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psnet.ahrq.gov/glossary
January 01, 2003 - Complexity theory differs importantly from systems thinking in its emphasis on the interaction between … Metacognition
Metacognition refers to thinking about thinking—that is, reflecting on the thought processes … Mistakes reflect failures during attentional behaviorsâbehavior that requires conscious thought, analysis
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psnet.ahrq.gov/glossary-0
January 01, 2003 - Complexity theory differs importantly from systems thinking in its emphasis on the interaction between … Metacognition
Metacognition refers to thinking about thinking—that is, reflecting on the thought … Mistakes reflect failures during attentional behaviorsâbehavior that requires conscious thought, analysis
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psnet.ahrq.gov/issue/preventing-workplace-violence
July 25, 2023 - International Meeting/Conference
Preventing Workplace Violence.
Citation Text:
National Action Alliance. June 27, 2023. 2:00- 3:00 PM (eastern)
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psnet.ahrq.gov/web-mm/looking-meds-all-wrong-places
June 16, 2021 - Looking for Meds in All the Wrong Places
Citation Text:
Manias E. Looking for Meds in All the Wrong Places. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012.
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psnet.ahrq.gov/web-mm/medication-overdose
September 01, 2011 - Medication Overdose
Citation Text:
Kaushal R. Medication Overdose. 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/49589/psn-pdf
August 01, 2009 - Hiding in Plain Sight
August 1, 2009
Weinberg JM. Hiding in Plain Sight. PSNet [internet]. 2009.
https://psnet.ahrq.gov/web-mm/hiding-plain-sight
The Case
A 65-year-old woman presented to an emergency department (ED) with 48 hours of nontraumatic left lower
back pain and general malaise. She was diagnosed with a …
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psnet.ahrq.gov/web-mm/moved-too-soon
November 01, 2006 - Moved Too Soon
Citation Text:
Lindenauer PK. Moved Too Soon. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004.
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psnet.ahrq.gov/node/49572/psn-pdf
October 01, 2008 - Mistaken Identity
October 1, 2008
Hall LW. Mistaken Identity. PSNet [internet]. 2008.
https://psnet.ahrq.gov/web-mm/mistaken-identity
The Case
An 85-year-old Cantonese-speaking woman was admitted to the medical service with altered mental status
and a reported fall. After finding tenderness in her left hip, the p…
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psnet.ahrq.gov/node/49494/psn-pdf
January 01, 2006 - One Dose, Fifty Pills
November 1, 2005
Smith L. One Dose, Fifty Pills . PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/one-dose-fifty-pills
The Case
A middle-aged man was admitted to the medical service of a teaching hospital with suspected vasculitis.
When the initial diagnostic studies failed to provide …
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psnet.ahrq.gov/primers-0
March 15, 2025 - Primers
Guides for key topics in patient safety through context, epidemiology, and relevant AHRQ PSNet content. The Patient Safety 101 Primer provides an overview of the patient safety field and covers key definitions and concepts.
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Clinical Decision Support Systems
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psnet.ahrq.gov/web-mm/pca-overdose
April 01, 2017 - PCA Overdose
Citation Text:
Doyle JD. PCA Overdose. 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/web-mm/rapid-mis-strep
February 01, 2004 - Rapid Mis-St(r)ep
Citation Text:
Kaplan EL. Rapid Mis-St(r)ep. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007.
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psnet.ahrq.gov/web-mm/after-visit-confusion
August 21, 2007 - After-Visit Confusion
Citation Text:
Ventres W. After-Visit Confusion. 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/node/33614/psn-pdf
June 01, 2005 - to
treat acetaminophen overdoses and bronchitis.(1) When I asked a nephrologist colleague what he thought
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psnet.ahrq.gov/node/49547/psn-pdf
October 01, 2007 - requires that a hospital's dedicated emergency department would not only encompass
what is generally thought
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psnet.ahrq.gov/node/865419/psn-pdf
March 27, 2024 - reliability in identifying
children at risk of poor outcomes and concern that clinicians may be misled into thinking … hyponatremia is known to be associated with community-acquired pneumonia, with the degree of
hyponatremia thought
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psnet.ahrq.gov/web-mm/do-not-miss-sepsis-needles-viral-haystacks
March 27, 2024 - reliability in identifying children at risk of poor outcomes and concern that clinicians may be misled into thinking … hyponatremia is known to be associated with community-acquired pneumonia, with the degree of hyponatremia thought
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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 - reliability in identifying children at risk of poor outcomes and
concern that clinicians may be misled into thinking … hyponatremia is known to be associated with community-acquired
pneumonia, with the degree of hyponatremia thought
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psnet.ahrq.gov/web-mm/too-many-cooks-kitchen
March 07, 2018 - ignoring others, akin to anchoring bias. 13,14 Learning tools that teach “outside-the-box” or “lateral” thinking
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psnet.ahrq.gov/perspective/conversation-katie-j-suda-pharmd-ms
December 07, 2020 - In Conversation With... Katie J. Suda, PharmD, MS
December 7, 2020
Also Read the Essay
Citation Text:
In Conversation With.. Katie J. Suda, PharmD, MS . PSNet [internet]. 2020.In Conversation With... Katie J. Suda, PharmD, MS . PSNet [internet]. Rockville (MD): …