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  1. psnet.ahrq.gov/web-mm/not-so-therapeutic-tap
    December 01, 2014 - SPOTLIGHT CASE Not-So-Therapeutic Tap Citation Text: Barsuk JH. Not-So-Therapeutic Tap. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49721/psn-pdf
    December 01, 2014 - Ebola: Are We Ready? December 1, 2014 Barsuk JH, Barnard C. Ebola: Are We Ready? PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/ebola-are-we-ready The Case A 28-year-old man, well-appearing but pale, walked into the emergency department (ED) on a Wednesday afternoon at 3 PM complaining of nausea, vomiting,…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49753/psn-pdf
    February 01, 2016 - Robotic Surgery: Risks vs. Rewards February 1, 2016 Kirkpatrick T, LaGrange C. Robotic Surgery: Risks vs. Rewards. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/robotic-surgery-risks-vs-rewards Case Objectives Discuss the background and current trends in robotic surgery. Identify the benefits of robotic s…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49611/psn-pdf
    October 01, 2010 - The Deadly Duo October 1, 2010 Maldonado JR. The Deadly Duo. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/deadly-duo The Case A 29-year-old man with a history of depression and possible psychosis was found unconscious and unresponsive at home and was brought to the emergency department. He was tachycardi…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861738/psn-pdf
    January 31, 2024 - A Laceration that Needed a Proper Exam, Not an X-Ray January 31, 2024 Wander J, Barnes DK. A Laceration that Needed a Proper Exam, Not an X-Ray. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/laceration-needed-proper-exam-not-x-ray Disclosure of Relevant Financial Relationships: As a provider accredited by t…
  6. 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…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837963/psn-pdf
    August 31, 2022 - Delayed Diagnosis of Mesenteric Ischemia August 31, 2022 Robles A, Utter GH. Delayed Diagnosis of Mesenteric Ischemia. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia Disclosure of Relevant Financial Relationships: As a provider accredited by the Accreditation Council for…
  8. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/training-tools/training-tools-slideset.pptx
    May 01, 2017 - Improving Communication and Teamwork in the Surgical Environment Sustainability Module AHRQ Safety Program for Ambulatory Surgery AHRQ Pub. No. 16(17)-0019-2-EF May 2017 Sustainability | ‹#› AHRQ Safety Program for Ambulatory Surgery 1 Learning Objectives Sustainability | ‹#› AHRQ Safety Program for Ambula…
  9. www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight10.html
    August 01, 2014 - How are CHIPRA quality demonstration States testing the Children's Electronic Health Record Format? Evaluation Highlight No. 10 Author: Leslie Foster Contents Key Messages Background Findings Conclusion Implications Learn More Endnotes The CHIPRA Quality Demonstration Grant Program…
  10. www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight05.html
    November 01, 2013 - How are CHIPRA Quality Demonstration States encouraging health care providers to put quality measures to work? Evaluation Highlight No. 5 Author: Leslie Foster Contents Key Messages Background Findings Conclusions Implications Learn More Endnotes The CHIPRA Quality Demonstration …
  11. www.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/hospital/about/child_hcaps_measures_909.pdf
    May 11, 2016 - Patient Experience Measures from the CAHPS® Child Hospital Survey CAHPS® Child Hospital Survey and Instructions Patient Experience Measures from the CAHPS® Child Hospital Survey Introduction........................................................................... 1 Types of Measures ...........................…
  12. www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/highlight10.pdf
    September 08, 2015 - Evaluation Highlight No.10, August 2014 The CHIPRA Quality Demonstration Grant Program In February 2010, the Centers for Medicare & Medicaid Services (CMS) awarded 10 grants, funding 18 States, to improve the quality of health care for children enrolled in Medicaid and the Children’s Health Insurance Program …
  13. www.ahrq.gov/hai/cauti-tools/archived-webinars/connecting-dots-slides.html
    December 01, 2017 - Connecting the Dots: Improving Unit Safety Culture to Stop HAI Slide Presentation Slide 1 Connecting the Dots: Improving Unit Safety Culture to Stop HAI Katherine J. Jones, PT, PhD University of Nebraska Medical Center Slide 2 Supported By AHRQ Partnerships in Implementing Patient Safety Gran…
  14. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2022-05/final_cme_reviewed_-_spotlight_missing_a_large_vessel_occlusion_stroke_04.14.2022_-_copy.pdf
    January 01, 2022 - Spotlight Spotlight Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures Source and Credits • This presentation is based on the May 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: Kevin Keenan, MD and D…
  15. 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…
  16. www.ahrq.gov/research/findings/nhqrdr/chartbooks/careaffordability/careaffordability-slides.html
    September 01, 2018 - Chartbook on Care Affordability: Slide Presentation National Healthcare Quality and Disparities Report Slide 1 National Healthcare Quality and Disparities Report Chartbook on Care Affordability August 2016 Slide 2 National Healthcare Quality and Disparities Report Annual report to Congress ma…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/857258/psn-pdf
    November 30, 2023 - Always Check the Muscle Twitch: Residual Neuromuscular Block After Removal of a Gastric Balloon November 30, 2023 Bohringer C, Ashley S. Always Check the Muscle Twitch: Residual Neuromuscular Block After Removal of a Gastric Balloon. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/always-check-muscle-twitch-…
  18. www.ahrq.gov/sites/default/files/2024-11/williams-galimbertti-report.pdf
    January 01, 2024 - Final Progress Report: Challenges and Innovations in Evaluation of Quality of Care AHRQ Grant Final Progress Report Title of Project: Challenges and Innovations in Evaluation of Quality of Care Measures Based on Small Counts “National Conference on Small Numbers” Principal Investigators and Team Members: …
  19. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2022-10/trocar_injury_final.pdf
    January 01, 2022 - Spotlight Spotlight Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong Source and Credits • This presentation is based on the October 2022 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838900/psn-pdf
    October 27, 2022 - Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong. October 27, 2022 Ahmed SM, Ali M. Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/fecal-contamination-…