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psnet.ahrq.gov/primer/radiation-safety
September 15, 2024 - Current Context Like all issues that have been the subject of Sentinel Event Alerts, radiation safety
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psnet.ahrq.gov/web-mm/diagnosing-diagnostic-mistakes
April 30, 2014 - SPOTLIGHT CASE
Diagnosing Diagnostic Mistakes
Citation Text:
McNutt RA, Abrams RI, Hasler S. Diagnosing Diagnostic Mistakes. 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/49811/psn-pdf
November 01, 2017 - Delayed Diagnosis of Endocrinologic Emergencies
November 1, 2017
Gomes-Lima C, Burman KD. Delayed Diagnosis of Endocrinologic Emergencies. PSNet [internet]. 2017.
https://psnet.ahrq.gov/web-mm/delayed-diagnosis-endocrinologic-emergencies
The Cases
Case #1:
A 47-year-old man with a history of hyperthyroidism and h…
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psnet.ahrq.gov/node/33784/psn-pdf
April 01, 2015 - In Conversation With… David Urbach, MD, MSc
April 1, 2015
In Conversation With… David Urbach, MD, MSc. PSNet [internet]. 2015.
https://psnet.ahrq.gov/perspective/conversation-david-urbach-md-msc
Editor's note: Dr. David Urbach is Professor of Surgery and Health Policy, Management, and Evaluation
at the University…
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psnet.ahrq.gov/web-mm/delayed-diagnosis-endocrinologic-emergencies
November 13, 2024 - Delayed Diagnosis of Endocrinologic Emergencies
Citation Text:
Gomes-Lima C, Burman KD. Delayed Diagnosis of Endocrinologic Emergencies. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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psnet.ahrq.gov/node/33799/psn-pdf
January 01, 2015 - Burnout Among Health Professionals and Its Effect on
Patient Safety
January 1, 2015
Lyndon A. Burnout Among Health Professionals and Its Effect on Patient Safety. PSNet [internet]. 2015.
https://psnet.ahrq.gov/perspective/burnout-among-health-professionals-and-its-effect-patient-safety
Annual Perspective 2015
Bur…
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psnet.ahrq.gov/web-mm/see-patient-first
September 27, 2023 - training care teams may have on patient outcomes and, unfortunately, the available literature on this subject
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psnet.ahrq.gov/web-mm/possible-probable-sure-wrong-premature-closure-and-anchoring-complicated-case
October 02, 2013 - therapeutic guidelines) all make retrospective assessments of "diagnosability" or "preventability" of harm subject … Human reasoning is subject to computational limitations and biasing factors that cause specific types
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psnet.ahrq.gov/node/33880/psn-pdf
May 01, 2019 - psnet.ahrq.gov//#ref21
Emergency medical services are a critical part of health care but they are subject
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psnet.ahrq.gov/node/33778/psn-pdf
March 01, 2015 - In 2013,
BMJ Quality & Safety devoted a special supplement to the subject.
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psnet.ahrq.gov/perspective/measuring-and-responding-deaths-medical-errors
April 01, 2008 - Preventable Adverse Events
The number of patients who die due to medical errors has been a controversial subject
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psnet.ahrq.gov/perspective/accountability-patient-safety
January 01, 2018 - espoused in the early years of the safety movement and the need for individual accountability has been a subject
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psnet.ahrq.gov/perspective/conversation-david-urbach-md-msc
June 12, 2019 - In Conversation With… David Urbach, MD, MSc
April 1, 2015
Citation Text:
In Conversation With… David Urbach, MD, MSc. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015.
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…
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psnet.ahrq.gov/node/33773/psn-pdf
September 01, 2014 - This is the subject of active research, largely trying to overcome the many challenges in
defining accurate
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psnet.ahrq.gov/node/49413/psn-pdf
September 01, 2003 - time-honored, simple preventive measure,
it is heavily dependent on human performance practices and is thus subject
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psnet.ahrq.gov/node/33623/psn-pdf
December 01, 2005 - The health care facilities or
providers subject to these requirements include hospitals, ambulatory
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psnet.ahrq.gov/primer/retained-surgical-items-causation-and-prevention
January 04, 2024 - are a time-honored preventive measure, they are heavily dependent on human performance and are thus subject … technological adjuncts have been invented, but these approaches also depend on human performance and are subject
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psnet.ahrq.gov/node/863641/psn-pdf
February 28, 2024 - sought input from several sources to inform the updates, including a technical expert
panel composed of subject
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psnet.ahrq.gov/web-mm/did-we-forget-something
April 28, 2021 - time-honored, simple preventive measure, it is heavily dependent on human performance practices and is thus subject
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psnet.ahrq.gov/web-mm/wrong-side-bedside-paravertebral-block-preventing-preventable
August 10, 2019 - "( 4 ) Wrong-site surgical and anesthesia procedures have been subject to extensive scrutiny.