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psnet.ahrq.gov/node/73258/psn-pdf
May 12, 2021 - Rate of sepsis hospitalizations after misdiagnosis in adult
emergency department patients: a look-forward analysis
with administrative claims data using Symptom-Disease
Pair Analysis of Diagnostic Error methodology in an
integrated health system.
May 12, 2021
Horberg MA, Nassery N, Rubenstein KB, et al. Rate of s…
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psnet.ahrq.gov/node/33773/psn-pdf
September 01, 2014 - Overuse as a Patient Safety Problem
September 1, 2014
Moriates C. Overuse as a Patient Safety Problem. PSNet [internet]. 2014.
https://psnet.ahrq.gov/perspective/overuse-patient-safety-problem
Perspective
Nearly half of primary care physicians in the United States believe that patients cared for in their own
prac…
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psnet.ahrq.gov/node/49827/psn-pdf
April 01, 2018 - Walking Patient, Missing Drain
April 1, 2018
Olkowski BF, Ravenel M, Stiefel MF. Walking Patient, Missing Drain. PSNet [internet]. 2018.
https://psnet.ahrq.gov/web-mm/walking-patient-missing-drain
The Case
A 43-year-old woman with a history of metastatic breast cancer was admitted to the hospital for an elective
…
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psnet.ahrq.gov/submit-innovations-landing
February 26, 2025 - Breadcrumb
Home
Improvement Resources
Innovations
Innovation Submissions
Individuals or organizations are encouraged to submit new or reimagined patient safety innovations that have been implemented, evaluated, sustained, and demonstrate significant improvement to patient safet…
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psnet.ahrq.gov/node/49606/psn-pdf
August 01, 2010 - Weighing In on Surgical Safety
August 1, 2010
Brodsky JB, Margarson M. Weighing In on Surgical Safety. PSNet [internet]. 2010.
https://psnet.ahrq.gov/web-mm/weighing-surgical-safety
Case Objectives
Identify the comorbidites associated with obesity that place patients at higher risk for surgical
complications.
Un…
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psnet.ahrq.gov/web-mm/new-oral-anticoagulants
July 01, 2011 - SPOTLIGHT CASE
New Oral Anticoagulants
Citation Text:
Fang MC. New Oral Anticoagulants. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013.
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psnet.ahrq.gov/node/42606/psn-pdf
September 25, 2013 - Health economic evaluation of an infection prevention
and control program: are quality and patient safety
programs worth the investment?
September 25, 2013
Raschka S, Dempster L, Bryce E. Health economic evaluation of an infection prevention and control
program: are quality and patient safety programs worth the in…
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psnet.ahrq.gov/node/37327/psn-pdf
March 03, 2011 - Patterns of technical error among surgical malpractice
claims: an analysis of strategies to prevent injury to
surgical patients.
March 3, 2011
Regenbogen SE, Greenberg CC, Studdert DM, et al. Patterns of technical error among surgical malpractice
claims: an analysis of strategies to prevent injury to surgical pati…
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psnet.ahrq.gov/node/39016/psn-pdf
April 04, 2011 - Variation in hospital mortality associated with inpatient
surgery.
April 4, 2011
Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N
Engl J Med. 2009;361(14):1368-75. doi:10.1056/NEJMsa0903048.
https://psnet.ahrq.gov/issue/variation-hospital-mortality-associate…
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psnet.ahrq.gov/node/46411/psn-pdf
April 12, 2019 - Effect of health information exchange on recognition of
medication discrepancies is interrupted when data
charges are introduced: results of a cluster-randomized
controlled trial.
April 12, 2019
Boockvar K, Ho W, Pruskowski J, et al. Effect of health information exchange on recognition of medication
discrepancies…
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psnet.ahrq.gov/web-mm/weighing-surgical-safety
August 04, 2021 - SPOTLIGHT CASE
Weighing In on Surgical Safety
Citation Text:
Brodsky JB, Margarson M. Weighing In on Surgical Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2010.
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Format:
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psnet.ahrq.gov/issue/critical-supply
June 16, 2019 - Audiovisual
Critical supply.
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April 3, 2013
View more articles from the same authors.
This news series reports on the drug shor…
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psnet.ahrq.gov/node/42969/psn-pdf
October 31, 2014 - Reducing the burden of surgical harm: a systematic
review of the interventions used to reduce adverse events
in surgery.
October 31, 2014
Howell A-M, Panesar S, Burns EM, et al. Reducing the burden of surgical harm: a systematic review of the
interventions used to reduce adverse events in surgery. Ann Surg. 2014;2…
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psnet.ahrq.gov/sites/default/files/2022-12/spotlight_case_strongyloides_final_11.21.22.pdf
January 01, 2022 - Spotlight
Spotlight
Strongyloides: A Hidden Traveler
and Potentially Lethal Missed
Diagnosis
Source and Credits
• This presentation is based on the November 2022 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/webmm
o CME credit is available
o Commentary by: Narath Carlile MD MPH,…
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psnet.ahrq.gov/issue/safercare-texas
November 26, 2018 - Multi-use Website
SaferCare Texas
Citation Text:
SaferCare Texas UNT Health Science Center; University of North Texas Health Science Center; UNTHSC.
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psnet.ahrq.gov/node/46893/psn-pdf
March 21, 2018 - Vital signs: trends in emergency department visits for
suspected opioid overdoses- United States, July 2016-
September 2017.
March 21, 2018
Vivolo-Kantor AM, Seth P, Gladden M, et al. Vital Signs: Trends in Emergency Department Visits for
Suspected Opioid Overdoses - United States, July 2016-September 2017. MMWR M…
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psnet.ahrq.gov/perspective/ems-patient-safety-field
July 28, 2021 - EMS Patient Safety in the Field
July 28, 2021
Also Read the Conversation
View more articles from the same authors.
Citation Text:
Augustine JJ, Fitall E, Hall KK, et al. EMS Patient Safety in the Field. PSNet [internet]. Rockville (MD): Agency for Healthcare Re…
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psnet.ahrq.gov/issue/agency-information-collection-activities-national-healthcare-safety-network-nhsn-comment
April 06, 2022 - Press Release/Announcement
Agency information collection activities: National Healthcare Safety Network (NHSN); comment request.
Citation Text:
Agency information collection activities: National Healthcare Safety Network (NHSN); comment request. Zirger JM, Centers for Disease Control and…
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psnet.ahrq.gov/issue/safety-and-human-performance-operating-room-and-other-extreme-environments
December 02, 2020 - Special or Theme Issue
Safety and Human Performance in the Operating Room and Other Extreme Environments.
Citation Text:
Safety and Human Performance in the Operating Room and Other Extreme Environments. Ruskin KJ, ed. Int Anesthesiol Clin. 2024;62(2):1-65.
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psnet.ahrq.gov/issue/surfing-healthcare-tsunami-bring-your-best-board
May 13, 2019 - Audiovisual
Surfing the Healthcare Tsunami: Bring Your Best Board.
Citation Text:
Surfing the Healthcare Tsunami: Bring Your Best Board. Austin, TX: Texas Medical Institute for Technology; 2012.
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