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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49592/psn-pdf
    October 01, 2009 - Danger in Disruption October 1, 2009 Fontaine DK. Danger in Disruption. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/danger-disruption The Case A 23-month-old toddler was severely dehydrated after vomiting due to gastric outlet obstruction. She had metabolic alkalosis (pH = 7.58), and her last peripheral…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49607/psn-pdf
    August 01, 2010 - Missed Patient Assignment: Is Anyone There? August 1, 2010 Sittig DF, Campbell EM, Singh H. Missed Patient Assignment: Is Anyone There? PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/missed-patient-assignment-anyone-there The Case In one hospital, nurses' patient assignments were communicated by listing the…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49823/psn-pdf
    March 01, 2018 - Shortcuts to Acetaminophen-induced Liver Failure March 1, 2018 Bacak S, Thornburg L. Shortcuts to Acetaminophen-induced Liver Failure. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/shortcuts-acetaminophen-induced-liver-failure The Case An 18-year-old woman, 27 weeks pregnant, presented to the emergency dep…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33624/psn-pdf
    December 01, 2005 - In Conversation with…Troyen A. Brennan, MD, JD, MPH December 1, 2005 In Conversation with…Troyen A. Brennan, MD, JD, MPH. PSNet [internet]. 2005. https://psnet.ahrq.gov/perspective/conversation-withtroyen-brennan-md-jd-mph Dr. Robert Wachter, Editor, AHRQ WebM&M: What got you interested in the law and its interface…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49725/psn-pdf
    January 01, 2015 - Haste Makes Care Unsafe January 1, 2015 Eichhorn JH. Haste Makes Care Unsafe. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/haste-makes-care-unsafe The Case An 80-year-old man with a history of coronary artery disease and atrial fibrillation underwent a combined elective coronary artery bypass graft (CABG…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73999/psn-pdf
    October 27, 2021 - To Dilute or Not Dilute: Drug Errors and Consequences in the Operating Room October 27, 2021 Aldwinckle R, Florendo E. To Dilute or Not Dilute: Drug Errors and Consequences in the Operating Room. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/dilute-or-not-dilute-drug-errors-and-consequences-operating-room …
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49674/psn-pdf
    December 01, 2012 - Preventing PICC Complications: Whose Line Is It? December 1, 2012 Moureau N. Preventing PICC Complications: Whose Line Is It? PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/preventing-picc-complications-whose-line-it The Case A 55-year-old woman with myasthenia gravis, hypertension, and hypothyroidism prese…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73515/psn-pdf
    August 01, 2022 - Missouri Quality Initiative (MOQI) Reduces Hospitalizations Among Nursing Home Residents July 28, 2021 https://psnet.ahrq.gov/innovation/missouri-quality-initiative-moqi-reduces-hospitalizations-among-nursing- home-residents Summary The MOQI seeks to reduce avoidable hospitalization among nursing home residents b…
  9. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.317_slideshow.ppt
    March 01, 2014 - PowerPoint Presentation Spotlight Case Tough Call: Addressing Errors From Previous Providers 1 This presentation is based on the March 2014 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: William Martinez, MD, MS, Assistant Professor of Medicine, …
  10. psnet.ahrq.gov/web-mm/dangerous-dapsone
    January 10, 2011 - Dangerous Dapsone Citation Text: Bookwalter T. Dangerous Dapsone. 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…
  11. psnet.ahrq.gov/web-mm/not-all-headaches-are-due-migraine-red-flags-dont-miss-diagnoses-and-diagnostic-pitfalls
    February 17, 2021 - Not All Headaches are Due to Migraine: Red Flags, Don’t Miss Diagnoses, and Diagnostic Pitfalls Citation Text: Olson APJ. Not All Headaches are Due to Migraine: Red Flags, Don’t Miss Diagnoses, and Diagnostic Pitfalls. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Departme…
  12. psnet.ahrq.gov/web-mm/workaround-error
    October 30, 2024 - Workaround Error Citation Text: Pape T. Workaround Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
  13. psnet.ahrq.gov/web-mm/untimely-end-despite-end-life-care-planning
    February 01, 2012 - An Untimely End Despite End-of-Life Care Planning Citation Text: Elia G, Barbour S, Anderson WG. An Untimely End Despite End-of-Life Care Planning. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: …
  14. psnet.ahrq.gov/web-mm/hospital-admission-due-high-dose-methotrexate-drug-interaction
    October 01, 2003 - Hospital Admission Due to High-Dose Methotrexate Drug Interaction Citation Text: Siegel LC, Gandhi TK. Hospital Admission Due to High-Dose Methotrexate Drug Interaction. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Cit…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49703/psn-pdf
    March 01, 2014 - After-Visit Confusion March 1, 2014 Ventres W. After-Visit Confusion. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/after-visit-confusion The Case An otherwise healthy 18-year-old woman presented to an urgent care clinic with new bumps and white spots near her tongue. The patient's mother accompanied her …
  16. psnet.ahrq.gov/web-mm/critical-opportunity-lost
    February 17, 2017 - Critical Opportunity Lost Citation Text: Genzen JR, Signorelli HN. Critical Opportunity Lost. 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 XML EndNote 7 XML…
  17. psnet.ahrq.gov/web-mm/collegiality-vs-competence
    August 28, 2024 - Collegiality vs. Competence Citation Text: Sagin T. Collegiality vs. Competence. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagg…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33626/psn-pdf
    January 01, 2006 - JB: That question—of "fixed" versus "formed" teams—comes up in both aviation and health care. … That's a teamwork question.
  19. psnet.ahrq.gov/perspective/conversation-withj-bryan-sexton-phd-ma
    December 01, 2006 - RW: In the patient satisfaction survey world, the question, "would you recommend this hospital"? … Is there one safety culture, or climate, question that captures all of these individual variables? … And they all answer the question for themselves: Are you going to feel supported socially and emotionally … BS: That's a great question.
  20. psnet.ahrq.gov/perspective/establishing-safety-culture-thinking-small
    December 01, 2006 - RW: In the patient satisfaction survey world, the question, "would you recommend this hospital"? … Is there one safety culture, or climate, question that captures all of these individual variables? … And they all answer the question for themselves: Are you going to feel supported socially and emotionally … BS: That's a great question.

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