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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…
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psnet.ahrq.gov/node/49476/psn-pdf
March 02, 2005 - Around the Block
March 1, 2005
Minichiello T. Around the Block. PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/around-block
The Case
A 77-year-old woman with multiple medical problems was admitted to the hospital for an elective knee
replacement. The orthopedic surgeon, recognizing the risk of deep vein th…
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psnet.ahrq.gov/node/37597/psn-pdf
February 15, 2010 - Accuracy of send-out test ordering: a College of
American Pathologists Q-Probes study of ordering
accuracy in 97 clinical laboratories.
February 15, 2010
Valenstein PN, Walsh MK, Stankovic AK. Accuracy of send-out test ordering: a College of American
Pathologists Q-Probes study of ordering accuracy in 97 clinical …
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psnet.ahrq.gov/node/34594/psn-pdf
January 04, 2017 - John M. Eisenberg Patient Safety Awards. The Leapfrog
Group for Patient Safety: rewarding higher standards.
January 4, 2017
Eikel C, Delbanco S. John M. Eisenberg Patient Safety Awards. The Leapfrog Group for Patient Safety:
rewarding higher standards. Jt Comm J Qual Saf. 2003;29(12):634-9.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/44547/psn-pdf
November 25, 2015 - Monitoring patient safety in primary care: an exploratory
study using in-depth semistructured interviews.
November 25, 2015
Samra R, Bottle A, Aylin PP. Monitoring patient safety in primary care: an exploratory study using in-depth
semistructured interviews. BMJ Open. 2015;5(9):e008128. doi:10.1136/bmjopen-2015-008…
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psnet.ahrq.gov/node/72469/psn-pdf
November 18, 2020 - Weekend effect on in-hospital mortality for ischemic and
hemorrhagic stroke in US rural and urban hospitals.
November 18, 2020
Mekonnen B, Wang G, Rajbhandari-Thapa J, et al. Weekend effect on in-hospital mortality for ischemic
and hemorrhagic stroke in US rural and urban hospitals. J Stroke Cerebrovasc Dis. 2020;2…
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psnet.ahrq.gov/node/73120/psn-pdf
April 07, 2021 - Medication reconciliation during hospitalization and in
hospital-home interface: an observational retrospective
study.
April 7, 2021
Volpi E, Giannelli A, Toccafondi G, et al. Medication reconciliation during hospitalization and in hospital-
home interface: an observational retrospective study. J Patient Saf. 2021…
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psnet.ahrq.gov/web-mm/missed-appendicitis
March 13, 2013 - with the classic history of abdominal discomfort migrating from the epigastrium to the periumbilical region … pain in the right lower quadrant, abdominal rigidity, and migration of pain from the periumbilical region
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psnet.ahrq.gov/node/37429/psn-pdf
February 17, 2011 - Outcomes of care by hospitalists, general internists, and
family physicians.
February 17, 2011
Lindenauer PK, Rothberg MB, Pekow PS, et al. Outcomes of Care by Hospitalists, General Internists, and
Family Physicians. New Engl J Med. 2007;357(25):2589-2600. doi:10.1056/nejmsa067735.
https://psnet.ahrq.gov/issue/ou…
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psnet.ahrq.gov/web-mm/hurried-team-huddle-and-poor-communication-unsafe-practice-during-anesthesia-emergency
September 27, 2023 - SPOTLIGHT CASE
Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery
Citation Text:
Curtin A, Schloemerkemper N. Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery.. PSNet [internet]…
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psnet.ahrq.gov/web-mm/around-block
March 04, 2020 - Around the Block
Citation Text:
Minichiello T. Around the Block. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2005.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
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psnet.ahrq.gov/node/45989/psn-pdf
June 07, 2017 - Radiologic safety events within a pediatric emergency
medicine network.
June 7, 2017
Blumberg SM, Mahajan P, O?Connell KJ, et al. Radiologic Safety Events Within a Pediatric Emergency
Medicine Network. Pediatr Emerg Care. 2017;33(2):92-96. doi:10.1097/PEC.0000000000000684.
https://psnet.ahrq.gov/issue/radiologic-s…
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psnet.ahrq.gov/node/43779/psn-pdf
May 28, 2015 - Debriefing in the emergency department after clinical
events: a practical guide.
May 28, 2015
Kessler DO, Cheng A, Mullan PC. Debriefing in the Emergency Department After Clinical Events: A
Practical Guide. Ann Emerg Med. 2015;65(6):690-698. doi:10.1016/j.annemergmed.2014.10.019.
https://psnet.ahrq.gov/issue/debri…
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psnet.ahrq.gov/node/44373/psn-pdf
August 12, 2015 - Healthcare Utilizing Deliberate Discussion Linking Events
(HUDDLE): a systematic review.
August 12, 2015
Glymph DC, Olenick M, Barbera S, et al. Healthcare Utilizing Deliberate Discussion Linking Events
(HUDDLE): A Systematic Review. AANA J. 2015;83(3):183-188.
https://psnet.ahrq.gov/issue/healthcare-utilizing-del…
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psnet.ahrq.gov/node/49831/psn-pdf
June 01, 2018 - hospitals, emergency medical services, and other agencies provide emergency
care to everyone in that region … Ideally, patients should be taken to the optimal facility within the region
based on their condition
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psnet.ahrq.gov/sites/default/files/2023-06/hurried_huddle_0.pdf
January 01, 2023 - Microsoft PowerPoint - Spotlight Case_Anesthesia Error During Cesarean_06.22.2023 - Final.pptx
Spotlight
Hurried Team Huddle and Poor Communication: Unsafe
Practice During Anesthesia for Emergency Cesarean
Delivery
Source and Credits
• This presentation is based on the June 2023 AHRQ WebM&M
Spotlight Case
o See…
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psnet.ahrq.gov/node/35703/psn-pdf
July 13, 2010 - Injury and liability associated with monitored anesthesia
care: a closed claims analysis.
July 13, 2010
Bhananker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia
care: a closed claims analysis. Anesthesiology. 2006;104(2):228-234.
https://psnet.ahrq.gov/issue/injury-and-l…
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psnet.ahrq.gov/node/43147/psn-pdf
July 19, 2017 - ACOG Committee Opinion #590: preparing for clinical
emergencies in obstetrics and gynecology.
July 19, 2017
Improvement AC of O and GC on PS and Q. Committee opinion no. 590: preparing for clinical emergencies
in obstetrics and gynecology. Obstet Gynecol. 2014;123(3):722-5.
doi:10.1097/01.AOG.0000444442.04111.c6.
…
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psnet.ahrq.gov/node/37686/psn-pdf
November 30, 2016 - Hospital Survey on Patient Safety Culture: 2008
Comparative Database Report.
November 30, 2016
Sorra J, Famolaro T, Dyer N, Nelson D, Khanna K. Rockville, MD: Agency for Healthcare Research and
Quality; March 2008. AHRQ Publication No. 08-0039.
https://psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-20…
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psnet.ahrq.gov/node/49696/psn-pdf
December 01, 2013 - New Oral Anticoagulants
December 1, 2013
Fang MC. New Oral Anticoagulants. PSNet [internet]. 2013.
https://psnet.ahrq.gov/web-mm/new-oral-anticoagulants
Case Objectives
Review properties of newer target-specific oral anticoagulants (TSOACs) such as dabigatran,
rivaroxaban, and apixaban.
State key perioperative c…