AHRQ Patient Safety Network

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PATIENT SAFETY PRIMERS
Patient Safety in Ambulatory Care

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Safety Target

•Device-related Complications (8)

•Diagnostic Errors (38)

•Identification Errors (9)

•Discontinuities, Gaps, and Hand-Off Problems (83)

•Fatigue and Sleep Deprivation (1)

•Medication Safety (204)

•Medical Complications (29)

•Nonsurgical Procedural Complications (6)

•Surgical Complications (14)

•Transfusion Complications (2)

•Psychological and Social Complications (9)

Origin/Sponsor

•Australia and New Zealand (12)

•North America (314)

Resource Types

•Audiovisual (10)

•Book/Report (37)

•Clinical Guideline (1)

•Journal Article (291)

•Legislation/Regulation (8)

•Meeting/Conference (6)

•Newspaper/Magazine Article (27)

•Press Release/Announcement (7)

•Special or Theme Issue (7)

•Tools/Toolkit (11)

•Web Resource (8)

Error Types

•Epidemiology of Errors and Adverse Events (165)

•Active Errors (82)

•Latent Errors (20)

•Near Miss (5)

Approach to Improving Safety

•Quality Improvement Strategies (95)

•Legal and Policy Approaches (45)

•Error Reporting and Analysis (113)

•Communication Improvement (145)

•Human Factors Engineering (35)

•Teamwork (17)

•Specialization of Care (18)

•Logistical Approaches (18)

•Culture of Safety (40)

•Technologic Approaches (107)

•Education and Training (61)

Clinical Areas

•Allied Health Services (3)

•Dentistry (5)

•Medicine (280)

•Nursing (13)

•Pharmacy (85)

Target Audience

•Health Care Providers (336)

•Health Care Executives and Administrators (267)

•Non-Health Care Professionals (145)

•Patients (48)

Setting of Care
< All

Ambulatory Care

•Home Care (29)

•Ambulatory Clinic or Office (122)

•Outpatient Pharmacy (26)

1 - 20 of 415

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BOOK/REPORT

Adverse Health Events in Minnesota: Ninth Annual Public Report.

St. Paul, MN: Minnesota Department of Health; January 2013.

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.

BOOK/REPORT

Safety in Doses.

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

NEWSPAPER/MAGAZINE ARTICLE

Preventing fatal errors.

Bailey B, Sevrens Lyons J. The Mercury News. November 27, 2005.

STUDY

Paid malpractice claims for adverse events in inpatient and outpatient settings.

Bishop TF, Ryan AK, Casalino LP. JAMA. 2011;305:2427-2431.

SPECIAL OR THEME ISSUE

Contributions from Ergonomics and Human Factors.

Qual Saf Health Care. 2010;19(suppl 3):i1-i79.

MULTI-USE WEBSITE

AHRQ Quality Indicators.

Agency for Healthcare Research and Quality.

NEWSPAPER/MAGAZINE ARTICLE

Survive your doctor.

Holt TE. Men's Health. November 3, 2006.

STUDY

'August is always a nightmare': results of the Royal College of Physicians of Edinburgh and Society of Acute Medicine August transition survey.

Vaughan L, McAlister G, Bell D. Clin Med. 2011;11:322-326.

STUDY

Health care–associated invasive MRSA infections, 2005–2008.

Kallen AJ, Mu Y, Bulens S, et al; Active Bacterial Core surveillance (ABCs) MRSA Investigators of the Emerging Infections Program. JAMA. 2010;304:641-648.

BOOK/REPORT

Managing Patients' Medicines after Discharge from Hospital.

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

BOOK/REPORT classic

classic

Advances in Patient Safety: New Directions and Alternative Approaches.

Rockville, MD: Agency for Healthcare Research and Quality; July 2008. AHRQ Publication Nos. 080034 (1-4).

BOOK/REPORT

Review of Patient Safety for Children and Young People.

London, UK: National Patient Safety Agency; 2009. ISBN: 978906624071.

AUDIOVISUAL

Avoiding medical error.

Colvin G. "The Colvin Interview." CNN. February 5, 2007.

STUDY

Self-reported medical, medication and laboratory error in eight countries: risk factors for chronically ill adults.

Scobie A. Int J Qual Health Care. 2011;23:182-186.

COMMENTARY

Getting moving on patient safety—harnessing electronic data for safer care.

Jha AK, Classen DC. N Engl J Med 2011;365:1756-1758.

STUDY

classic

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.

ORGANIZATIONAL POLICY/GUIDELINES

Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine.

Snow V, Beck D, Budnitz T, et al. J Gen Intern Med. 2009;24:971-976.

REVIEW

Routinely recorded patient safety events in primary care: a literature review.

Tsang C, Majeed A, Aylin P. Fam Pract. 2012;29:8-15.

NEWSPAPER/MAGAZINE ARTICLE

Approved: 2010 National Patient Safety Goals.

Jt Comm Perspect. October 2009;29:1, 20-31.

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