154(4):e2023065245. doi:10.1542/peds.2023-065245…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/857581/psn-pdf
    January 01, 2025 - Medicare and Medicaid Programs and the Children’s Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long- Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes. Au…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837208/psn-pdf
    May 25, 2022 - Interprofessional model on speaking up behaviour in healthcare professionals: a qualitative study. May 25, 2022 Umoren R, Kim S, Gray MM, et al. Interprofessional model on speaking up behaviour in healthcare professionals: a qualitative study. BMJ Lead. 2022;6(1):15-19. doi:10.1136/leader-2020-000407. https://psne…
  5. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.110_slideshow.ppt
    December 01, 2005 - Spotlight Case [MONTH] 2003 Spotlight Case December 2005 Low on the Totem Pole Source and Credits This presentation is based on the Dec. 2005 Spotlight Case in Surgery/Anesthesia See the full article at http://webmm.ahrq.gov CME credit is available through the Web site Commentary by: Robert Wachter, MD, …
  6. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.218_slideshow.ppt
    May 01, 2010 - Spotlight Case [MONTH] 2003 Spotlight Case Fatal Error in Neonate: Does ‘Just Culture’ Provide an Answer? * * Source and Credits This presentation is based on the May 2010 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Sidney W.A. Dekker, Ph…
  7. psnet.ahrq.gov/curated-library/opioid-stewardship
    December 15, 2024 - Breadcrumb Home The PSNet Collection Curated Libraries Subscribed Opioid Stewardship  Download  Share Facebook Twitter Linkedin Copy URL Subscribe Created By: AHRQ Date Created: January 24, 2025 …
  8. psnet.ahrq.gov/print/pdf/node/867659
    July 10, 2024 - PSNet Curated Library AHRQ: Agency for Healthcare Research and Quality Rapid Response Systems Curated Library Primers Rapid Response Systems UC Davis PSNet Editorial Team | September, 15 2024 Rapid response teams represent an intuitively simple concept: when a patient demonstrates signs of imminent clinical de…
  9. psnet.ahrq.gov/web-mm/lap-burn
    March 01, 2018 - Lap Burn Citation Text: Ball K. Lap Burn. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download Cita…
  10. psnet.ahrq.gov/sites/default/files/2020-09/final_slides_sept_spotlight_case_when_the_lytes_go_out_slides_08.25.2020-revised.pdf
    January 01, 2020 - Microsoft PowerPoint - FINAL SLIDES Sept_Spotlight Case_When the Lytes Go Out_SLIDES_08.25.2020-revised.pptx Spotlight When the Lytes Go Out: A Case of Inpatient Cardiac Arrest Source and Credits • This presentation is based on the September 2020 AHRQ WebM&M Spotlight Case o See the full article at https://psne…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49488/psn-pdf
    August 21, 2005 - PCA Overdose August 21, 2005 Doyle JD. PCA Overdose. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/pca-overdose The Case A 49-year-old woman underwent an uneventful total abdominal hysterectomy bilateral salpingo- oophorectomy. Postoperatively, the patient complained of severe pain and received intravenou…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49514/psn-pdf
    July 01, 2006 - One ACE Too Many July 1, 2006 Juurlink DN. One ACE Too Many. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/one-ace-too-many The Case A 72-year-old man with coronary artery disease, diabetes, and recently diagnosed congestive heart failure presented to the emergency department (ED) with chest pain. An acut…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49716/psn-pdf
    August 21, 2014 - Benefits vs. Risks of Intraosseous Vascular Access August 21, 2014 Fowler RL, Lippmann MJ. Benefits vs. Risks of Intraosseous Vascular Access. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/benefits-vs-risks-intraosseous-vascular-access The Case A 72-year-old woman with a history of asthma, congestive heart…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33747/psn-pdf
    March 01, 2013 - The Literature on Health Care Simulation Education: What Does It Show? March 1, 2013 Cook DA. The Literature on Health Care Simulation Education: What Does It Show? PSNet [internet]. 2013. https://psnet.ahrq.gov/perspective/literature-health-care-simulation-education-what-does-it-show Perspective The education o…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49701/psn-pdf
    February 01, 2014 - An Easily Forgotten Tube February 1, 2014 Ousey K. An Easily Forgotten Tube. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/easily-forgotten-tube The Case A 45-year-old man was admitted to the intensive care unit (ICU) for acute liver failure secondary to alcohol abuse. His illness was complicated by acute…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49435/psn-pdf
    February 01, 2004 - X-ray Flip February 1, 2004 Shapiro MJ. X-ray Flip. PSNet [internet]. 2004. https://psnet.ahrq.gov/web-mm/x-ray-flip The Case A 19-year-old man presented to the emergency department with respiratory distress after blunt chest trauma. A digital chest radiograph was labeled backwards; a "left" marker was mistakenly…
  17. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.314_slideshow.ppt
    February 01, 2014 - PowerPoint Presentation Spotlight Case Multifactorial Medication Mishap 1 This presentation is based on the February 2014 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Annie Yang, PharmD, BCPS NYU Langone Medical Center Editor, AHRQ WebM&M: Robe…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49590/psn-pdf
    January 01, 2010 - Is the Admission Drug Dose Too Low? August 1, 2009 Kaushal R, Abramson EL. Is the Admission Drug Dose Too Low? PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/admission-drug-dose-too-low The Case A 72-year-old man with a long history of chronic obstructive pulmonary disease (COPD) was admitted to the hospit…
  19. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.230_slideshow.ppt
    December 01, 2010 - Spotlight Case July 2008 Spotlight Case The Forgotten Turn * * Source and Credits This presentation is based on the December 2010 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Susan Barbour, RN, FNP, University of California San Francisco …
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49387/psn-pdf
    February 01, 2003 - Patient Mix-Up February 1, 2003 Shojania KG. Patient Mix-Up. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/patient-mix The Case Joe Smith [not his real name], a 42-year-old man with nausea and vomiting for 4 days, was on the general medical service at an academic medical center. Overnight, another man wit…

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