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psnet.ahrq.gov/node/847934/psn-pdf
April 26, 2023 - updates (such as the transition from ICD-9-CM to ICD-10-CM), evidence from validation studies, and
suggestions
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psnet.ahrq.gov/primer/clinical-decision-support-systems
December 15, 2024 - New
Clinical Decision Support Systems
Citation Text:
Clinical Decision Support Systems. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/web-mm/acute-care-admission-behavioral-health-patient
July 19, 2023 - Acute Care Admission of the Behavioral Health Patient
Citation Text:
Weiss AP, Rosenbaum JF. Acute Care Admission of the Behavioral Health Patient. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013.
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psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-6
June 16, 2019 - Commentary
ISMP medication error report analysis.
Citation Text:
ISMP medication error report analysis. Cohen MR.
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psnet.ahrq.gov/web-mm/liver-biopsy-proceed-caution
March 07, 2012 - Liver Biopsy: Proceed With Caution
Citation Text:
Rockey DC. Liver Biopsy: Proceed With Caution. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014.
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psnet.ahrq.gov/web-mm/who-nose-where-airway
May 01, 2016 - Who Nose Where the Airway Is?
Citation Text:
Lee CR. Who Nose Where the Airway Is?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009.
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psnet.ahrq.gov/web-mm/fatal-oversight-misdiagnosis-nocturnal-chest-pain-elevated-d-dimer
May 01, 2005 - Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D-dimer.
Citation Text:
Agusala V, Deen J, Schaefer S. Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D-dimer.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and H…
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psnet.ahrq.gov/web-mm/inside-time-out
March 01, 2004 - The Inside of a Time Out
Citation Text:
Feldman DL. The Inside of a Time Out. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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psnet.ahrq.gov/periodic-issue/periodic-issue-470
December 31, 2024 - January 15, 2025 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, report…
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psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-1
June 16, 2019 - Commentary
ISMP medication error report analysis.
Citation Text:
ISMP medication error report analysis. Cohen MR.
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psnet.ahrq.gov/issue/remembering-learn-overlooked-role-remembrance-safety-improvement
February 28, 2024 - Commentary
Remembering to learn: the overlooked role of remembrance in safety improvement.
Citation Text:
Macrae C. Remembering to learn: the overlooked role of remembrance in safety improvement. BMJ Qual Saf. 2017;26(8):678-682. doi:10.1136/bmjqs-2016-005547.
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psnet.ahrq.gov/node/43846/psn-pdf
January 21, 2015 - Quantifying and monitoring overdiagnosis in cancer
screening: a systematic review of methods.
January 21, 2015
Carter JL, Coletti RJ, Harris RP. Quantifying and monitoring overdiagnosis in cancer screening: a
systematic review of methods. BMJ. 2015;350:g7773. doi:10.1136/bmj.g7773.
https://psnet.ahrq.gov/issue/qua…
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psnet.ahrq.gov/web-mm/framework-assessing-reasoning-about-controversial-end-life-clinical-decisions
November 30, 2023 - This suggestion implies that care providers have a responsibility to continually educate themselves about
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psnet.ahrq.gov/print/pdf/node/73848
July 01, 2022 - PSNet
Curated Library
AHRQ: Agency for Healthcare Research and Quality
Maternal Safety
Curated Library
Foundations
Maternal Safety
Marla Shauer, PhD(c), MSN, CNM; Amy Nichols, EdD, RN, CNS, CHSE, ANEF; Audrey Lyndon, RN,
PhD, FAAN | January, 31 2024
Pregnancy, childbirth, and the postpartum year present a comp…
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psnet.ahrq.gov/web-mm/missing-large-vessel-occlusion-stroke-patient-history-seizures
August 31, 2022 - SPOTLIGHT CASE
Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures.
Citation Text:
Keenan KJ, Nishijima DK. Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, U…
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psnet.ahrq.gov/node/46723/psn-pdf
April 12, 2019 - Diagnostic assessment of deep learning algorithms for
detection of lymph node metastases in women with
breast cancer.
April 12, 2019
Bejnordi BE, Veta M, van Diest PJ, et al. Diagnostic Assessment of Deep Learning Algorithms for Detection
of Lymph Node Metastases in Women With Breast Cancer. JAMA. 2017;318(22):219…
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psnet.ahrq.gov/node/44445/psn-pdf
September 16, 2015 - Understanding nurses' and physicians' fear of
repercussions for reporting errors: clinician
characteristics, organization demographics, or leadership
factors?
September 16, 2015
Castel ES, Ginsburg LR, Zaheer S, et al. Understanding nurses' and physicians' fear of repercussions for
reporting errors: clinician cha…
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psnet.ahrq.gov/perspective/zero-harm-striving-reduce-preventable-harms-point-counterpoint-and-areas-agreement
September 24, 2024 - Zero Harm: Striving to Reduce Preventable Harms – Point, Counterpoint, and Areas of Agreement
Carole Stockmeier, MHA, BS, Eric Thomas, MD, MPH, Merton Lee, PharmD, PhD, Sarah E. Mossburg, RN, PhD | September 24, 2024
Also Read the Conversations
In Conversation with Ca…
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psnet.ahrq.gov/issue/ismp-survey-tall-man-mixed-case-lettering-reduce-drug-name-confusion
January 26, 2023 - Press Release/Announcement
ISMP survey on tall man (mixed case) lettering to reduce drug name confusion.
Citation Text:
ISMP survey on tall man (mixed case) lettering to reduce drug name confusion. Institute for Safe Medication Practices.
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psnet.ahrq.gov/perspective/impact-system-failures-healthcare-workers
August 30, 2023 - In addition to the system-based recommendations for supporting healthcare workers, below are some suggestions