AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (198)

•Diagnostic Errors (280)

•Identification Errors (150)

•Discontinuities, Gaps, and Hand-Off Problems (748)

•Fatigue and Sleep Deprivation (108)

•Medication Safety (1345)

•Medical Complications (513)

•Nonsurgical Procedural Complications (110)

•Surgical Complications (514)

•Transfusion Complications (26)

•Psychological and Social Complications (157)

Origin/Sponsor

•Australia and New Zealand (128)

•Central and South America (9)

•Europe (425)

•North America (3991)

Resource Types

•Audiovisual (48)

•Bibliography (4)

•Book/Report (294)

•Clinical Guideline (6)

•Journal Article (3330)

•Legislation/Regulation (58)

•Meeting/Conference (46)

•Newsletter/Journal (14)

•Newspaper/Magazine Article (522)

•Press Release/Announcement (36)

•Special or Theme Issue (71)

•Tools/Toolkit (66)

•Web Resource (141)

Error Types

•Epidemiology of Errors and Adverse Events (1418)

•Active Errors (869)

•Latent Errors (301)

•Near Miss (89)

Approach to Improving Safety

•Quality Improvement Strategies (1135)

•Legal and Policy Approaches (537)

•Error Reporting and Analysis (1343)

•Communication Improvement (1202)

•Human Factors Engineering (551)

•Teamwork (358)

•Specialization of Care (344)

•Logistical Approaches (335)

•Culture of Safety (648)

•Technologic Approaches (810)

•Education and Training (878)

Clinical Areas

•Allied Health Services (17)

•Dentistry (3)

•Medicine (3110)

•Nursing (286)

•Pharmacy (495)

Target Audience

•Health Care Providers (3571)

•Health Care Executives and Administrators (3741)

•Non-Health Care Professionals (1724)

•Patients (410)

Setting of Care

•Hospitals (2887)

•Psychiatric Facilities (17)

•Residential Facilities (82)

•Ambulatory Care (460)

•Outpatient Surgery (53)

•Patient Transport (51)

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STUDY

"Sign right here and you're good to go": a content analysis of audiotaped emergency department discharge instructions.

Vashi A, Rhodes KV. Ann Emerg Med. 2011;57:315-322.e1.

NEWSPAPER/MAGAZINE ARTICLE

Inquiry into reporter's death finds multiple failures in care.

Stout D. New York Times. June 17, 2006;National desk:9.

STUDY

The association between transfer of emergency department boarders to inpatient hallways and mortality: a 4-year experience.

Viccellio A, Santora C, Singer AJ, Thode HC Jr, Henry MC. Ann Emerg Med. 2009;54:511-513.

STUDY

The "July phenomenon": is trauma the exception?

Schroeppel TJ, Fischer PE, Magnotti LJ, Croce MA, Fabian TC. J Am Coll Surg. 2009;209:378-384.

STUDY

Diagnostic accuracy of emergency nurse practitioners versus physicians related to minor illnesses and injuries.

van der Linden C, Reijnen R, de Vos R. J Emerg Nurs. 2010;36:311-316.

STUDY

ED overcrowding is associated with an increased frequency of medication errors.

Kulstad EB, Sikka R, Sweis RT, Kelley KM, Rzechula KH. Am J Emerg Med. 2010;28:304-309.

STUDY

Accuracy of radiographic readings in the emergency department.

Petinaux B, Bhat R, Boniface K, Aristizabal J. Am J Emerg Med. 2011;29:18-25.

STUDY

Reevaluating recovery: perceived violations and preemptive interventions on emergency psychiatry rounds.

Cohen T, Blatter B, Almeida C, Patel VL. J Am Med Inform Assoc. 2007;14:312-319.

STUDY

Older veterans and emergency department discharge information.

Hastings S, Stechuchak K, Oddone E, et al. BMJ Qual Saf. 2012;21:835-842.

COMMENTARY

Improving handoffs in the emergency department.

Cheung DS, Kelly JJ, Beach C, et al; American College of Emergency Physicians Section of Quality Improvement and Patient Safety. Ann Emerg Med. 2010;55:171-180.

STUDY

Older patients' understanding of emergency department discharge information and its relationship with adverse outcomes.

Hastings SN, Barrett A, Weinberger M, et al. J Patient Saf. 2011;7:19-25.

STUDY

National study on the frequency, types, causes, and consequences of voluntarily reported emergency department medication errors.

Pham JC, Story JL, Hicks RW, et al. J Emerg Med. 2011;40:485-492.

STUDY

Computerized decision support for medication dosing in renal insufficiency: a randomized, controlled trial.

Terrell KM, Perkins AJ, Hui SL, Callahan CM, Dexter PR, Miller DK. Ann Emerg Med. 2010;56:623-629.

STUDY

Medical reconciliation in patients discharged from the emergency department.

Sharma AN, Dvorkin R, Tucker V, Margulies J, Yens D, Rosalia A Jr. J Emerg Med. 2012;43:366-373.

REVIEW

Missed injuries in trauma patients: a literature review.

Pfeifer R, Pape HC. Patient Saf Surg. 2008;2:20.

STUDY

classic

Emergency hospitalizations for adverse drug events in older Americans.

Budnitz DS, Lovegrove MC, Shehab N, Richards CL. N Engl J Med. 2011;365:2002-2012.

STUDY

Beating the weekend trend: increased mortality in older adult traumatic brain injury (TBI) patients admitted on weekends.

Schneider EB, Hirani SA, Hambridge HL, et al. J Surg Res. 2012;177:295-300.

STUDY

Pediatric adverse drug events in the outpatient setting: an 11-year national analysis.

Bourgeois FT, Mandl KD, Valim C, Shannon MW. Pediatrics. 2009;124:e744-e750.

STUDY

'The ABC of Handover': impact on shift handover in the emergency department.

Farhan M, Brown R, Vincent C, Woloshynowych M. Emerg Med J. 2012;29:947-953.

NEWSPAPER/MAGAZINE ARTICLE

A hospital races to learn lessons of Ferrari pit stop.

Naik G. Wall Street Journal. November 14, 2006:A1. [reprinted on Post-gazette.com].

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