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Patient Safety Network

The PSNet Collection: All Content

The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.

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Displaying 1 - 8 of 8 Results
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    • Doctors must stop tuning out Black women. It happened to me, as a pregnant OB-GYN.
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    • Gillispie-Bell V. USA Today. April 14, 2023.

    Structural racism and implicit biases can lead to poor quality of care and adverse outcomes among Black women. This article describes the experience of a Black OB/GYN patient whose concerns about abdominal pain during her pregnancy were not thoroughly evaluated; clinicians also missed risk factors placing her at risk of spontaneous preterm birth.
    Charlie Bourg was on the lookout for veterans harmed by a new VA computer system. He didn’t expect to be one of them.
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    • Donovan-Smith O. Spokesman-Review. September 11, 2022.

    Electronic health record (EHR) system issues degrade the data sharing and communication needed to inform safe patient care. This newspaper feature discusses problems with the new Veterans Affairs EHR system from the patient and family perspective in the context of diagnostic and treatment delay.
    Cancer diagnoses delayed among prisoners in Washington state.
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    • Medscape Medical News. May 12, 2021.

    Delays and mistakes in health care for distinct patient populations hold improvement lessons for the broader system. This news story highlights problems in correctional system cancer diagnoses and treatment that may indicate other types of prison care delivery problems.
    Sent home to die.
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    • Waldman A, Kaplan J. ProPublica. 2020.
    Hospitals have been deeply challenged to provide effective care during the COVID crisis. This article discusses how rationing and ineffective protection for families and patients may have contributed to preventable death and the spread of the virus in families due to unnecessary referrals of patients to home care and hospice.
    A 25-year-old teacher died after waiting hours at the ER. She's not the only one who saw delays.
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    • Linnane R, Diedrich J. Milwaukee Journal Sentinel. February 25, 2020.

    Delays in emergency room (ER) triage and assessment contribute to wide range of failures that degrade patient safety. This news story highlights the findings of a government report highlighting overcrowding and production pressures as factors resulting in the death of a patient waiting for care who initially presented at the ER with symptoms of heart attack.
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