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The Collection
Annotated links to patient safety literature, news, and other resources.
The 25 most-viewed-items, updated weekly.
  1. STUDY 
    Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.
    Han YY, Carcillo JA, Venkataraman ST, et al. Pediatrics. 2005;116:1506-1512.
    National Patient Safety Goals.
    Oakbrook Terrace, IL: The Joint Commission; 2014.
    Patient Safety and the "Just Culture": A Primer for Health Care Executives.
    Marx D. New York, NY: Columbia University; 2001.
  4. STUDY
    Analysis of adverse events associated with adult moderate procedural sedation outside the operating room.
    Karamnov S, Sarkisian N, Grammer R, Gross WL, Urman RD. J Patient Saf. 2014 Sep 8; [Epub ahead of print].
    The evolving literature on safety WalkRounds: emerging themes and practical messages.
    Singer SJ, Tucker AL. BMJ Qual Saf. 2014;23:789-800.
    National Action Plan for Adverse Drug Event Prevention.
    Washington, DC: Office of Disease Prevention and Health Promotion, United States Department of Health and Human Services; September 2014.
    Discussing harm-causing errors with patients: an ethics primer for plastic surgeons.
    Vercler CJ, Buchman SR, Chung KC. Ann Plast Surg. 2014 May 14; [Epub ahead of print].
    A cycle of redemption in a medical error disclosure and apology program.
    Carmack HJ. Qual Health Res. 2014;24:860-869.
    Restoring trust in VA health care.
    Kizer KW, Jha AK. N Engl J Med. 2014;371:295-297.
    Reducing the Risks of Wrong-Site Surgery: Safety Practices from The Joint Commission Center for Transforming Healthcare Project.
    Chicago, IL: American Hospital Association, Health Research and Educational Trust, and Joint Commission Center for Transforming Healthcare; 2014.
  11. STUDY
    Natural history of retained surgical items supports the need for team training, early recognition, and prompt retrieval.
    Stawicki SP, Cook CH, Anderson HL III, et al; OPUS 12 Foundation Multicenter Trials Group. Am J Surg. 2014;208:65-72.
    10 years in, why time out still matters.
    Guglielmi CL, Canacari EG, DuPree ES, et al. AORN J. 2014;99:783-794.
  13. STUDY
    Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety.
    Griffiths P, Dall'Ora C, Simon M, et al; RN4CAST Consortium. Med Care. 2014 Sep 15; [Epub ahead of print].
  14. STUDY
    A qualitative analysis of physician perspectives on missed and delayed outpatient diagnosis: the focus on system-related factors.
    Sarkar U, Simchowitz B, Bonacum D, et al. Jt Comm J Qual Patient Saf. 2014;40:461-470.
  15. STUDY
    Exploring new avenues to assess the sharp end of patient safety: an analysis of nationally aggregated peer review data.
    Meeks DW, Meyer AND, Rose B, Walker YN, Singh H. BMJ Qual Saf. 2014 Sep 26; [Epub ahead of print].
    Special Focus Issue: Patient Safety.
    Wagner VD, ed. AORN J. 2014;100:351-456.
    Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
    Hughes RG, ed. Rockville, MD: Agency for Healthcare Research and Quality; 2008. AHRQ Publication No. 08-0043.  
    To Err Is Human: Building a Safer Health System.
    Kohn L, Corrigan J, Donaldson M, eds. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press; 1999. ISBN: 9780309068376.
  19. REVIEW
    Bedside shift reports: what does the evidence say?
    Gregory S, Tan D, Tilrico M, Edwardson N, Gamm L. J Nurs Adm. 2014 Sep 9; [Epub ahead of print].
  20. STUDY
    Support from hospital to home for elders: a randomized trial.
    Goldman LE, Sarkar U, Kessell E, et al. Ann Intern Med. 2014;161:472-481.
  21. STUDY
    The automated operating room: a team approach to patient safety and communication.
    Nissan J, Campos V, Delgado H, Matadial C, Spector S. JAMA Surg. 2014 Sep 24; [Epub ahead of print].
  22. REVIEW
    Reducing medication errors in critical care: a multimodal approach.
    Kruer RM, Jarrell AS, Latif A. Clin Pharmacol. 2014;6:117-126.
    The Definition of Quality and Approaches to Its Assessment. Vol 1. Explorations in Quality Assessment and Monitoring.
    Donabedian A. Ann Arbor, MI: Health Administration Press; 1980.
  24. STUDY
    Family participation during intensive care unit rounds: goals and expectations of parents and health care providers in a tertiary pediatric intensive care unit.
    Stickney CA, Ziniel SI, Brett MS, Truog RD. J Pediatr. 2014 Sep 19; [Epub ahead of print].
  25. REVIEW
    Interventions employed to improve intrahospital handover: a systematic review.
    Robertson ER, Morgan L, Bird S, Catchpole K, McCulloch P. BMJ Qual Saf. 2014;23:600-607.
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