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psnet.ahrq.gov/issue/improving-teamwork-healthcare-current-approaches-and-path-forward
February 12, 2020 - Commentary
Improving teamwork in healthcare: current approaches and the path forward.
Citation Text:
Thomas EJ. Improving teamwork in healthcare: current approaches and the path forward. BMJ Qual Saf. 2011;20(8):647-50. doi:10.1136/bmjqs-2011-000117.
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psnet.ahrq.gov/issue/another-look-medical-error
November 16, 2022 - Commentary
Another look at medical error.
Citation Text:
Deskin WC, Hoye RE. Another look at medical error. J Surg Oncol. 2004;88(3):122-9.
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psnet.ahrq.gov/issue/teamwork-and-legal-and-ethical-responsibility-anaesthetist
February 14, 2024 - Review
Teamwork and the legal and ethical responsibility of the anaesthetist.
Citation Text:
Booij LHDJ, van Leeuwen E. Teamwork and the legal and ethical responsibility of the anaesthetist. Curr Opin Anaesthesiol. 2008;21(2):178-82. doi:10.1097/ACO.0b013e3282f5ff87.
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psnet.ahrq.gov/issue/evaluation-healthcare-safety-climate-measurement-tool
August 08, 2018 - Study
Evaluation of a healthcare safety climate measurement tool.
Citation Text:
Turnberg W, Daniell W. Evaluation of a healthcare safety climate measurement tool. J Safety Res. 2008;39(6):563-8. doi:10.1016/j.jsr.2008.09.004.
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psnet.ahrq.gov/issue/medication-safety-moving-illusion-reality
July 29, 2020 - Commentary
Medication safety: moving from illusion to reality.
Citation Text:
Classen D. Medication safety. JAMA. 2003;289(9):1154-1156. doi:10.1001/jama.289.9.1154.
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psnet.ahrq.gov/issue/relationships-among-clinician-delay-diagnosis-breast-cancer-and-tumor-size-nodal-status-and
March 08, 2017 - Study
The relationships among clinician delay of diagnosis of breast cancer and tumor size, nodal status, and stage.
Citation Text:
Hardin C, Pommier S, Pommier RF. The relationships among clinician delay of diagnosis of breast cancer and tumor size, nodal status, and stage. Am J Surg.…
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psnet.ahrq.gov/issue/process-analysis-sentinel-events-due-health-care-associated-infection
January 22, 2014 - Commentary
A process for analysis of sentinel events due to health care–associated infection.
Citation Text:
Carrico R, Ramírez J. A process for analysis of sentinel events due to health care-associated infection. Am J Infect Control. 2007;35(8):501-7.
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psnet.ahrq.gov/issue/inadvertent-administration-magnesium-sulfate-through-epidural-catheter-report-and-analysis
March 06, 2019 - Study
Inadvertent administration of magnesium sulfate through the epidural catheter: report and analysis of a drug error.
Citation Text:
Goodman EJ, Haas AJ, Kantor GS. Inadvertent administration of magnesium sulfate through the epidural catheter: report and analysis of a drug error. I…
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psnet.ahrq.gov/issue/engineering-risk-analysis-hospital-oxygen-supply-system
July 23, 2014 - Commentary
Engineering risk analysis of a hospital oxygen supply system.
Citation Text:
Deleris LA, Yeo GL, Seiver A, et al. Engineering risk analysis of a hospital oxygen supply system. Med Decis Making. 2006;26(2):162-72.
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psnet.ahrq.gov/periodic-issue/periodic-issue-450
August 28, 2024 - July 31, 2024 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, reports, …
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psnet.ahrq.gov/periodic-issue/periodic-issue-453
August 28, 2024 - August 21, 2024 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, reports…
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psnet.ahrq.gov/periodic-issue/periodic-issue-452
August 28, 2024 - August 14, 2024 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, reports…
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psnet.ahrq.gov/node/49403/psn-pdf
June 01, 2003 - Missed Appendicitis
June 1, 2003
Adams JG. Missed Appendicitis. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/missed-appendicitis
Case Objectives
Appreciate the variable presentations of appendicitis
List complications of missed appendicitis
Understand the advantages and disadvantages of CT in diagnosing…
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psnet.ahrq.gov/web-mm/mid-summer-fog
September 29, 2017 - A Mid-Summer Fog
Citation Text:
Braddock CH. A Mid-Summer Fog. 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/web-mm/wrong-time-error-high-alert-medication
February 01, 2014 - Wrong-Time Error With High-Alert Medication
Citation Text:
Yang A, Nelson LS. Wrong-Time Error With High-Alert Medication. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
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psnet.ahrq.gov/web-mm/chest-tube-complications
September 27, 2023 - Chest Tube Complications
Citation Text:
Santhosh L, Broaddus C. Chest Tube Complications. 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/sites/default/files/import/webmm.ahrq.gov.350_slideshow.ppt
June 01, 2015 - PowerPoint Presentation
Spotlight
Anchoring Bias With Critical Implications
1
This presentation is based on the June 2015
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Edward Etchells, MD, MSc, Division of General Internal Medicine, Centre for Q…
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psnet.ahrq.gov/node/860015/psn-pdf
September 01, 2024 - Retained Surgical Items: Definition and Epidemiology.
January 4, 2024
Romano PS, Gibbs VC. Retained Surgical Items: Definition and Epidemiology. PSNet [internet]. 2024.
https://psnet.ahrq.gov/primer/retained-surgical-items-definition-and-epidemiology
Background
Prudent medical practice and federal and state laws r…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.329_slideshow.ppt
August 01, 2014 - PowerPoint Presentation
Spotlight
Pitfalls in Diagnosing Necrotizing Fasciitis
This presentation is based on the July/August 2014
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Terence Goh, MBBS, Department of Plastic Surgery, Singapore General Hos…
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psnet.ahrq.gov/web-mm/hiding-plain-sight
April 24, 2019 - Hiding in Plain Sight
Citation Text:
Weinberg JM. Hiding in Plain Sight. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009.
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