AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (130)

•Diagnostic Errors (129)

•Identification Errors (137)

•Discontinuities, Gaps, and Hand-Off Problems (335)

•Fatigue and Sleep Deprivation (114)

•Medication Safety (735)

•Medical Complications (371)

•Nonsurgical Procedural Complications (86)

•Surgical Complications (846)

•Transfusion Complications (13)

•Psychological and Social Complications (280)

Origin/Sponsor

•Africa (3)

•Asia (41)

•Australia and New Zealand (77)

•Central and South America (4)

•Europe (393)

•North America (3094)

Resource Types

•Audiovisual (30)

•Award (19)

•Book/Report (163)

•Clinical Guideline (7)

•Journal Article (2833)

•Legislation/Regulation (42)

•Meeting/Conference (24)

•Newsletter/Journal (5)

•Newspaper/Magazine Article (330)

•Press Release/Announcement (8)

•Special or Theme Issue (73)

•Tools/Toolkit (39)

•Web Resource (75)

•Grant (5)

Error Types

•Epidemiology of Errors and Adverse Events (691)

•Active Errors (535)

•Latent Errors (218)

•Near Miss (69)

Approach to Improving Safety

•Quality Improvement Strategies (862)

•Legal and Policy Approaches (284)

•Error Reporting and Analysis (984)

•Communication Improvement (914)

•Human Factors Engineering (510)

•Teamwork (514)

•Specialization of Care (195)

•Logistical Approaches (283)

•Culture of Safety (882)

•Technologic Approaches (466)

•Education and Training (1011)

Clinical Areas

•Allied Health Services (10)

•Complementary and Alternative Medicine (1)

Target Audience

•Health Care Providers (2394)

•Health Care Executives and Administrators (3011)

•Non-Health Care Professionals (1743)

•Patients (213)

Setting of Care

•Hospitals (2348)

•Psychiatric Facilities (10)

•Residential Facilities (51)

•Ambulatory Care (211)

•Outpatient Surgery (53)

•Patient Transport (20)

1 - 20 of 3653

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STUDY

The relationship of the emotional climate of work and threat to patient outcome in a high-volume thoracic surgery operating room team.

Nurok M, Evans LA, Lipsitz S, Satwicz P, Kelly A, Frankel A. BMJ Qual Saf. 2011;20:237-242.

STUDY

Crew resource management improved perception of patient safety in the operating room.

Gore DC, Powell JM, Baer JG, et al. Am J Med Qual. 2010;25:60-63.

STUDY

Attitudinal changes resulting from repetitive training of operating room personnel using high-fidelity simulation at the point of care.

Paige JT, Kozmenko V, Yang T, et al. Am Surg. 2009;75:584-591.

COMMENTARY

Surgical team training: promoting high reliability with nontechnical skills.

Paige JT. Surg Clin North Am. 2010;90:569-581.

STUDY

Surgical team training: the Northwestern Memorial Hospital experience.

Halverson AL, Andersson JL, Anderson K, et al. Arch Surg. 2009;144:107-112.

REVIEW

Enhancing communication in surgery through team training interventions: a systematic literature review.

Gillespie BM, Chaboyer W, Murray P. AORN J. 2010;92:642-657.

STUDY

The efficacy of medical team training: improved team performance and decreased operating room delays: a detailed analysis of 4863 cases.

Wolf FA, Way LW, Stewart L. Ann Surg. 2010;252:477-485.

STUDY

A novel method for reproducibly measuring the effects of interventions to improve emotional climate, indices of team skills and communication, and threat to patient outcome in a high-volume thoracic surgery center.

Nurok M, Lipsitz S, Satwicz P, Kelly A, Frankel A. Arch Surg. 2010;145:489-495.

STUDY

The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre.

McCulloch P, Mishra A, Handa A, Dale T, Hirst G, Catchpole K. Qual Saf Health Care. 2009;18:109-115.

STUDY

Communication failure in the operating room.

Halverson AL, Casey JT, Andersson J, et al. Surgery. 2011;49:305-310.

STUDY

Medical team training and coaching in the veterans health administration; assessment and impact on the first 32 facilities in the programme.

Neily J, Mills PD, Lee P, et al. Qual Saf Health Care. 2010;19:360-364.

STUDY

Predictors of successful implementation of preoperative briefings and postoperative debriefings after medical team training.

Paull DE, Mazzia LM, Izu BS, Neily J, Mills PD, Bagian JP. Am J Surg. 2009;198:675-678.

STUDY

Can aviation-based team training elicit sustainable behavioral change?

Sax HC, Browne P, Mayewski RJ, et al. Arch Surg. 2009;144:1133-1137.

STUDY

Incorrect surgical procedures within and outside of the operating room.

Neily J, Mills PD, Eldridge N, et al. Arch Surg. 2009;144:1028-1034.

STUDY

The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre.

Mishra A, Catchpole K, McCulloch P. Qual Saf Health Care. 2009;18:104-108.

STUDY

Improving operating room safety.

Hurlbert SN, Garrett J. Patient Saf Surg. 2009;3:25.

STUDY

Action research, simulation, team communication, and bringing the tacit into voice. Society for Simulation in Healthcare.

Forsythe L. Simul Healthc. 2009;4:143-148.

COMMENTARY

The normalization of deviance: what are the perioperative risks?

McNamara SA. AORN J. 2011;93:796-801.

STUDY

Use of the Safety Attitudes Questionnaire as a measure in patient safety improvement.

Watts BV, Percarpio K, West P, Mills PD. J Patient Saf. 2010;6:206-209.

STUDY

Improving perceptions of teamwork climate with the Veterans Health Administration medical team training program.

Carney BT, West P, Neily JB, Mills PD, Bagian JP. Am J Med Qual. 2011;26:480-484.

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