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psnet.ahrq.gov/sites/default/files/2024-03/final_spotlight_case_not_missing_sepsis_needles_in_viral_haystacks_slides_march_date.pdf
January 01, 2024 - • Laboratory testing showed normal white blood cell count of 8,500, but with 1.6%
abnormal metamyelocytes
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psnet.ahrq.gov/perspective/conversation-cindy-brach
December 27, 2019 - studies and videos. [24] The success of TeamSTEPPS is well documented in the literature [25] and field testing
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psnet.ahrq.gov/web-mm/under-pressure-tracheostomy-cuff-over-inflation-leading-tissue-necrosis-and-cuff-rupture
March 15, 2023 - WebM&M Cases
Agitated Delirium Contributes to Missed Testing
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psnet.ahrq.gov/web-mm/despite-clues-failed-rescue
August 02, 2015 - technology-focused solutions developed in research environments will require appropriate real-world testing
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psnet.ahrq.gov/web-mm/when-patients-and-providers-speak-different-languages
December 08, 2021 - symptoms concerning for unstable angina and determined that the patient would require additional cardiac testing
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psnet.ahrq.gov/web-mm/challenges-diabetes-management-and-medication-reconciliation
March 15, 2023 - open-ended questions may help team members to obtain important information on affordability and access to testing
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psnet.ahrq.gov/web-mm/forgotten-turn
August 01, 2018 - End Despite End-of-Life Care Planning
August 1, 2018
A simulation systems testing
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psnet.ahrq.gov/issue/emedication-monitoring
April 25, 2018 - Multi-use Website
eMedication Monitoring.
Citation Text:
Agency for Healthcare Research and Quality; AHRQ.
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March 30, 2011
A…
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psnet.ahrq.gov/perspectives
May 01, 2021 - Perspectives on Safety
Our Perspectives on Safety section features expert viewpoints on current themes in patient safety, including interviews and written essays published monthly. Annual Perspectives highlight vital and emerging patient safety topics.
Pod…
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psnet.ahrq.gov/issue/mri-safety-week
January 29, 2021 - Multi-use Website
MRI Safety Week.
Citation Text:
International Society for Magnetic Resonance in Medicine.
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June 27, 2007
I…
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psnet.ahrq.gov/issue/why-doctors-so-often-get-it-wrong
October 03, 2007 - Newspaper/Magazine Article
Why doctors so often get it wrong.
Citation Text:
Leonhardt D.
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March 8, 2006
Leonhardt D.
V…
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psnet.ahrq.gov/issue/state-nurse-error-caused-death
May 10, 2006 - Newspaper/Magazine Article
State: nurse error caused death.
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August 2, 2006
View more articles from the same authors.
This article reports on a fe…
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psnet.ahrq.gov/issue/facts-about-patient-safety
May 30, 2012 - Fact Sheet/FAQs
Facts About Patient Safety.
Citation Text:
The Joint Commission.
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March 6, 2005
The Joint Commission.
…
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psnet.ahrq.gov/node/49471/psn-pdf
December 01, 2004 - Carpe Diem (Seize the Day)
December 1, 2004
Krumholz A. Carpe Diem (Seize the Day). PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/carpe-diem-seize-day
The Case
A 53-year-old man presented for a new patient visit at a local medical clinic. He had several chronic
medical conditions including hypertension, h…
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psnet.ahrq.gov/primer/strategies-and-approaches-tracking-improvements-patient-safety
June 15, 2024 - Strategies and Approaches for Tracking Improvements in Patient Safety
Citation Text:
Shaikh U. Strategies and Approaches for Tracking Improvements in Patient Safety . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021.
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psnet.ahrq.gov/node/612828/psn-pdf
February 23, 2022 - Delayed Diagnosis of Kidney Transplant Complications
February 23, 2022
Kapa N, Morfín JA. Delayed Diagnosis of Kidney Transplant Complications. PSNet [internet]. 2022.
https://psnet.ahrq.gov/web-mm/delayed-diagnosis-kidney-transplant-complications
Objectives
Recognition, early evaluation, and management of kidney …
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psnet.ahrq.gov/node/49740/psn-pdf
August 21, 2015 - Baffled by Botulinum Toxin
August 21, 2015
Sivaraman-Nair KP. Baffled by Botulinum Toxin. PSNet [internet]. 2015.
https://psnet.ahrq.gov/web-mm/baffled-botulinum-toxin
The Case
A 5-year-old boy with a history of transverse myelitis with resultant spasticity of both lower extremities, gait
abnormalities, neurogeni…
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psnet.ahrq.gov/web-mm/shake-well
September 01, 2006 - Shake Well
Citation Text:
Flynn EA. Shake Well. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
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psnet.ahrq.gov/node/49532/psn-pdf
March 15, 2007 - Back to Basics
March 1, 2007
Hellman R. Back to Basics. PSNet [internet]. 2007.
https://psnet.ahrq.gov/web-mm/back-basics
The Case
A 48-year-old woman with insulin-dependent diabetes mellitus presents to the emergency department with
right upper quadrant pain, fever, and leukocytosis, prompting admission for pres…
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psnet.ahrq.gov/node/33870/psn-pdf
November 01, 2018 - The Comprehensivist Model of Care: A Hospitalist's View
November 1, 2018
Wachter R. The Comprehensivist Model of Care: A Hospitalist's View. PSNet [internet]. 2018.
https://psnet.ahrq.gov/perspective/comprehensivist-model-care-hospitalists-view
Perspective
In this month's PSNet perspective, I interview Dr. David M…