AHRQ Patient Safety Network

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The Collection

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Safety Target

•Device-related Complications (79)

•Diagnostic Errors (132)

•Identification Errors (68)

•Discontinuities, Gaps, and Hand-Off Problems (260)

•Fatigue and Sleep Deprivation (59)

•Medication Safety (775)

•Medical Complications (234)

•Nonsurgical Procedural Complications (47)

•Surgical Complications (414)

•Transfusion Complications (11)

•Psychological and Social Complications (73)

Origin/Sponsor

•Africa (2)

•Asia (49)

•Australia and New Zealand (74)

•Central and South America (6)

•Europe (364)

•North America (1683)

Resource Types
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Study

Error Types

•Epidemiology of Errors and Adverse Events (1185)

•Active Errors (395)

•Latent Errors (87)

•Near Miss (61)

Approach to Improving Safety

•Quality Improvement Strategies (404)

•Legal and Policy Approaches (90)

•Error Reporting and Analysis (740)

•Communication Improvement (429)

•Human Factors Engineering (282)

•Teamwork (171)

•Specialization of Care (138)

•Logistical Approaches (180)

•Culture of Safety (184)

•Technologic Approaches (402)

•Education and Training (359)

Clinical Areas

•Allied Health Services (4)

Target Audience

•Health Care Providers (1529)

•Health Care Executives and Administrators (1866)

•Non-Health Care Professionals (767)

•Patients (16)

Setting of Care

•Hospitals (1547)

•Psychiatric Facilities (9)

•Residential Facilities (48)

•Ambulatory Care (216)

•Outpatient Surgery (19)

•Patient Transport (23)

1 - 20 of 2183

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STUDY

Quality improvement project to reduce perioperative opioid oversedation events in a paediatric hospital.

Vermaire D, Caruso MC, Lesko A, et al. BMJ Qual Saf. 2011;20:895-902.

STUDY

Human factors in pediatric anesthesia incidents.

Marcus R. Paediatr Anaesth. 2006;16:242-250.

STUDY

Safety on an inpatient pediatric otolaryngology service: many small errors, few adverse events.

Shah RK, Lander L, Forbes P, Jenkins K, Healy GB, Roberson DW. Laryngoscope. 2009;119:871-879.

STUDY

Risk factors and outcomes for foreign body left during a procedure: analysis of 413 incidents after 1,946,831 operations in children.

Camp M, Chang DC, Zhang Y, Chrouser K, Colombani PM, Abdullah F. Arch Surg. 2010;145:1085-1090.

STUDY

Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomised clinical evaluation.

Merry AF, Webster CS, Hannam J, et al. BMJ. 2011;343:d5543.

STUDY

Nature, causes and consequences of unintended events in surgical units.

van Wagtendonk I, Smits M, Merten H, Heetveld MJ, Wagner C. Br J Surg. 2010;97:1730-1740.

STUDY

An intervention to decrease patient identification band errors in a children's hospital.

Hain PD, Joers B, Rush M, et al. Qual Saf Health Care. 2010;19:244-247.

STUDY

The influence of resident involvement on surgical outcomes.

Raval MV, Wang X, Cohen ME, et al. J Am Coll Surg. 2011;212:889-898.

STUDY

Cranshaw J, Gupta KJ, Cook TM. Anaesthesia. 2009;64:1317-1323.

STUDY

Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.

Weiser TG, Haynes AB, Dziekan G, et al; Safe Surgery Saves Lives Investigators and Study Group. Ann Surg. 2010;251:976-980.

STUDY

Preventable anesthesia mishaps: a study of human factors.

Cooper JB, Newbower RS, Long CD, McPeek B. Anesthesiology. 1978;49:399-406.

STUDY

Implementing a surgical checklist: more than checking a box.

Levy SM, Senter CE, Hawkins RB, et al. Surgery. 2012;152:331-336.

STUDY

Paid malpractice claims for adverse events in inpatient and outpatient settings.

Bishop TF, Ryan AK, Casalino LP. JAMA. 2011;305:2427-2431.

STUDY

Time of day effects on the incidence of anesthetic adverse events.

Wright MC, Phillips-Bute B, Mark JB, et al. Qual Saf Health Care. 2006;15:258-263.

STUDY

Missed steps in the preanesthetic set-up.

Demaria S Jr, Blasius K, Neustein SM. Anesth Analg. 2011;113:84-88.

STUDY

Medical errors in orthopaedics. Results of an AAOS member survey.

Wong DA, Herndon JH, Canale ST, et al. J Bone Joint Surg Am. 2009;91:547-557.

STUDY

Analysis of surgical errors in closed malpractice claims at 4 liability insurers.

Rogers SO Jr, Gawande AA, Kwaan M, Puopolo AL, Yoon C, Brennan TA, Studdert DM. Surgery. 2006;140:25-33.

STUDY

Infrequent physician use of implantable cardioverter-defibrillators risks patient safety.

Lyman S, Sedrakyan A, Do H, Razzano R, Mushlin AI. Heart. 2011;97:1655-1660.

STUDY

Classification of adverse events occurring in a surgical intensive care unit.

Frankel H, Sperry J, Kaplan L, Foley A, Rabinovici R. Am J Surg. 2007;194:328-332.

STUDY

Critical phase distractions in anaesthesia and the sterile cockpit concept.

Broom MA, Capek AL, Carachi P, Akeroyd MA, Hilditch G. Anaesthesia. 2011;66:175-179.

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