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effectivehealthcare.ahrq.gov/sites/default/files/related_files/hospital-length-of-stay-disposition-comments_0.pdf
September 20, 2021 - As we do better in keeping 'less sick' folks out of inpatient
settings, and move surgeries safely to
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psnet.ahrq.gov/node/49389/psn-pdf
February 01, 2003 - Procedural Mishap: Learning Curve?
February 1, 2003
Gibbs VC, Leape L. Procedural Mishap: Learning Curve? PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/procedural-mishap-learning-curve
The Case
A 28-year-old multiparous obese female presented for laparoscopic tubal ligation. The patient had
undesired fert…
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psnet.ahrq.gov/node/49814/psn-pdf
December 01, 2017 - Miscommunication in the OR Leads to Anticoagulation
Mishap
December 1, 2017
Solsky I, Haynes AB. Miscommunication in the OR Leads to Anticoagulation Mishap. PSNet [internet].
2017.
https://psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap
The Case
A 63-year-old man with a history of coronary…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/tools/surgical-complication-prevention/bim.docx
December 01, 2017 - Barrier Identification and Mitigation Tool
AHRQ Safety Program for Surgery
AHRQ Safety Program for Surgery
Barrier Identification and Mitigation Tool
Introduction
Problem Statement
Guidelines summarizing evidence exist to help ensure that patients receive recommended interventions. In addition, consistent guidel…
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/cer-260-improved-cancer-outcomes-executive-summary_0.pdf
May 01, 2023 - Executive Summary - Nutrition as Prevention for Improved Cancer Outcomes: Comparative Effectiveness Review No. 260
Comparative Effectiveness Review
Number 260
Nutrition as Prevention for Improved
Cancer Health Outcomes
Executive Summary
Main Points
• Two decades of randomized trial evidence from 206 studies o…
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effectivehealthcare.ahrq.gov/sites/default/files/arthritis-horizon-scan-high-impact-1306.pdf
June 01, 2013 - improved surgical outcomes, reduced
patient stays and complications, and a lower rate of additional surgeries … , changes in patient management and infrastructure might occur because of fewer joint-
replacement surgeries
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/tools/applying-cusp/learn_from_defects.docx
December 01, 2017 - Learn From Defects Tool
AHRQ Safety Program for Surgery
Learn From Defects Tool – Perioperative Setting
What is a defect? A defect is any event or situation that you don’t want to repeat. This could include an incident that caused patient harm or put patients at risk for harm, such as a patient fall.
Problem statem…
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www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary4/lung-cancer-screening-december-2013
July 30, 2013 - Biopsy: NR
Surgery, CT group only: 83%–85% of cases of LC resected; 4/45 (9%) of
all surgeries … FNA
Surgery: 2% ( n = 153), 0.6% ( n = 45) for benign
disease
29% of VATS or other surgeries … LC: 9 (of 5481.5 person-years)
All-cause: 48
Additional procedures
15 surgeries … during the screening period, 99 and 53 needle biopsies, 303 and 92 bronchoscopies, and 673 vs. 234 surgeries
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psnet.ahrq.gov/web-mm/inadequate-preanesthetic-evaluation-airway-trouble
November 01, 2023 - Inadequate Preanesthetic Evaluation, Airway Trouble
Citation Text:
Blitz J. Inadequate Preanesthetic Evaluation, Airway Trouble. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018.
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Format:
Google Scholar …
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.113_slideshow.ppt
January 01, 2006 - Spotlight Case [MONTH] 2003
Spotlight Case January 2006
An Ounce of Prevention
Source and Credits
This presentation is based on the Jan. 2006
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available through the Web site
Commentary by: Nils Kucher, MD; University Ho…
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www.ahrq.gov/sites/default/files/2024-03/connolly-report.pdf
January 01, 2024 - Final Progress Report: Topical Vancomycin for Neurosurgery Wound Prophylaxis
Title: Topical Vancomycin for Neurosurgery Wound Prophylaxis
Principal Investigator: Connolly, Edward Sander
Team Members:
Jared Knopman, MD - Site PI (Cornell)
Emilia Bagiella, PhD - Site PI (Mount Sinai)
Franklin Lowy, MD - Co-Investigato…
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psnet.ahrq.gov/web-mm/endotracheal-tube-fallout-patient-severe-obesity-during-eye-surgery
January 29, 2021 - Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery.
Citation Text:
Bohringer C. Endotracheal Tube Fallout in a Patient with Severe Obesity During Eye Surgery.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services.…
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psnet.ahrq.gov/issue/integration-formalized-handoff-system-surgical-curriculum-resident-perspectives-and-early
May 25, 2016 - Study
Integration of a formalized handoff system into the surgical curriculum: resident perspectives and early results.
Citation Text:
Telem DA. Integration of a Formalized Handoff System Into the Surgical Curriculum. Archives of Surgery. 2011;146(1). doi:10.1001/archsurg.2010.294.
Cop…
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/TND-0623-140828.pdf
April 25, 2014 - Topic 0527 Fertility Treatment in Women NSD SJ clean
Fertility Treatment in Women
Nomination Summary Document
Results of Topic Selection Process & Next St…
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psnet.ahrq.gov/issue/towards-model-surgeons-leadership-operating-room
July 01, 2020 - Review
Towards a model of surgeons' leadership in the operating room.
Citation Text:
Parker SH, Yule S, Flin R, et al. Towards a model of surgeons' leadership in the operating room. BMJ Qual Saf. 2011;20(7):570-9. doi:10.1136/bmjqs.2010.040295.
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Format:
DOI G…
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psnet.ahrq.gov/issue/tracking-intraoperative-complications
April 30, 2014 - Study
Tracking intraoperative complications.
Citation Text:
Platz J, Hyman N. Tracking intraoperative complications. J Am Coll Surg. 2012;215(4):519-23. doi:10.1016/j.jamcollsurg.2012.06.001.
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Format:
DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 …
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psnet.ahrq.gov/issue/surgical-fires-clear-and-present-danger
May 16, 2018 - Review
Surgical fires, a clear and present danger.
Citation Text:
Yardley IE, Donaldson LJ. Surgical fires, a clear and present danger. Surgeon. 2010;8(2):87-92. doi:10.1016/j.surge.2010.01.005.
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DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote …
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psnet.ahrq.gov/issue/enhancing-surgical-team-communication-sops-and-teamstepps-action
August 01, 2012 - Meeting/Conference Proceedings
Enhancing Surgical Team Communication: SOPS and TeamSTEPPS in Action.
Citation Text:
Enhancing Surgical Team Communication: SOPS and TeamSTEPPS in Action. Agency for Healthcare Research and Quality. July 25, 2024.
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psnet.ahrq.gov/issue/tqip-mortality-reporting-system-case-reports
March 23, 2022 - Special or Theme Issue
TQIP Mortality Reporting System Case Reports.
Citation Text:
TQIP Mortality Reporting System Case Reports. ACS TQIP Mortality Reporting System Writing Group. J Trauma Acute Care Surg. 2023.
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Pri…
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psnet.ahrq.gov/issue/safety-and-quality-perioperative-anesthesia-care
June 15, 2011 - Special or Theme Issue
Safety and Quality in Perioperative Anesthesia Care.
Citation Text:
Safety and Quality in Perioperative Anesthesia Care. Preckel B, ed. Best Pract Res Clin Anaesthesiol. 2021;35(1):1-154.
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