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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865540/psn-pdf
    April 11, 2024 - Misplaced Nasogastric Tube Resulting in Aspiration April 11, 2024 Singh A, Huang C. Misplaced Nasogastric Tube Resulting in Aspiration. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/misplaced-nasogastric-tube-resulting-aspiration The Case An 82-year-old woman presented to the Emergency Department (ED) for …

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49735/psn-pdf
    June 01, 2015 - Anchoring Bias With Critical Implications June 1, 2015 Etchells E. Anchoring Bias With Critical Implications. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/anchoring-bias-critical-implications Case Objectives Appreciate that diagnostic errors are common in primary and ambulatory care. Define premature clo…

  3. Microsoft PowerPoint - Spotlight Case_Postop Cervical Hematomas_12.15.2022 FINAL.pptx (pdf file)

    psnet.ahrq.gov/sites/default/files/2023-01/spotlight_respiratory_distress_after_neck_surgery_two_cases_of_postoperative_cervical_hematoma.pdf
    January 01, 2023 - Microsoft PowerPoint - Spotlight Case_Postop Cervical Hematomas_12.15.2022 FINAL.pptx Spotlight Respiratory Distress after Neck Surgery: Two Cases of Post-Operative Cervical Hematoma Source and Credits • This presentation is based on the January 2023 AHRQ WebM&M Spotlight Case o See the full article at https://…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49771/psn-pdf
    July 01, 2016 - Unintended Consequences of CPOE October 1, 2016 Wears RL. Unintended Consequences of CPOE. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/unintended-consequences-cpoe Case Objectives Explain how technology, including computerized provider order entry, can transform, rather than eliminate, hazards. Recogni…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49834/psn-pdf
    July 01, 2018 - "The Ultrasound Looked Fine": Point-of-Care Ultrasound and Patient Safety July 1, 2018 Lewiss RE. "The Ultrasound Looked Fine": Point-of-Care Ultrasound and Patient Safety. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/ultrasound-looked-fine-point-care-ultrasound-and-patient-safety Case Objectives Unders…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33742/psn-pdf
    December 01, 2012 - In Conversation With… Sharon K. Inouye, MD, MPH December 1, 2012 In Conversation With… Sharon K. Inouye, MD, MPH. PSNet [internet]. 2012. https://psnet.ahrq.gov/perspective/conversation-sharon-k-inouye-md-mph Editor's note: Sharon K. Inouye, MD, MPH, one of the world's leaders in geriatrics research and innovatio…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49615/psn-pdf
    December 01, 2010 - The Forgotten Turn December 1, 2010 Barbour S. The Forgotten Turn. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/forgotten-turn Case Objectives Describe the six stages of pressure ulceration per the National Pressure Ulcer Advisory Panel. List risk factors for the development of pressure ulcers in hospita…

  8. Editorial Team | PSNet

    psnet.ahrq.gov/Information/Editor
    May 23, 2025 - Browse Author Resources Meet PSNet's Editorial Team The PSNet editorial team is committed to producing the highest quality patient safety content. The team brings a wealth of experience and deep subject matter expertise in the field, ensuring that PSNet content is accurate, reliable, and…

  9. Radiology Missed an Intracranial Bleed in a Lethargic Infant. | PSNet

    psnet.ahrq.gov/web-mm/radiology-missed-intracranial-bleed-lethargic-infant
    August 21, 2016 - Radiology Missed an Intracranial Bleed in a Lethargic Infant. Citation Text: Yuk J, Magana J. Radiology Missed an Intracranial Bleed in a Lethargic Infant.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024. Copy Citation For…

  10. In Conversation With… Paul G. Shekelle, MD, MPH, PhD | PSNet

    psnet.ahrq.gov/perspective/conversation-paul-g-shekelle-md-mph-phd
    February 26, 2025 - In Conversation With… Paul G. Shekelle, MD, MPH, PhD October 1, 2011  Citation Text: In Conversation With… Paul G. Shekelle, MD, MPH, PhD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. …

