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psnet.ahrq.gov/node/72689/psn-pdf
January 29, 2021 - But See the Patient First
January 29, 2021
Sinigayan VR. But See the Patient First. PSNet [internet]. 2021.
https://psnet.ahrq.gov/web-mm/see-patient-first
The Case
A 55-year-old man with acute myeloid leukemia presented to the emergency department (ED) with a chief
complaint of fever. Five days previously, he …
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psnet.ahrq.gov/node/49774/psn-pdf
November 01, 2016 - Don't Dismiss the Dangerous: Obstetric Hemorrhage
November 1, 2016
Main EK. Don't Dismiss the Dangerous: Obstetric Hemorrhage. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/dont-dismiss-dangerous-obstetric-hemorrhage
Case Objectives
List the common causes of obstetric hemorrhage and the need for a unit-sta…
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psnet.ahrq.gov/node/49786/psn-pdf
March 01, 2017 - Consequences of Medical Overuse
March 1, 2017
Morgan DJ, Foy AJ. Consequences of Medical Overuse. PSNet [internet]. 2017.
https://psnet.ahrq.gov/web-mm/consequences-medical-overuse
Case Objectives
Define overuse and overdiagnosis.
State how much of all care is estimated to be overuse.
Describe why the likelihood…
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psnet.ahrq.gov/curated-library/artificial-intelligence-system-level-considerations
March 27, 2024 - Breadcrumb
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The PSNet Collection
Curated Libraries
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Artificial Intelligence: System-Level Considerations
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Created By: Lorri Zipper…
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psnet.ahrq.gov/primer/nursing-and-patient-safety
September 15, 2024 - Nursing and Patient Safety
Citation Text:
Phillips J, Malliaris AP, Bakerjian D. Nursing and Patient Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021.
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psnet.ahrq.gov/innovation/project-boost-increases-patient-understanding-treatment-and-follow-care
February 26, 2025 - Project BOOST Increases Patient Understanding of Treatment and Follow-up Care
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May 26, 2021
Innovation
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psnet.ahrq.gov/issue/application-human-factors-methods-understand-missed-follow-abnormal-test-results
December 16, 2020 - Study
Application of human factors methods to understand missed follow-up of abnormal test results.
Citation Text:
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. do…
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psnet.ahrq.gov/issue/6-pack-programme-decrease-fall-injuries-acute-hospitals-cluster-randomised-controlled-trial
December 21, 2014 - Study
Classic
6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial.
Citation Text:
Barker AL, Morello RT, Wolfe R, et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled t…
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psnet.ahrq.gov/issue/graphical-display-diagnostic-test-results-electronic-health-records-comparison-8-systems
November 11, 2020 - Study
Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems.
Citation Text:
Sittig DF, Murphy DR, Smith MW, et al. Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems. J Am Med Inform Assoc. 2…
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psnet.ahrq.gov/issue/moving-beyond-misuse-and-diversion-urgent-need-consider-role-iatrogenic-addiction-current
July 18, 2012 - Commentary
Moving beyond misuse and diversion: the urgent need to consider the role of iatrogenic addiction in the current opioid epidemic.
Citation Text:
Beauchamp GA, Winstanley EL, Ryan SA, et al. Moving beyond misuse and diversion: the urgent need to consider the role of iatrogenic a…
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psnet.ahrq.gov/issue/family-safety-reporting-medically-complex-children-parent-staff-and-leader-perspectives
July 20, 2022 - Study
Family safety reporting in medically complex children: parent, staff, and leader perspectives.
Citation Text:
Khan A, Baird JD, Kelly MM, et al. Family safety reporting in medically complex children: parent, staff, and leader perspectives. Pediatrics. 2022;149(6):e2021053913. doi:1…
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psnet.ahrq.gov/issue/systematic-review-psychological-literature-interruption-and-its-patient-safety-implications
September 24, 2016 - Review
Classic
A systematic review of the psychological literature on interruption and its patient safety implications.
Citation Text:
Li SYW, Magrabi F, Coiera E. A systematic review of the psychological literature on interruption and its patient safety implica…
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psnet.ahrq.gov/issue/drug-related-problems-among-older-people-dementia-systematic-review
January 12, 2022 - Review
Drug-related problems among older people with dementia: a systematic review.
Citation Text:
Xue Qin QN, Ming LC, Abd Wahab MS, et al. Drug-related problems among older people with dementia: a systematic review. Res Social Adm Pharm. 2023;19(6):873-881. doi:10.1016/j.sapharm.2023.0…
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psnet.ahrq.gov/issue/initiatives-identify-and-mitigate-medication-errors-england
July 22, 2020 - Commentary
Initiatives to identify and mitigate medication errors in England.
Citation Text:
Cousins D, Gerrett D, Richards N, et al. Initiatives to identify and mitigate medication errors in England. Drug Saf. 2015;38(4):349-357. doi:10.1007/s40264-015-0270-3.
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psnet.ahrq.gov/issue/standardized-multidisciplinary-protocol-improves-handover-cardiac-surgery-patients-intensive
July 14, 2010 - Study
Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit.
Citation Text:
Joy BF, Elliott E, Hardy C, et al. Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit*. P…
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psnet.ahrq.gov/issue/evaluation-problem-specific-sbar-tool-improve-after-hours-nurse-physician-phone-communication
December 30, 2014 - Study
Evaluation of a problem-specific SBAR tool to improve after-hours nurse-physician phone communication: a randomized trial.
Citation Text:
Joffe E, Turley JP, Hwang KO, et al. Evaluation of a problem-specific SBAR tool to improve after-hours nurse-physician phone communication: a ra…
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psnet.ahrq.gov/issue/evaluating-clinical-decision-support-systems-monitoring-cpoe-order-check-override-rates
October 19, 2022 - Study
Evaluating clinical decision support systems: monitoring CPOE order check override rates in the Department of Veterans Affairs' computerized patient record system.
Citation Text:
Lin C-P, Payne TH, Nichol P, et al. Evaluating clinical decision support systems: monitoring CPOE ord…
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psnet.ahrq.gov/issue/adverse-events-present-arrival-emergency-department-ed-dual-safety-net
September 30, 2020 - Study
Adverse events present on arrival to the emergency department: the ED as a dual safety net.
Citation Text:
Griffey RT, Schneider RM, Todorov AA. Adverse Events Present on Arrival to the Emergency Department: The ED as a Dual Safety Net. Jt Comm J Qual Patient Saf. 2020;46(4):192-19…
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psnet.ahrq.gov/issue/impact-80-hour-resident-workweek-surgical-residents-and-attending-surgeons
January 04, 2010 - Study
The impact of the 80-hour resident workweek on surgical residents and attending surgeons.
Citation Text:
Hutter MM, Kellogg KC, Ferguson CM, et al. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg. 2006;243(6):864-71; discussion 8…
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psnet.ahrq.gov/issue/impact-digitally-acquired-peer-diagnostic-input-diagnostic-confidence-outpatient-cases
June 15, 2022 - Study
Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: a pragmatic randomized trial.
Citation Text:
Khoong EC, Fontil V, Rivadeneira NA, et al. Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases:…