AHRQ Patient Safety Network

The Collection > Operating Room

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Safety Target

•Device-related Complications (25)

•Diagnostic Errors (9)

•Identification Errors (73)

•Discontinuities, Gaps, and Hand-Off Problems (54)

•Fatigue and Sleep Deprivation (24)

•Medication Safety (45)

•Medical Complications (30)

•Nonsurgical Procedural Complications (6)

•Surgical Complications (597)

•Transfusion Complications (2)

•Psychological and Social Complications (38)

Origin/Sponsor

•Asia (8)

•Australia and New Zealand (23)

Resource Types

•Clinical Guideline (3)

•Journal Article (568)

•Legislation/Regulation (13)

•Meeting/Conference (1)

•Newspaper/Magazine Article (71)

•Press Release/Announcement (1)

•Special or Theme Issue (11)

•Tools/Toolkit (11)

•Web Resource (17)

Error Types

•Epidemiology of Errors and Adverse Events (163)

•Active Errors (150)

•Latent Errors (44)

•Near Miss (16)

Approach to Improving Safety

•Quality Improvement Strategies (146)

•Legal and Policy Approaches (51)

•Error Reporting and Analysis (160)

•Communication Improvement (220)

•Human Factors Engineering (175)

•Teamwork (133)

•Specialization of Care (16)

•Logistical Approaches (39)

•Culture of Safety (74)

•Technologic Approaches (62)

•Education and Training (171)

Clinical Areas

•Medicine (698)

•Nursing (59)

•Pharmacy (5)

Target Audience

•Health Care Providers (547)

•Health Care Executives and Administrators (503)

•Non-Health Care Professionals (216)

•Patients (67)

Setting of Care
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Operating Room

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MULTI-USE WEBSITE classic

National Surgical Quality Improvement Program.

American College of Surgeons.

STUDY

Relationship between occurrence of surgical complications and hospital finances.

Eappen S, Lane BH, Rosenberg B, et al. JAMA. 2013;309:1599-1606.

STUDY

Automated identification of postoperative complications within an electronic medical record using natural language processing.

Murff HJ, FitzHenry F, Matheny ME, et al. JAMA. 2011;306:848-855.

COMMENTARY classic

Case 34-2010: a 65-year-old woman with an incorrect operation on the left hand.

Ring DC, Herndon JH, Meyer GS. N Engl J Med. 2010;363:1950-1957.

STUDY

Effect of a comprehensive surgical safety system on patient outcomes.

de Vries EN, Prins HA, Crolla RM, et al; SURPASS Collaborative Group. N Engl J Med. 2010;363:1928-1937.

STUDY

Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.

Weiser TG, Haynes AB, Dziekan G, et al; Safe Surgery Saves Lives Investigators and Study Group. Ann Surg. 2010;251:976-980.

STUDY

Risks of complications by attending physicians after performing nighttime procedures.

Rothschild JM, Keohane CA, Rogers S, et al. JAMA. 2009;302:1565-1572.

STUDY

Rate of undesirable events at beginning of academic year: retrospective cohort study.

Haller G, Myles PS, Taffé P, Perneger TV, Wu CL. BMJ. 2009;339:b3974.

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

A surgical safety checklist to reduce morbidity and mortality in a global population.

Haynes AB, Weiser TG, Berry WR, et al; for the Safe Surgery Saves Lives Study Group. N Engl J Med. 2009;360:491-499.

STUDY

Validity of selected AHRQ Patient Safety Indicators based on VA National Surgical Quality Improvement program data.

Romano PS, Mull HJ, Rivard PE, et al. Health Serv Res. 2009;44:182-204.

STUDY

Surgical team behaviors and patient outcomes.

Mazzocco K, Petitti DB, Fong KT, et al. Am J Surg. 2009;197:678-685.

STUDY

Incidence and characteristics of potential and actual retained foreign object events in surgical patients.

Cima RR, Kollengode A, Garnatz J, et al. J Am Coll Surg. 2008;207:80-87.

STUDY

Managing the prevention of retained surgical instruments: what is the value of counting?

Egorova NN, Moskowitz A, Gelijns A, et al. Ann Surg. 2008;247:13-18.

STUDY

Bar-coding surgical sponges to improve safety: a randomized controlled trial.

Greenberg CC, Diaz-Flores R, Lipsitz SR, et al. Ann Surg. 2008;247:612-616.

STUDY

Postoperative handover: problems, pitfalls, and prevention of error.

Nagpal K, Arora S, Abboudi M, et al. Ann Surg. 2010;252:171-176.

STUDY

Variation in hospital mortality associated with inpatient surgery.

Ghaferi AA, Birkmeyer JD, Dimick JB. N Engl J Med. 2009;361:1368-1375.

COMMENTARY classic

A 62-year-old woman with skin cancer who experienced wrong-site surgery.

Gallagher TH. JAMA. 2009;302:669-677.

STUDY

Operating room briefings and wrong-site surgery.

Makary MA, Mukherjee A, Sexton BJ, et al. J Am Coll Surg. 2007;204:236-243.

STUDY

Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder.

Makary MA, Sexton JB, Freischlag JA, et al. J Am Coll Surg. 2006;202:746-752.

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