AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (179)

•Diagnostic Errors (83)

•Identification Errors (79)

•Discontinuities, Gaps, and Hand-Off Problems (401)

•Fatigue and Sleep Deprivation (92)

•Medication Safety (760)

•Medical Complications (462)

•Nonsurgical Procedural Complications (62)

•Surgical Complications (294)

•Transfusion Complications (18)

•Psychological and Social Complications (104)

Origin/Sponsor

•Africa (2)

•Asia (33)

•Australia and New Zealand (57)

•Central and South America (1)

•Europe (289)

•North America (2486)

Resource Types

•Audiovisual (40)

•Award (22)

•Book/Report (176)

•Clinical Guideline (5)

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•Legislation/Regulation (41)

•Meeting/Conference (11)

•Newspaper/Magazine Article (439)

•Press Release/Announcement (10)

•Special or Theme Issue (34)

•Tools/Toolkit (45)

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Error Types

•Epidemiology of Errors and Adverse Events (647)

•Active Errors (364)

•Latent Errors (223)

•Near Miss (37)

Approach to Improving Safety

•Quality Improvement Strategies (761)

•Legal and Policy Approaches (341)

•Error Reporting and Analysis (817)

•Communication Improvement (674)

•Human Factors Engineering (414)

•Teamwork (232)

•Specialization of Care (251)

•Logistical Approaches (267)

•Culture of Safety (568)

•Technologic Approaches (502)

•Education and Training (553)

Clinical Areas

•Allied Health Services (3)

•Medicine (2159)

•Nursing (257)

•Pharmacy (313)

Target Audience

•Health Care Providers (1782)

•Health Care Executives and Administrators (2308)

•Non-Health Care Professionals (1069)

•Patients (309)

Setting of Care
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Hospitals

•General Hospitals (656)

•Children’s Hospitals (79)

•Specialty Hospitals (34)

1 - 20 of 2920

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COMMENTARY

Hospital board checklist to improve culture and reduce central line–associated bloodstream infections.

Goeschel CA, Holzmueller CG, Pronovost PJ. Jt Comm J Qual Patient Saf. 2010;36:525-528.

COMMENTARY

Learning accountability for patient outcomes.

Pronovost PJ. JAMA. 2010;304:204-205.

BOOK/REPORT

Tennessee Center for Patient Safety Annual Report 2010.

Nashville, TN: Tennessee Center for Patient Safety; August 2011.

STUDY

A multidisciplinary approach to reduce central line–associated bloodstream infections.

McMullan C, Propper G, Schuhmacher C, et al. Jt Comm J Qual Patient Saf. 2013;39:61-69.

ORGANIZATIONAL POLICY/GUIDELINES classic

A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals.

Yokoe DS, Mermel LA, Anderson DJ, et al. Infect Control Hosp Epidemiol. 2008;29:901-994.

BOOK/REPORT classic

Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out.

Pronovost P, Vohr E. New York, NY: Hudson Street Press; 2010. ISBN: 9781594630644.

BOOK/REPORT

2009 National Healthcare Quality Report.

Rockville, MD: Agency for Healthcare Research and Quality; March 2010. AHRQ Publication No. 10-0003.

BOOK/REPORT

Meeting the Joint Commission's 2013 National Patient Safety Goals.

Oakbrook Terrace, IL: The Joint Commission; September 2012. ISBN: 9781599407555.

NEWSPAPER/MAGAZINE ARTICLE

Rounding to influence.

Reinertsen JL, Johnson KM. Healthc Exec. Sept/Oct 2010;25:72-75.

NEWSPAPER/MAGAZINE ARTICLE

Driving out errors, with mom in mind.

Weinstock M. Hosp Health Netw. April 2011.

STUDY

Association between hospital-reported Leapfrog Safe Practices scores and inpatient mortality.

Kernisan LP, Lee SJ, Boscardin WJ, Landefeld CS, Dudley RA. JAMA. 2009;301:1341-1348.

AUDIOVISUAL

How a simple checklist can dramatically reduce medical errors.

Pronovost PJ. On Call. IHI Open School for Health Professionals. November 3, 2008.

BOOK/REPORT

First, Do Less Harm: Confronting the Inconvenient Problems of Patient Safety.

Koppel R, Gordon S, ed. Ithaca, NY: Cornell University Press; 2012. ISBN: 9780801450778.

COMMENTARY

Addressing healthcare-associated infections and antimicrobial resistance from an organizational perspective: progress and challenges.

Murray E, Holmes A. J Antimicrob Chemother. 2012;67(suppl 1):i29-i36.

AUDIOVISUAL

Battling hospital-acquired infections.

Gross T. "Fresh Air." National Public Radio. January 9, 2008.

STUDY

Patient safety begins with proper planning: a quantitative method to improve hospital design.

Birnbach DJ, Nevo I, Scheinman SR, Fitzpatrick M, Shekhter I, Lombard JL. Qual Saf Health Care. 2010;19:462-465.

SPECIAL OR THEME ISSUE

Front-Line Ownership: Generating a Cure Mindset for Patient Safety.

Kitts J, ed. Healthcare Papers. 2013;13:1-82.

STUDY

The importance of leadership in preventing healthcare–associated infection: results of a multisite qualitative study.

Saint S, Kowalski CP, Banaszak-Holl J, Forman J, Damschroder L, Krein SL. Infect Control Hosp Epidemiol. 2010;31:901-907.

BOOK/REPORT

To Err Is Human—But Don't Expect to Get Paid For It.

ASQ Quarterly Quality Report. Milwaukee, WI: American Society of Quality; October 2008.

STUDY

Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis.

Lipitz-Snyderman A, Steinwachs D, Needham DM, Colantuoni E, Morlock LL, Pronovost PJ. BMJ. 2011;342:d219.

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