AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (184)

•Diagnostic Errors (220)

•Identification Errors (151)

•Discontinuities, Gaps, and Hand-Off Problems (487)

•Fatigue and Sleep Deprivation (192)

•Medication Safety (1142)

•Medical Complications (452)

•Nonsurgical Procedural Complications (116)

•Surgical Complications (796)

•Transfusion Complications (20)

•Psychological and Social Complications (177)

Origin/Sponsor

•Australia and New Zealand (100)

•Central and South America (9)

•Europe (469)

•North America (3844)

Resource Types

•Audiovisual (47)

•Bibliography (2)

•Book/Report (214)

•Clinical Guideline (9)

•Journal Article (3421)

•Legislation/Regulation (61)

•Meeting/Conference (29)

•Newsletter/Journal (12)

•Newspaper/Magazine Article (401)

•Press Release/Announcement (33)

•Special or Theme Issue (73)

•Tools/Toolkit (66)

•Web Resource (119)

Error Types

•Epidemiology of Errors and Adverse Events (1007)

•Active Errors (707)

•Latent Errors (271)

•Near Miss (81)

Approach to Improving Safety

•Quality Improvement Strategies (1032)

•Legal and Policy Approaches (381)

•Error Reporting and Analysis (1227)

•Communication Improvement (1093)

•Human Factors Engineering (601)

•Teamwork (437)

•Specialization of Care (254)

•Logistical Approaches (384)

•Culture of Safety (527)

•Technologic Approaches (692)

•Education and Training (1132)

Clinical Areas

•Allied Health Services (12)

•Complementary and Alternative Medicine (1)

•Dentistry (7)

•Medicine (3099)

•Nursing (380)

•Pharmacy (387)

Target Audience

•Health Care Providers (3545)

•Health Care Executives and Administrators (3690)

•Non-Health Care Professionals (1813)

•Patients (314)

Setting of Care

•Hospitals (2801)

•Psychiatric Facilities (13)

•Residential Facilities (71)

•Ambulatory Care (349)

•Outpatient Surgery (56)

•Patient Transport (32)

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STUDY

Implementation of resident work hour restrictions is associated with a reduction in mortality and provider-related complications on the surgical service: a concurrent analysis of 14,610 patients.

Privette AR, Shackford SR, Osler T, Ratliff J, Sartorelli K, Hebert JC. Ann Surg. 2009;250:316-321.

COMMENTARY

How long does it take to train a surgeon?

Purcell Jackson G, Tarpley JL. BMJ. 2009;339:b4260.

STUDY

Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity.

Jagannathan J, Vates GE, Pouratian N, et al. J Neurosurg. 2009;110:820-827.

STUDY

The 80-hour work guidelines and resident survey perceptions of quality.

Biller CK, Antonacci AC, Pelletier S, et al. J Surg Res. 2006;135:275-281.

STUDY

The impact of the 80-hour resident workweek on surgical residents and attending surgeons.

Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. Ann Surg. 2006;243:864-871; discussion 871-875.

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.

COMMENTARY

Resident duty hour regulation and patient safety: establishing a balance between concerns about resident fatigue and adequate training in neurosurgery.

Grady MS, Batjer HH, Dacey RG. J Neurosurg. 2009;110:828-836.

COMMENTARY

Resident duty hours in surgery for ensuring patient safety, providing optimum resident education and training, and promoting resident well-being: a response from the American College of Surgeons to the Report of the Institute of Medicine, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety."

Britt LD, Sachdeva AK, Healy GB, Whalen TV, Blair PG; Members of the ACS Task Force on Resident Duty Hours. Surgery. 2009;146:398-409.

STUDY

The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program.

Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. Arch Intern Med. 2005;165:2601-2606.

STUDY

A policy-based intervention for the reduction of communication breakdowns in inpatient surgical care: results from a Harvard surgical safety collaborative.

Arriaga AF, Elbardissi AW, Regenbogen SE, et al. Ann Surg. 2011;253:849-854.

REVIEW

classic

Systematic review: association of shift length, protected sleep time, and night float with patient care, residents' health, and education.

Reed DA, Fletcher KE, Arora VM. Ann Intern Med. 2010;153:829-842.

COMMENTARY

Duty hours in emergency medicine: balancing patient safety, resident wellness, and the resident training experience: a consensus response to the 2008 Institute of Medicine resident duty hours recommendations.

Wagner MJ, Wolf S, Promes S, et al. J Emerg Med. 2010;39:348-355.

COMMENTARY

The top 10 list for a safe and effective sign-out.

Kemp CD, Bath JM, Berger J, et al. Arch Surg. 2008;143:1008-1010.

STUDY

Internal medicine trainees' views of training adequacy and duty hours restrictions in 2009.

Shea JA, Weissman A, McKinney S, Silber JH, Volpp KG. Acad Med. 2012;87:889-894.

STUDY

Should all duty hours be the same? Results of a national survey of surgical trainees.

Moalem J, Salzman P, Ruan DT, et al. J Am Coll Surg. 2009;209:47-54.

STUDY

The impact of the 80-hour work week on appropriate resident case coverage.

Shin S, Britt R, Doviak M, Britt LD. J Surg Res. 2010;162:33-36.

REVIEW

Restricted duty hours for surgeons and impact on residents quality of life, education, and patient care: a literature review.

Pape H, Pfeifer R. Patient Saf Surg. 2009;3:3.

BOOK/REPORT classic

classic

Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.

Ulmer C, Wolman DM, Johns MME, eds. Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedule to Improve Patient Safety, Institute of Medicine. Washington, DC: The National Academies Press; 2008. ISBN: 9780309127721.

NEWSPAPER/MAGAZINE ARTICLE

IOM: shorten residents' work shifts to reduce fatigue, improve patient safety.

Kuehn BM. JAMA. 2009;301:259-261.

STUDY

Handing over patient care: is it just the old broken telephone game?

Zendejas B, Ali SM, Huebner M, Farley DR. J Surg Educ. 2011;68:465-471.

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