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  1. psnet.ahrq.gov/perspective/conversation-withgerald-b-hickson-md
    December 01, 2009 - In Conversation with…Gerald B. Hickson, MD December 1, 2009  Also Read an Essay Citation Text: In Conversation with…Gerald B. Hickson, MD . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2…
  2. psnet.ahrq.gov/perspective/comprehensivist-model-care-hospitalists-view
    November 01, 2018 - The Comprehensivist Model of Care: A Hospitalist's View Robert Wachter, MD | November 1, 2018  Also Read a Conversation View more articles from the same authors. Citation Text: Wachter R. The Comprehensivist Model of Care: A Hospitalist's View. PSNet [internet].…
  3. psnet.ahrq.gov/perspective/how-identify-and-manage-problem-behaviors
    December 01, 2009 - How to Identify and Manage Problem Behaviors Alan H. Rosenstein, MD, MBA; Michelle O'Daniel, MSG, MHA | December 1, 2009  Also Read a Conversation View more articles from the same authors. Citation Text: Rosenstein AH, O'Daniel M. How to Identify and Manage Prob…
  4. psnet.ahrq.gov/perspective/doctors-multiple-malpractice-claims-disciplinary-actions-and-complaints-what-do-we-know
    July 01, 2017 - Doctors With Multiple Malpractice Claims, Disciplinary Actions, and Complaints: What Do We Know? David Studdert, LLB, ScD | July 1, 2017  Also Read a Conversation View more articles from the same authors. Citation Text: Studdert DM. Doctors With Multiple Malprac…
  5. psnet.ahrq.gov/web-mm/risks-malpositioned-gastrostomy-tube-and-poor-communication
    August 01, 2012 - SPOTLIGHT CASE The Risks of a Malpositioned Gastrostomy Tube and Poor Communication Citation Text: Hight RA. The Risks of a Malpositioned Gastrostomy Tube and Poor Communication. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Servic…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50699/psn-pdf
    November 26, 2019 - Patient Safety in Frail Older Patients November 26, 2019 Wald HL, Hall KK, Fitall E. Patient Safety in Frail Older Patients. PSNet [internet]. 2019. https://psnet.ahrq.gov/perspective/patient-safety-frail-older-patients Background Older patients are at a particular risk of experiencing a patient safety event. Stud…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49500/psn-pdf
    January 01, 2006 - Confusion With Acetaminophen January 1, 2006 Heubi JE. Confusion With Acetaminophen. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/confusion-acetaminophen The Case Parents brought their 5-year-old son to the emergency department (ED) with a 24-hour history of fever, cough, and frontal headache. Physical e…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49412/psn-pdf
    September 01, 2003 - Shake Well September 1, 2003 Flynn EA. Shake Well. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/shake-well The Case A 35-year-old patient on the neurology service was receiving carbamazepine for a seizure disorder. Daily serum drug levels consistently fell below the therapeutic range, which led the physi…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49425/psn-pdf
    November 01, 2003 - Misread Label November 1, 2003 Franklin BD. Misread Label. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/misread-label The Case An infant was born with sluggish respirations. During labor the infant’s mother had received meperidine [Demerol, a pain medication], a narcotic with a half-life of 2.5-4.0 hours…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49743/psn-pdf
    September 01, 2015 - Dual Therapy Debacle September 1, 2015 Kayser SR. Dual Therapy Debacle. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/dual-therapy-debacle The Case An elderly man with a history of arthritis, benign prostatic hypertrophy with urinary obstruction, hyperlipidemia, obesity, and a long history of tobacco use …
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33617/psn-pdf
    August 01, 2005 - In Conversation with…Barbara A. Blakeney, MS, RN August 1, 2005 In Conversation with…Barbara A. Blakeney, MS, RN. PSNet [internet]. 2005. https://psnet.ahrq.gov/perspective/conversation-withbarbara-blakeney-ms-rn Editor's Note: Barbara A. Blakeney, MS, RN, is President of the 150,000-member American Nurses Associa…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49421/psn-pdf
    October 01, 2003 - Urine a Tough Position October 1, 2003 Gandhi TK. Urine a Tough Position. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/urine-tough-position The Case A 22-year-old unmarried woman came to her doctor’s office worried that she might be pregnant. Although she did not want to have a baby at that time, she sta…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49767/psn-pdf
    August 21, 2016 - Falling Between the Cracks in the Software August 21, 2016 Adler-Milstein J. Falling Between the Cracks in the Software. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/falling-between-cracks-software The Case A 61-year-old man with a history of osteoarthritis was scheduled for a total knee replacement. Prio…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49647/psn-pdf
    February 01, 2012 - Amended Lab Results: Communication Slip February 1, 2012 Mohta V. Amended Lab Results: Communication Slip. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/amended-lab-results-communication-slip The Case A 25-year-old woman in her first pregnancy was seen at 33 weeks' gestation with new onset hypertension an…
  15. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.257_slideshow.ppt
    December 01, 2011 - Spotlight Case July 2008 Spotlight Case Order Interrupted by Text: Multitasking Mishap * * Source and Credits This presentation is based on the December 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: John Halamka, MD, MS, Chief Informa…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33780/psn-pdf
    July 01, 2015 - Safety and Medical Education January 1, 2014 Ranji SR. Safety and Medical Education. PSNet [internet]. 2014. https://psnet.ahrq.gov/perspective/safety-and-medical-education Annual Perspective 2014 As the patient safety field has grown, so too has the appreciation for the need to improve safety in medical educatio…
  17. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.326_slideshow.ppt
    June 01, 2014 - PowerPoint Presentation Spotlight Wandering Off the Floors: Safety and Security Risks of Patient Wandering 1 This presentation is based on the June 2014 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Thomas A. Smith, CHPA, CPP, President, Healthc…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33595/psn-pdf
    December 15, 2024 - Fatigue, Sleep Deprivation, and Patient Safety December 15, 2024 Fatigue, Sleep Deprivation, and Patient Safety. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/fatigue-sleep-deprivation-and-patient-safety PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that th…
  19. psnet.ahrq.gov/perspective/introducing-redesigned-ahrq-patient-safety-network
    December 01, 2005 - Introducing the Redesigned AHRQ Patient Safety Network Robert M. Wachter, MD | November 1, 2015  View more articles from the same authors. Citation Text: Wachter R. Introducing the Redesigned AHRQ Patient Safety Network . PSNet [internet]. Rockville (MD): Agency f…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49689/psn-pdf
    August 21, 2013 - Anesthesia: A Weighty Issue August 21, 2013 Sinha AC. Anesthesia: A Weighty Issue. PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/anesthesia-weighty-issue The Case A 77-year-old woman was evaluated preoperatively in anticipation of an elective left hip arthroplasty. She reported having a history of hyperte…

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