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psnet.ahrq.gov/issue/identification-and-characterization-failures-infectious-agent-transmission-precaution
October 13, 2018 - Study
Emerging Classic
Identification and characterization of failures in infectious agent transmission precaution practices in hospitals: a qualitative study.
Citation Text:
Krein SL, Mayer J, Harrod M, et al. Identification and Characterization of Failures in …
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psnet.ahrq.gov/issue/use-technology-urgent-clinician-clinician-communications-systematic-review-literature
September 09, 2015 - Review
The use of technology for urgent clinician to clinician communications: a systematic review of the literature.
Citation Text:
Nguyen C, McElroy LM, Abecassis MM, et al. The use of technology for urgent clinician to clinician communications: a systematic review of the literature. I…
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psnet.ahrq.gov/issue/electronic-trigger-based-intervention-reduce-delays-diagnostic-evaluation-cancer-cluster
April 09, 2013 - Study
Classic
Electronic trigger-based intervention to reduce delays in diagnostic evaluation for cancer: a cluster randomized controlled trial.
Citation Text:
Murphy DR, Wu L, Thomas EJ, et al. Electronic Trigger-Based Intervention to Reduce Delays in Diagnosti…
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psnet.ahrq.gov/node/867986/psn-pdf
March 24, 2025 - Then the decision is, do we need to send this person directly to a crisis
center or get a behavioral … The medical center can choose to
send the person to a bed or an area that has reduced risk. … suggests that the person is at high risk when they return back to their environment, then you may send
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psnet.ahrq.gov/node/837658/psn-pdf
July 08, 2022 - failed to document and write orders for
hospice in the chart leaving the nursing staff no option but to send
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psnet.ahrq.gov/issue/using-incident-reports-assess-communication-failures-and-patient-outcomes
February 06, 2019 - Study
Using incident reports to assess communication failures and patient outcomes.
Citation Text:
Umberfield E, Ghaferi AA, Krein SL, et al. Using Incident Reports to Assess Communication Failures and Patient Outcomes. Jt Comm J Qual Patient Saf. 2019;45(6):406-413. doi:10.1016/j.jcjq.2…
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psnet.ahrq.gov/node/49616/psn-pdf
December 01, 2010 - Milliliters vs. Milligrams
December 1, 2010
Poole RL, Dixon T. Milliliters vs. Milligrams. PSNet [internet]. 2010.
https://psnet.ahrq.gov/web-mm/milliliters-vs-milligrams
The Case
A 32-year-old man was admitted to the hospital after a vehicle collision and multiple traumatic injuries. His
evaluation showed acu…
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psnet.ahrq.gov/node/49750/psn-pdf
January 01, 2016 - multiple patients arriving simultaneously.(11)
In addition, software applications are available that send
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psnet.ahrq.gov/node/861838/psn-pdf
January 31, 2024 - Perhaps an easy starting point is targeting selected
high-risk drugs and using the patient portal to send
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psnet.ahrq.gov/node/33654/psn-pdf
August 01, 2007 - There are measurement and reporting delays because you have to send it out to
get all the data from … now this is
serious enough we're going to send a signal.
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psnet.ahrq.gov/node/836978/psn-pdf
May 16, 2022 - Check Twice, Transport Once
May 16, 2022
DePew A, Rice J, Chou J. Check Twice, Transport Once. PSNet [internet]. 2022.
https://psnet.ahrq.gov/web-mm/check-twice-transport-once
The Case
Case #1: A 26-year-old woman (Patient A) presented to the Emergency Department (ED) with abdominal
pain and was diagnosed with “s…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.2_slideshow.ppt
February 01, 2003 - hypercarbia
Increase O2 flow to breathing circuit to enhance elimination of inhalation anesthetics
Send
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psnet.ahrq.gov/node/33585/psn-pdf
March 15, 2025 - CT scans send X-rays through the body area being studied,
with each scan rotation providing a slice
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psnet.ahrq.gov/web-mm/room-without-orders
September 01, 2011 - multiple patients arriving simultaneously.( 11 ) In addition, software applications are available that send
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psnet.ahrq.gov/web-mm/preventable-transfer-hospital
March 31, 2022 - failed to document and write orders for hospice in the chart leaving the nursing staff no option but to send
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psnet.ahrq.gov/web-mm/milliliters-vs-milligrams
September 01, 2004 - Milliliters vs. Milligrams
Citation Text:
Poole RL, Dixon T. Milliliters vs. Milligrams. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2010.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endn…
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psnet.ahrq.gov/perspective/conversation-charles-crecelius-md-phd-cmd-and-lori-l-popejoy-phd-rn-faan
October 28, 2020 - your facility is willing to admit publicly they are below minimum staffing levels, the government will send … CC : Setting firmer guidance for when you send people to the hospital. … Earlier in the pandemic, homes would send people that weren’t that serious to the hospital when they
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psnet.ahrq.gov/perspective/long-term-care-and-response-covid-19
October 28, 2020 - your facility is willing to admit publicly they are below minimum staffing levels, the government will send … CC : Setting firmer guidance for when you send people to the hospital. … Earlier in the pandemic, homes would send people that weren’t that serious to the hospital when they
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.218_slideshow.ppt
May 01, 2010 - Spotlight Case [MONTH] 2003
Spotlight Case
Fatal Error in Neonate: Does ‘Just Culture’ Provide an Answer?
*
*
Source and Credits
This presentation is based on the May 2010
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Sidney W.A. Dekker, Ph…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.365_slideshow.ppt
January 01, 2016 - ://www.ncbi.nlm.nih.gov/pubmed/25340919
16
Hospital-based Technology (2)
Software applications can send