AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (203)

•Diagnostic Errors (249)

•Identification Errors (140)

•Discontinuities, Gaps, and Hand-Off Problems (769)

•Fatigue and Sleep Deprivation (124)

•Medication Safety (1432)

•Medical Complications (594)

•Nonsurgical Procedural Complications (106)

•Surgical Complications (455)

•Transfusion Complications (25)

•Psychological and Social Complications (202)

Origin/Sponsor

•Africa (8)

•Asia (53)

•Australia and New Zealand (138)

•Central and South America (5)

•Europe (527)

•North America (4417)

Resource Types

•Clinical Guideline (12)

•Journal Article (3582)

•Legislation/Regulation (81)

•Meeting/Conference (45)

•Newsletter/Journal (15)

•Newspaper/Magazine Article (614)

•Press Release/Announcement (39)

•Special or Theme Issue (80)

•Tools/Toolkit (109)

•Web Resource (168)

•Grant (16)

Error Types

•Epidemiology of Errors and Adverse Events (1032)

•Active Errors (703)

•Latent Errors (332)

•Near Miss (80)

Approach to Improving Safety

•Quality Improvement Strategies (1481)

•Legal and Policy Approaches (632)

•Error Reporting and Analysis (1450)

•Communication Improvement (1372)

•Human Factors Engineering (591)

•Teamwork (397)

•Specialization of Care (369)

•Logistical Approaches (393)

•Culture of Safety (782)

•Technologic Approaches (911)

•Education and Training (978)

Clinical Areas

•Allied Health Services (17)

Target Audience

•Health Care Providers (3729)

•Health Care Executives and Administrators (4011)

•Non-Health Care Professionals (1964)

•Patients (498)

Setting of Care

•Hospitals (3387)

•Psychiatric Facilities (25)

•Residential Facilities (87)

•Ambulatory Care (581)

•Outpatient Surgery (50)

•Patient Transport (37)

1 - 20 of 5242

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REVIEW

Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.

Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. JAMA. 2007;297:831-841.

STUDY

The care transitions intervention: translating from efficacy to effectiveness.

Voss R, Gardner R, Baier R, Butterfield K, Lehrman S, Gravenstein S. Arch Intern Med. 2011;171:1232-1237.

STUDY

Preliminary assessment of pediatric health care quality and patient safety in the United States using readily available administrative data.

McDonald KM, Davies SM, Haberland CA, et al. Pediatrics. 2008;122:e416-e425.

BOOK/REPORT

Managing Patients' Medicines after Discharge from Hospital.

London, UK: Care Quality Commission; October 2009. CQC-039-500-ESP-102009. ISBN: 9781845622442.

STUDY

Physician perspectives on quality and error in the outpatient setting.

Manwell LB, Williams ES, Babbott S, Rabatin JS, Linzer M. WMJ. 2009;108:139-144.

STUDY

Information exchange among physicians caring for the same patient in the community.

van Walraven C, Taljaard M, Bell CM, et al. CMAJ. 2008;179:1013-1018.

MULTI-USE WEBSITE

Getting Safer Care.

Agency for Healthcare Research and Quality.

BOOK/REPORT

Safety in Doses.

London, UK: National Patient Safety Agency; 2009. ISBN: 9781906624088.

ORGANIZATIONAL POLICY/GUIDELINES

Preventing errors relating to commonly used anticoagulants.

Sentinel Event Alert. September 24, 2008;(41):1-4.

NEWSPAPER/MAGAZINE ARTICLE

Small patients, big consequences in medical errors.

Tarkan L. New York Times. September 14, 2008;Health section:7.

STUDY

Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary.

O'Leary KJ, Liebovitz SM, Feinglass J, et al. J Hosp Med. 2009;4:219-225.

STUDY

A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.

Jack BW, Chetty VK, Anthony D, et al. Ann Intern Med. 2009;150:178-187.

NEWSPAPER/MAGAZINE ARTICLE

Perfect is possible.

Berwick DM, Leape LL. Newsweek. October 16, 2006:70-71.

STUDY

Association of communication between hospital-based physicians and primary care providers with patient outcomes.

Bell CM, Schnipper JL, Auerbach AD, et al. J Gen Intern Med. 2009;24:381-386.

STUDY

Are opioid dependence and methadone maintenance treatment (MMT) documented in the medical record? A patient safety issue.

Walley AY, Farrar D, Cheng DM, Alford DP, Samet JH. J Gen Intern Med. 2009;24:1007-1011.

BOOK/REPORT

Safety First: Top of Your Board's Agenda: 100 Day Challenge Survey Report.

The Patients Association. Harrow, Middlesex, UK: The Patients Association; June 2009.

COMMENTARY

Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction.

Clancy CM. Am J Med Qual. 2009;24:344-346.

STUDY

The relationship between patients' perception of care and measures of hospital quality and safety.

Isaac T, Zaslavsky AM, Cleary PD, Landon BE. Health Serv Res. 2010;45:1024-1040.

MULTI-USE WEBSITE

Project Red (Re-Engineered Discharge).

Boston, MA: Boston University Medical Center.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2009;44:654-657.

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