AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (13)

•Diagnostic Errors (26)

•Identification Errors (17)

•Discontinuities, Gaps, and Hand-Off Problems (81)

•Fatigue and Sleep Deprivation (30)

•Medication Safety (176)

•Medical Complications (39)

•Nonsurgical Procedural Complications (4)

•Surgical Complications (45)

•Transfusion Complications (3)

•Psychological and Social Complications (17)

Origin/Sponsor

•Australia and New Zealand (24)

•North America (449)

Resource Types

•Audiovisual (2)

•Book/Report (29)

•Clinical Guideline (1)

•Journal Article (450)

•Legislation/Regulation (6)

•Meeting/Conference (2)

•Newsletter/Journal (2)

•Newspaper/Magazine Article (53)

•Press Release/Announcement (2)

•Special or Theme Issue (5)

•Tools/Toolkit (13)

•Web Resource (12)

Error Types

•Epidemiology of Errors and Adverse Events (125)

•Active Errors (51)

•Latent Errors (43)

•Near Miss (14)

Approach to Improving Safety

•Quality Improvement Strategies (159)

•Legal and Policy Approaches (62)

•Error Reporting and Analysis (203)

•Communication Improvement (136)

•Human Factors Engineering (49)

•Teamwork (39)

•Specialization of Care (39)

•Logistical Approaches (69)

•Culture of Safety (99)

•Technologic Approaches (132)

•Education and Training (85)

Clinical Areas

•Allied Health Services (2)

•Complementary and Alternative Medicine (1)

•Medicine (345)

•Nursing (42)

•Pharmacy (32)

Target Audience
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Facility and Group Administrators

Setting of Care

•Hospitals (305)

•Psychiatric Facilities (2)

•Residential Facilities (30)

•Ambulatory Care (85)

•Outpatient Surgery (10)

•Patient Transport (6)

1 - 20 of 578

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STUDY

The safety of hospital stroke care.

Holloway RG, Tuttle D, Baird T, Skelton WK. Neurology. 2007;68:550-555.

STUDY

Discontinuity of chronic medications in patients discharged from the intensive care unit.

Bell CM, Rahimi-Darabad P, Orner AI. J Gen Intern Med. 2006;21:937-941.

STUDY

An observational study of changes to long-term medication after admission to an intensive care unit.

Campbell AJ, Bloomfield R, Noble DW. Anaesthesia. 2006;61:1087-1092.

REVIEW

Epidemiology of medication-related adverse events in nursing homes.

Handler SM, Wright RM, Ruby CM, Hanlon JT. Am J Geriatr Pharmacother. 2006;4:264-272.

STUDY

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Costs of adverse events in intensive care units.

Kaushal R, Bates DW, Franz C, Soukup JR, Rothschild JM. Crit Care Med. 2007;35:2479-2483.

STUDY

Medication error reporting in nursing homes: identifying targets for patient safety improvement.

Greene SB, Williams CE, Pierson S, Hansen RA, Carey TS. Qual Saf Health Care. 2010;19:218-222.

NEWSPAPER/MAGAZINE ARTICLE

Leveraging technical and managerial changes to improve safety.

Pronovost P, Heifetz RA. Hosp Health Netw. March 27, 2007.

STUDY

Direct observation approach for detecting medication errors and adverse drug events in a pediatric intensive care unit.

Buckley MS, Erstad BL, Kopp BJ, Theodorou AA, Priestley G. Pediatr Crit Care Med. 2007;8:145-152.

STUDY

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An intervention to decrease catheter-related bloodstream infections in the ICU.

Pronovost P, Needham D, Berenholtz S, et al. N Engl J Med. 2006;355:2725-2732.

STUDY

Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations.

Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA, on behalf of the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Crit Care Med. 2006;34:1016-1024.

STUDY

Adverse drug events in general practice patients in Australia.

Miller GC, Britt HC, Valenti L. Med J Aust. 2006;184:321-324.

COMMENTARY

Using incident reporting to improve patient safety: a conceptual model.

Pronovost PJ, Holzmueller CG, Young J, et al. J Patient Saf. 2007;3:27-33.

STUDY

Assessment of adverse drug events among patients in a tertiary care medical center.

Johnston PE, France DJ, Byrne DW, et al. Am J Health Syst Pharm. 2006;63:2218-2227.

REVIEW

Aftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure.

Manser T, Staender S. Acta Anaesthesiol Scand. 2005;49:728-734.

STUDY

Personalised performance feedback reduces narcotic prescription errors in a NICU.

Sullivan KM, Suh S, Monk H, Chuo J. BMJ Qual Saf. 2013;22:256-262.

STUDY

Validity of unplanned admission to an intensive care unit as a measure of patient safety in surgical patients.

Haller G, Myles PS, Wolfe R, Weeks AM, Stoelwinder J, McNeil J. Anesthesiology. 2005;103:1121-1129.

NEWSPAPER/MAGAZINE ARTICLE

Intensivists: an Rx for the ICU?

Meyers S. Trustee. March 2006;59:29-30.

COMMENTARY classic

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Fixing healthcare from the inside, today.

Spear SJ. Harv Bus Rev. September 2005;83:78-91.

COMMENTARY

Using medical malpractice closed claims data to reduce surgical risk and improve patient safety.

Manuel BM, Greenwald LM. Bull Am Coll Surg. March 2007;92:27-30.

REVIEW

Quality and safety in the intensive care unit.

Stockwell DC, Slonim AD. J Intensive Care Med. 2006;21:199-210.

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