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psnet.ahrq.gov/node/49483/psn-pdf
June 01, 2005 - for high-risk procedures or for the use of high-risk drugs;
There was poor staff/trainee teamwork skills
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digital.ahrq.gov/sites/default/files/docs/publication/r13hs021925-pratt-final-report-2013.pdf
January 01, 2013 - Knowledge, Abilities and Skills as Predictors of Behavior in an Interactive Consumer Health
Informatics
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psnet.ahrq.gov/node/851389/psn-pdf
July 31, 2023 - Resources Used and Skills Needed
https://psnet.ahrq.gov//#1
https://psnet.ahrq.gov//#1
https://psnet.ahrq.gov
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digital.ahrq.gov/computerized-provider-order-entry-inpatient
January 01, 2023 - AHRQ projects provided health IT training and education to clinical staff so they could acquire the skills
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psnet.ahrq.gov/node/863649/psn-pdf
February 28, 2024 - update to fully support
healthcare teams and continue to improve their collaboration and communication skills
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hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2001.jsp
January 01, 2001 - of this service are to increase awareness of the strengths and uses of HCUP data and to enhance the skills
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psnet.ahrq.gov/node/49451/psn-pdf
June 01, 2004 - The Result Stopped Here
June 1, 2004
Astion ML. The Result Stopped Here. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/result-stopped-here
The Case
A 91-year-old female was transferred to a hospital-based skilled nursing unit from the acute care hospital
for continued wound care and intravenous (IV) antib…
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psnet.ahrq.gov/sites/default/files/2022-10/spotlight_case_missed_pneumothorax_10.09.2022_-_final.pdf
January 01, 2022 - Spotlight
Spotlight
False Assumptions Result in a Missed
Pneumothorax after Bronchoscopy with
Transbronchial Biopsy
Source and Credits
• This presentation is based on the September 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:…
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psnet.ahrq.gov/node/49747/psn-pdf
December 01, 2015 - Harm From Alarm Fatigue
December 1, 2015
Pelter MM, Drew BJ. Harm From Alarm Fatigue. PSNet [internet]. 2015.
https://psnet.ahrq.gov/web-mm/harm-alarm-fatigue
Case Objectives
Define alarm fatigue and describe potential errors that can occur due to alarm fatigue.
Identify federal and national agencies focusing on …
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www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu3a.html
October 01, 2014 - Preventing Pressure Ulcers in Hospitals
3. What Are the Best Practices in Pressure Ulcer Prevention that We Want to Use? (continued)
Previous Page Next Page
Table of Contents
Preventing Pressure Ulcers in Hospitals
Overview
Key Subject Area Index
1. Are we ready for this change?
2. How will …
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psnet.ahrq.gov/clinical-areas
March 24, 2025 - Clinical Areas
Scroll down to search or browse using Clinical Area if you would like to explore PSNet by the healthcare profession, such as the nurse care or medical specialty, featured in the resources.
Latest by Clinical Areas
In Conversation with Edwin Boudreaux about S…
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www.ahrq.gov/es/patient-safety/settings/hospital/resource/pressureulcer/tool/pu3a.html
October 01, 2014 - Preventing Pressure Ulcers in Hospitals
3. What Are the Best Practices in Pressure Ulcer Prevention that We Want to Use? (continued)
Previous Page Next Page
Table of Contents
Preventing Pressure Ulcers in Hospitals
Overview
Key Subject Area Index
1. Are we ready for this change?
2. How will …
-
www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm8b.html
October 01, 2014 - Designing and Implementing Medicaid Disease and Care Management Programs
Section 8: The Care Management Evidence Base (continued)
Previous Page Next Page
Table of Contents
Designing and Implementing Medicaid Disease and Care Management Programs
Introduction
Section 1: Planning a Care Management …
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www.ahrq.gov/talkingquality/translate/display/index.html
May 01, 2019 - Displaying the Data in a Health Care Quality Report
Graphs and tables remain the most efficient and practical way to convey a large amount of information, especially comparative information and numbers. Visual presentations are powerful tools for concisely making points that are hard to put into words.
Howe…
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www.ahrq.gov/hai/cusp/modules/spread/notes.html
December 01, 2012 - CUSP Toolkit Spread Facilitator Notes
CUSP Toolkit
The Spread module of the CUSP Toolkit helps an organization share, tailor, and implement the components of a process that have worked well at the unit level. The other CUSP Toolkit modules focus on quality improvement projects at the unit level, where culture…
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psnet.ahrq.gov/node/49545/psn-pdf
September 01, 2007 - Coming Undone: Failure of Closure Device
September 1, 2007
Baez-Escudero JL, Levine GN. Coming Undone: Failure of Closure Device. PSNet [internet]. 2007.
https://psnet.ahrq.gov/web-mm/coming-undone-failure-closure-device
The Case
A 65-year-old man underwent coronary angiography because of atypical exertional chest…
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psnet.ahrq.gov/node/33788/psn-pdf
June 01, 2015 - In Conversation With… Christine Cassel, MD
June 1, 2015
In Conversation With… Christine Cassel, MD. PSNet [internet]. 2015.
https://psnet.ahrq.gov/perspective/conversation-christine-cassel-md
Editor's note: Christine Cassel, MD, is President and CEO of the National Quality Forum (NQF). Dr.
Cassel, one of the foun…
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psnet.ahrq.gov/perspective/conversation-withtroyen-brennan-md-jd-mph
December 21, 2022 - In Conversation with…Troyen A. Brennan, MD, JD, MPH
December 1, 2005
Citation Text:
In Conversation with…Troyen A. Brennan, MD, JD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2005.
…
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psnet.ahrq.gov/node/49762/psn-pdf
June 01, 2016 - The Case of Mistaken Intubation
June 1, 2016
Silveira MJ. The Case of Mistaken Intubation. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/case-mistaken-intubation
Case Objectives
Appreciate that most older adults and many younger chronically ill patients have discussed or
documented their preferences for l…
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psnet.ahrq.gov/node/33883/psn-pdf
July 01, 2019 - In Conversation With… Suchi Saria, PhD
July 1, 2019
In Conversation With… Suchi Saria, PhD. PSNet [internet]. 2019.
https://psnet.ahrq.gov/perspective/conversation-suchi-saria-phd
Editor's note: Dr. Saria is the John C. Malone Assistant Professor of computer science, statistics, and
health policy at Johns Hopkins …