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psnet.ahrq.gov/node/49502/psn-pdf
February 01, 2006 - Deciphering the Code
February 1, 2006
Goldstein MK. Deciphering the Code. PSNet [internet]. 2006.
https://psnet.ahrq.gov/web-mm/deciphering-code
The Case
An 85-year-old man with advanced oxygen-dependent chronic obstructive pulmonary disease (COPD)
presented to the emergency department (ED) with increasing shortn…
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psnet.ahrq.gov/primer/individual-clinician-performance-issues
March 15, 2025 - Individual Clinician Performance Issues
Citation Text:
Individual Clinician Performance Issues. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/node/60167/psn-pdf
April 12, 2024 - Discharge Planning and Transitions of Care
March 25, 2020
Bajorek SA, McElroy V. Discharge Planning and Transitions of Care. PSNet [internet]. 2020.
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
Background
Transitions of care refer to the movement of patients between different healthcare se…
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psnet.ahrq.gov/web-mm/dnr-or-and-afterwards
July 01, 2003 - DNR in the OR and Afterwards
Citation Text:
Lo B. DNR in the OR and Afterwards. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006.
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psnet.ahrq.gov/issue/accuracy-practitioner-estimates-probability-diagnosis-and-after-testing
May 05, 2021 - Study
Accuracy of practitioner estimates of probability of diagnosis before and after testing.
Citation Text:
Morgan DJ, Pineles L, Owczarzak J, et al. Accuracy of practitioner estimates of probability of diagnosis before and after testing. JAMA Intern Med. 2021;181(6):747-755. doi:10.10…
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psnet.ahrq.gov/issue/gpt-versus-resident-physicians-benchmark-based-official-board-scores
November 03, 2021 - Study
GPT versus resident physicians — a benchmark based on official board scores.
Citation Text:
Katz U, Cohen E, Shachar E, et al. GPT versus resident physicians — a benchmark based on official board scores. NEJM AI. 2024;1(5):5. doi:10.1056/aidbp2300192.
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…
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psnet.ahrq.gov/issue/scoping-review-distributed-cognition-acute-care-clinical-decision-making
April 08, 2020 - Review
A scoping review of distributed cognition in acute care clinical decision-making.
Citation Text:
Wilson E, Daniel M, Rao A, et al. A scoping review of distributed cognition in acute care clinical decision-making. Diagnosis (Berl). 2023;10(2):68-88. doi:10.1515/dx-2022-0095.
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psnet.ahrq.gov/issue/exploring-role-salient-distracting-clinical-features-emergence-diagnostic-errors-and
July 03, 2014 - Study
Exploring the role of salient distracting clinical features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes.
Citation Text:
Mamede S, Splinter TAW, Van Gog T, et al. Exploring the role of salient distracting clinical features…
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psnet.ahrq.gov/sites/default/files/2024-03/final_spotlight_case_not_missing_sepsis_needles_in_viral_haystacks_slides_march_date.pdf
January 01, 2024 - Spotlight
Spotlight
Do Not Miss Sepsis Needles in Viral Haystacks!
Source and Credits
• This presentation is based on the March 2024 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/webmm
o CME credit is available
o Commentary by: Michelle Hamline, MD, PhD, MAS and Ulfat
Shaikh, MD, M…
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psnet.ahrq.gov/perspective/conversation-susan-haas-md-msc
March 01, 2019 - One reason: doctors don't take them seriously.
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psnet.ahrq.gov/perspective/patient-safety-united-kingdom-evolution-and-progress
May 01, 2007 - Reason JT. Human Error. New York, NY: Cambridge University Press; 1990.
7.
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psnet.ahrq.gov/perspective/conversation-jose-morfin-md-fasn
April 28, 2021 - you have more aggressive fluid removal than if you are doing it every day, which is really the major reason
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psnet.ahrq.gov/perspective/conversation-withjoseph-britto-md
February 01, 2007 - In Conversation with...Joseph Britto, MD
February 1, 2007
Also Read an Essay
Citation Text:
In Conversation with..Joseph Britto, MD. PSNet [internet]. 2007.In Conversation with...Joseph Britto, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research …
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psnet.ahrq.gov/perspective/conversation-withsir-liam-donaldson-md-msc
May 01, 2007 - Reason JT. Human Error. New York, NY: Cambridge University Press; 1990.
7.
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psnet.ahrq.gov/issue/do-patients-disruptive-behaviours-influence-accuracy-doctors-diagnosis-randomised-experiment
July 03, 2014 - Study
Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment.
Citation Text:
Schmidt HG, Van Gog T, Schuit SC, et al. Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment. BMJ Qual S…
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psnet.ahrq.gov/node/43002/psn-pdf
March 12, 2014 - Exposure to media information about a disease can cause
doctors to misdiagnose similar-looking clinical cases.
March 12, 2014
Schmidt HG, Mamede S, Van den Berge K, et al. Exposure to media information about a disease can
cause doctors to misdiagnose similar-looking clinical cases. Acad Med. 2014;89(2):285-91.
doi…
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psnet.ahrq.gov/issue/alarm-algorithms-critical-care-monitoring
February 03, 2010 - Review
Alarm algorithms in critical care monitoring.
Citation Text:
Imhoff M, Kuhls S. Alarm algorithms in critical care monitoring. Anesth Analg. 2006;102(5):1525-37.
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Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId …
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psnet.ahrq.gov/issue/teaching-about-diagnostic-errors-through-virtual-patient-cases-pilot-exploration
September 18, 2013 - Study
Teaching about diagnostic errors through virtual patient cases: a pilot exploration.
Citation Text:
Geha R, Trowbridge RL, Dhaliwal G, et al. Teaching about diagnostic errors through virtual patient cases: a pilot exploration. Diagnosis (Berl). 2018;5(4):223-227. doi:10.1515/dx-201…
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psnet.ahrq.gov/issue/does-time-pressure-have-negative-effect-diagnostic-accuracy
January 16, 2019 - Study
Does time pressure have a negative effect on diagnostic accuracy?
Citation Text:
ALQahtani DA, Rotgans JI, Mamede S, et al. Does Time Pressure Have a Negative Effect on Diagnostic Accuracy? Acad Med. 2016;91(5):710-716. doi:10.1097/ACM.0000000000001098.
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psnet.ahrq.gov/issue/reflecting-diagnostic-errors-taking-second-look-not-enough
September 26, 2016 - Study
Reflecting on diagnostic errors: taking a second look is not enough.
Citation Text:
Monteiro SD, Sherbino J, Patel A, et al. Reflecting on Diagnostic Errors: Taking a Second Look is Not Enough. J Gen Intern Med. 2015;30(9):1270-4. doi:10.1007/s11606-015-3369-4.
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