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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74017/psn-pdf
    October 27, 2021 - Ensuring primary care diagnostic quality in the era of telemedicine. October 27, 2021 Willis JS, Tyler C, Schiff GD, et al. Ensuring primary care diagnostic quality in the era of telemedicine. Am J Med. 2021;134(9):1101-1103. doi:10.1016/j.amjmed.2021.04.027. https://psnet.ahrq.gov/issue/ensuring-primary-care-diag…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/841479/psn-pdf
    December 14, 2022 - Fast does not imply flawed: analyzing emergency physician productivity and medical errors. December 14, 2022 Hoot NR, Barbosa TJ, Chan HK, et al. Fast does not imply flawed: analyzing emergency physician productivity and medical errors. J Am Coll Emerg Physicians Open. 2022;3(6):e12849. doi:10.1002/emp2.12849. ht…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73113/psn-pdf
    April 07, 2021 - Analysis of results from event investigations in industrial and patient safety contexts. April 7, 2021 Harms-Ringdahl L. Analysis of results from event investigations in industrial and patient safety contexts. Safety. 2021;7(1):19. doi:10.3390/safety7010019. https://psnet.ahrq.gov/issue/analysis-results-event-inve…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837324/psn-pdf
    July 08, 2022 - Involve experts across the state or region to develop materials and support implementation. … Reports in a format that allows hospitals to track performance against other sites across a state or region … data collection and reporting methods Using multidisciplinary experts from throughout the targeted region
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861760/psn-pdf
    January 31, 2024 - Syringe Swap During Regional Block: A Case of Medication Error and Recovery January 31, 2024 Beres K, Gutierrez MC. Syringe Swap During Regional Block: A Case of Medication Error and Recovery. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/syringe-swap-during-regional-block-case-medication-error-and-recover…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35186/psn-pdf
    July 13, 2005 - Saving lives: hospitals have signed on to a six-part plan to avoid a multitude of unnecessary deaths. July 13, 2005 Comarow A. US News & World Report. July 2005 https://psnet.ahrq.gov/issue/saving-lives-hospitals-have-signed-six-part-plan-avoid-multitude-unnecessary- deaths This article, accompanying the widely r…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40897/psn-pdf
    November 02, 2011 - Infrequent physician use of implantable cardioverter- defibrillators risks patient safety. November 2, 2011 Lyman S, Sedrakyan A, Do H, et al. Infrequent physician use of implantable cardioverter-defibrillators risks patient safety. Heart. 2011;97(20):1655-60. doi:10.1136/hrt.2011.226282. https://psnet.ahrq.gov/is…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46081/psn-pdf
    April 19, 2017 - Why are medical errors still a leading cause of death? April 19, 2017 Headley M. https://psnet.ahrq.gov/issue/why-are-medical-errors-still-leading-cause-death This magazine article explores the need for robust research and effective reporting to better understand the prevalence of medical errors and how to prevent…
  9. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.311_slideshow.ppt
    December 01, 2013 - PowerPoint Presentation Spotlight Case New Oral Anticoagulants 1 This presentation is based on the December 2013 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Margaret C. Fang, MD, MPH, University of California, San Francisco Editor, AHRQ WebM&M…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865924/psn-pdf
    May 22, 2024 - Health professionals' experiences of whistleblowing in maternal and newborn healthcare settings: a scoping review and thematic analysis. May 22, 2024 Capper T, Ferguson B, Muurlink O. Health professionals' experiences of whistleblowing in maternal and newborn healthcare settings: a scoping review and thematic anal…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/863209/psn-pdf
    February 28, 2024 - Emergency department volume and delayed diagnosis of serious pediatric conditions. February 28, 2024 Michelson KA, Rees CA, Florin TA, et al. Emergency department volume and delayed diagnosis of serious pediatric conditions. JAMA Pediatr. 2024;178(4):362-368. doi:10.1001/jamapediatrics.2023.6672. https://psnet.ahr…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853433/psn-pdf
    September 13, 2023 - Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals. September 13, 2023 Michelson KA, Bachur RG, Grubenhoff JA, et al. Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric ho…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42961/psn-pdf
    February 19, 2014 - Healthcare-associated infections: a national patient safety problem and the coordinated response. February 19, 2014 Jeeva RR, Wright D. Healthcare-associated infections: a national patient safety problem and the coordinated response. Med Care. 2014;52(2 Suppl 1):S4-8. doi:10.1097/MLR.0b013e3182a54581. https://psne…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42751/psn-pdf
    November 20, 2013 - What makes maternity teams effective and safe? Lessons from a series of research on teamwork, leadership and team training. November 20, 2013 Siassakos D, Fox R, Bristowe K, et al. What makes maternity teams effective and safe? Lessons from a series of research on teamwork, leadership and team training. Acta Obste…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40349/psn-pdf
    May 11, 2011 - Use of briefings and debriefings as a tool in improving team work, efficiency, and communication in the operating theatre. May 11, 2011 Bethune R, Sasirekha G, Sahu A, et al. Use of briefings and debriefings as a tool in improving team work, efficiency, and communication in the operating theatre. Postgrad Med J. 2…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38904/psn-pdf
    September 02, 2009 - Litigation related to inadequate anaesthesia: an analysis of claims against the NHS in England 1995-2007. September 2, 2009 Mihai R, Scott SD, Cook TM. Litigation related to inadequate anaesthesia: an analysis of claims against the NHS in England 1995-2007. Anaesthesia. 2009;64(8):829-35. doi:10.1111/j.1365-2044.20…
  17. psnet.ahrq.gov/web-mm/endotracheal-tube-fallout-patient-severe-obesity-during-eye-surgery
    January 29, 2021 - Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery. Citation Text: Bohringer C. Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services.…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846768/psn-pdf
    March 29, 2023 - Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery. March 29, 2023 Bohringer C. Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/endotracheal-tube-fallout-patient-severe-obesity-during-eye-surgery The Ca…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838316/psn-pdf
    October 12, 2022 - The Lancet Commission on lessons for the future from the COVID-19 pandemic. October 12, 2022 Sachs JD, Karim SSA, Aknin L, et al. The Lancet Commission on lessons for the future from the COVID-19 pandemic. Lancet. 2022;400(10359):1224-1280. doi:10.1016/s0140-6736(22)01585-9. https://psnet.ahrq.gov/issue/lancet-com…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50887/psn-pdf
    February 12, 2020 - Lessons learned from a systems approach to engaging patients and families in patient safety transformation. February 12, 2020 Hatlie MJ, Nahum A, Leonard R, et al. Lessons Learned from a Systems Approach to Engaging Patients and Families in Patient Safety Transformation. Jt Comm J Qual Patient Saf. 2020;46(3):158-1…

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