AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (4)

•Diagnostic Errors (19)

•Identification Errors (2)

•Discontinuities, Gaps, and Hand-Off Problems (46)

•Fatigue and Sleep Deprivation (39)

•Medication Safety (57)

•Medical Complications (30)

•Nonsurgical Procedural Complications (14)

•Surgical Complications (46)

•Psychological and Social Complications (24)

Origin/Sponsor

•Australia and New Zealand (11)

•Central and South America (1)

•North America (325)

Resource Types

•Audiovisual (2)

•Book/Report (17)

•Journal Article (354)

•Legislation/Regulation (1)

•Meeting/Conference (1)

•Newsletter/Journal (1)

•Newspaper/Magazine Article (17)

•Press Release/Announcement (2)

•Special or Theme Issue (12)

•Tools/Toolkit (6)

•Web Resource (14)

Error Types

•Epidemiology of Errors and Adverse Events (69)

•Active Errors (56)

•Latent Errors (18)

•Near Miss (5)

Approach to Improving Safety

•Quality Improvement Strategies (62)

•Legal and Policy Approaches (20)

•Error Reporting and Analysis (60)

•Communication Improvement (118)

•Human Factors Engineering (24)

•Teamwork (90)

•Specialization of Care (15)

•Logistical Approaches (64)

•Culture of Safety (58)

•Technologic Approaches (29)

•Education and Training (364)

Clinical Areas

•Allied Health Services (1)

•Complementary and Alternative Medicine (1)

•Medicine (282)

•Nursing (39)

•Pharmacy (15)

Target Audience
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Educators

Setting of Care

•Hospitals (292)

•Residential Facilities (4)

•Ambulatory Care (27)

•Outpatient Surgery (1)

•Patient Transport (1)

1 - 20 of 428

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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

classic

Medical error disclosure among pediatricians: choosing carefully what we might say to parents.

Loren DJ, Klein EJ, Garbutt J, et al. Arch Pediatr Adolesc Med. 2008;162:922-927.

TOOLKIT

Partnering to Heal: Teaming-Up Against Healthcare-Associated Infections.

Washington, DC: US Department of Health and Human Services; May 2011.

STUDY

Medication errors and response bias: the tip of the iceberg.

Bar-Oz B, Goldman M, Lahat E, et al. Isr Med Assoc J. 2008;10:771-774.

NEWSPAPER/MAGAZINE ARTICLE

Safe intrahospital transport of the non-ICU patient using standardized handoff communication.

PA-PSRS Patient Saf Advis. March 2009;6:16-19.

MULTI-USE WEBSITE

Strategic Alliance For Error Reduction in California Healthcare (SAFER).

University of California Medical Centers.

COMMENTARY

Rapid response systems: from implementation to evidence base.

Sarani B, Scott S. Jt Comm J Qual Patient Saf. 2010;36:514-517.

MULTI-USE WEBSITE

Quality & Safety Research Group.

Johns Hopkins University, Department of Anesthesiology & Critical Care Medicine.

STUDY

Hospitalized patients' understanding of their plan of care.

O'Leary KJ, Kulkarni N, Landler MP, et al. Mayo Clin Proc. 2010;85:47-52.

STUDY

Improving the quality of the surgical morbidity and mortality conference: a prospective intervention study.

Mitchell EL, Lee DY, Arora S, et al. Acad Med. 2013 Apr 24; [Epub ahead of print].

STUDY

Nurses' clinical reasoning: processes and practices of medication safety.

Dickson GL, Flynn L. Qual Health Res. 2012;22:3-16.

STUDY

Admission handoff communications: clinician's shared understanding of patient severity of illness and problems.

Brannen ML, Cameron KA, Adler M, Goodman D, Holl JL. J Patient Saf. 2009;5:237-242.

STUDY

Medication administration errors in assisted living: scope, characteristics, and the importance of staff training.

Zimmerman S, Love K, Sloane PD, Cohen LW, Reed D, Carder PC; Center for Excellence in Assisted Living-University of North Carolina Collaborative. J Am Geriatr Soc. 2011;59:1060-1068.

STUDY

classic

Structured interdisciplinary rounds in a medical teaching unit: improving patient safety.

O’Leary KJ, Buck R, Fligiel HM, et al. Arch Intern Med. 2011;171:678-684.

STUDY

Improving sleep hygiene of medical interns: can the sleep, alertness, and fatigue education in residency program help?

Arora VM, Georgitis E, Woodruff JN, Humphrey HJ, Meltzer D. Arch Intern Med. 2007;167:1738-1744.

STUDY

ACGME duty-hour recommendations—a national survey of residency program directors.

Antiel RM, Thompson SM, Reed DA, et al. N Engl J Med. 2010;363:e12.

BOOK/REPORT classic

classic

Patient Safety, 2nd edition.

Vincent C. West Sussex, UK: Wiley-Blackwell; 2010. ISBN: 9781405192217.

STUDY

classic

A July spike in fatal medication errors: a possible effect of new medical residents.

Phillips DP, Barker GEC. J Gen Intern Med. 2010;25:774-779.

STUDY

The impact of resident duty hour reform on hospital readmission rates among Medicare beneficiaries.

Press MJ, Silber JH, Rosen AK, et al. J Gen Intern Med. 2011;26:405-411.

STUDY

The computerized rounding report: implementation of a model system to support transitions of care.

Wohlauer MV, Rove KO, Pshak TJ, et al. J Surg Res. 2012;172:11-17.

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