AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (155)

•Diagnostic Errors (220)

•Identification Errors (122)

•Discontinuities, Gaps, and Hand-Off Problems (413)

•Fatigue and Sleep Deprivation (105)

•Medication Safety (1112)

•Medical Complications (404)

•Nonsurgical Procedural Complications (103)

•Surgical Complications (651)

•Transfusion Complications (17)

•Psychological and Social Complications (134)

Origin/Sponsor

•Africa (5)

•Asia (48)

•Australia and New Zealand (94)

•Central and South America (8)

•Europe (427)

•North America (3060)

Resource Types

•Clinical Guideline (10)

•Journal Article (2776)

•Legislation/Regulation (58)

•Meeting/Conference (27)

•Newsletter/Journal (13)

•Newspaper/Magazine Article (302)

•Press Release/Announcement (28)

•Special or Theme Issue (60)

•Tools/Toolkit (53)

•Web Resource (105)

•Grant (6)

Error Types

•Epidemiology of Errors and Adverse Events (1077)

•Active Errors (632)

•Latent Errors (226)

•Near Miss (70)

Approach to Improving Safety

•Quality Improvement Strategies (870)

•Legal and Policy Approaches (317)

•Error Reporting and Analysis (972)

•Communication Improvement (955)

•Human Factors Engineering (536)

•Teamwork (327)

•Specialization of Care (241)

•Logistical Approaches (267)

•Culture of Safety (406)

•Technologic Approaches (592)

•Education and Training (708)

Clinical Areas

•Allied Health Services (10)

Target Audience
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Health Care Providers

•Allied Health Professionals (3)

•Clinical Technologists (38)

Setting of Care

•Psychiatric Facilities (14)

•Residential Facilities (67)

•Ambulatory Care (359)

•Outpatient Surgery (49)

•Patient Transport (31)

1 - 20 of 3690

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STUDY

Communication failure in the operating room.

Halverson AL, Casey JT, Andersson J, et al. Surgery. 2011;49:305-310.

STUDY

Postoperative sepsis in the United States.

Vogel TR, Dombrovskiy VY, Carson JL, Graham AM, Lowry SF. Ann Surg. 2010;252:1065-1071.

STUDY

Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice.

Lingard L, Regehr G, Cartmill C, et al. BMJ Qual Saf. 2011;20:475-482.

STUDY

An evaluation of information transfer through the continuum of surgical care: a feasibility study.

Nagpal K, Vats A, Ahmed K, Vincent C, Moorthy K. Ann Surg. 2010;252:402-407.

REVIEW

Avoiding wrong site surgery: a systematic review.

DeVine J, Chutkan N, Norvell DC, Dettori JR. Spine. 2010;35(suppl 9):S28-S36.

NEWSPAPER/MAGAZINE ARTICLE

Preventing wrong-site surgery in Minnesota: a 5-year journey.

Rydrych D, Apold J, Harder K. Patient Saf Qual Healthc. November/December 2012;9:24-27,30-32,34.

STUDY

Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit.

McCulloch P, Kreckler S, New S, Sheena Y, Handa A, Catchpole K. BMJ. 2010;341:c5469.

STUDY

Impact of resident participation in surgical operations on postoperative outcomes: National Surgical Quality Improvement Program.

Kiran RP, Ahmed Ali U, Coffey JC, Vogel JD, Pokala N, Fazio VW. Ann Surg. 2012;256:469-475.

STUDY

Prevention of surgical malpractice claims by a surgical safety checklist.

de Vries EN, Eikens-Jansen MP, Hamersma AM, Smorenburg SM, Gouma DJ, Boermeester MA. Ann Surg. 2011;253:624-628.

STUDY

Implementing a surgical checklist: more than checking a box.

Levy SM, Senter CE, Hawkins RB, et al. Surgery. 2012;152:331-336.

STUDY

Crisis checklists for the operating room: development and pilot testing.

Ziewacz JE, Arriaga AF, Bader AM, et al. J Am Coll Surg. 2011;213:212-219.

COMMENTARY

Use of an anatomic marking form as an alternative to the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery.

Knight N, Aucar J. Am J Surg. 2010;200:803-807.

REVIEW

A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery.

Borchard A, Schwappach DL, Barbir A, Bezzola P. Ann Surg. 2012;256:925-933.

STUDY

Thirty-day outcomes support implementation of a surgical safety checklist.

Bliss LA, Ross-Richardson CB, Sanzari LJ, et al. J Am Coll Surg. 2012;215:766-776.

STUDY

Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality.

Anderson CI, Nelson CS, Graham CF, et al. J Surg Res. 2012;177:43-48.

COMMENTARY

Learning from adverse events and near misses.

Greenberg CC. J Gastrointest Surg. 2008;13:3-5.

STUDY

Validity of selected patient safety indicators: opportunities and concerns.

Kaafarani HM, Borzecki AM, Itani KM, et al. J Am Coll Surg. 2011; 212:924-934.

STUDY

Eight-year experience with a neurosurgical checklist.

Lyons MK. Am J Med Qual. 2010;25:285-288.

STUDY

Interruptions and miscommunications in surgery: an observational study.

Gillespie BM, Chaboyer W, Fairweather N. AORN J. 2012;95:576-590.

STUDY

Infrequent physician use of implantable cardioverter-defibrillators risks patient safety.

Lyman S, Sedrakyan A, Do H, Razzano R, Mushlin AI. Heart. 2011;97:1655-1660.

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