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49810/psn-pdf
    November 01, 2017 - Palliative Care: Comfort vs. Harm November 1, 2017 Jox RJ. Palliative Care: Comfort vs. Harm. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/palliative-care-comfort-vs-harm Case Objectives Recognize errors may be difficult to identify in palliative care. State that medication errors and errors in communica…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33792/psn-pdf
    September 01, 2015 - In Conversation With… Eric J. Topol, MD September 1, 2015 In Conversation With… Eric J. Topol, MD. PSNet [internet]. 2015. https://psnet.ahrq.gov/perspective/conversation-eric-j-topol-md Editor's note: Eric J. Topol, MD, is Director of Scripps Translational Science Institute, Professor of Genomics at The Scripps …

  13. The Safety and Quality of Long Term Care | PSNet

    psnet.ahrq.gov/web-mm/safety-and-quality-long-term-care
    January 01, 2016 - SPOTLIGHT CASE The Safety and Quality of Long Term Care Citation Text: Vogelsmeier AA. The Safety and Quality of Long Term Care. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Goog…

  14. Unexplained Apnea Under Anesthesia | PSNet

    psnet.ahrq.gov/web-mm/unexplained-apnea-under-anesthesia
    December 01, 2005 - SPOTLIGHT CASE Unexplained Apnea Under Anesthesia Citation Text: Barach P. Unexplained Apnea Under Anesthesia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX …

  15. Triaging Interhospital Transfers | PSNet

    psnet.ahrq.gov/web-mm/triaging-interhospital-transfers
    April 12, 2023 - SPOTLIGHT CASE Triaging Interhospital Transfers Citation Text: Mueller SK. Triaging Interhospital Transfers. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX En…

  16. In Conversation with...Patrick S. Romano, MD, MPH | PSNet

    psnet.ahrq.gov/perspective/conversation-withpatrick-s-romano-md-mph
    July 10, 2024 - In Conversation with...Patrick S. Romano, MD, MPH November 1, 2010  Citation Text: In Conversation with..Patrick S. Romano, MD, MPH. PSNet [internet]. 2010.In Conversation with...Patrick S. Romano, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Rese…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866995/psn-pdf
    October 30, 2024 - A Cognitive and Communication Blind Spot Contributes to Permanent Paralysis October 30, 2024 Utter GH. A Cognitive and Communication Blind Spot Contributes to Permanent Paralysis. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/cognitive-and-communication-blind-spot-contributes-permanent-paralysis Disclosur…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865610/psn-pdf
    April 24, 2024 - Suicide Prevention in an Emergency Department Population: ED-SAFE April 24, 2024 https://psnet.ahrq.gov/innovation/suicide-prevention-emergency-department-population-ed-safe Summary Suicide is the 12th leading cause of death in the United States, and the 3rd leading cause of death for people ages 15-24.1 More tha…

  19. Remote Patient Monitoring | PSNet

    psnet.ahrq.gov/perspective/remote-patient-monitoring
    March 15, 2023 - Remote Patient Monitoring Colton Hood, MD, MBI,Neal Sikka, MD,Cindy Manaoat Van, MHSA,Sarah E. Mossburg, RN, PhD | March 15, 2023  Also Read the Conversation View more articles from the same authors. Citation Text: Hood C, Sikka N, Van CM, et al. Remote Patien…

  20. In Conversation with... Dr. Neal Sikka and Dr. Colton Hood about Remote Patient Monitoring | PSNet

    psnet.ahrq.gov/perspective/conversation-dr-neal-sikka-and-dr-colton-hood-about-remote-patient-monitoring
    March 15, 2023 - In Conversation with... Dr. Neal Sikka and Dr. Colton Hood about Remote Patient Monitoring March 15, 2023  Also Read the Essay Citation Text: In Conversation with.. Dr. Neal Sikka and Dr. Colton Hood about Remote Patient Monitoring. PSNet [internet]. 2023.In Conve…
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