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Policy Makers
PATIENT SAFETY PRIMERS
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BOOK/REPORT
2009 Utah Sentinel Events Data Report.
Salt Lake City, UT: Utah Department of Health, Utah Hospitals & Health Systems Association, and HealthInsight; March 10, 2010.
PENNSYLVANIA LEGISLATION
An Amendment of the Medical Care Availability and Reduction of Error (Mcare) Act.
General Assembly of Pennsylvania. SB968 (2007).
STUDY
Exploring the causes of adverse events in hospitals and potential prevention strategies.
Smits M, Zegers M, Groenewegen PP, et al. Qual Saf Health Care. 2010;19:e5.
NEWSPAPER/MAGAZINE ARTICLE
Transparency and public reporting are essential for a safe health care system.
Leape LL. Perspect Health Reform. New York, NY: The Commonwealth Fund; March 17, 2010.
BOOK/REPORT
Patient Safety Authority Annual Reports.
Harrisburg, PA: Patient Safety Authority; April 2013.
ORGANIZATIONAL POLICY/GUIDELINES
Leadership committed to safety.
Sentinel Event Alert. August 27, 2009;(43):1-3.
BOOK/REPORT
Few Adverse Events in Hospitals Were Reported to State Adverse Event Reporting Systems.
Wright S. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; July 2012. Report No. OEI-06-09-00092.
BOOK/REPORT
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2011.
Oakbrook Terrace, IL: The Joint Commission; September 2011.
BOOK/REPORT
Adverse Events in Hospitals: State Reporting Systems.
Levinson DR. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; December 2008. Report No. OEI-06-07-00471.
STUDY
The incidence of adverse events in Swedish hospitals: a retrospective medical record review study.
Soop M, Fryksmark U, Koster M, Haglund B. Int J Qual Health Care. 2009;21:285-291.
BOOK/REPORT
Adverse Health Care Events Reporting System: What Have We Learned?
St. Paul, MN: Minnesota Department of Health; January 2009.
BOOK/REPORT
How Safe Is Your Hospital?
Dr Foster Intelligence Unit. London, UK: Imperial College London; 2009.
BOOK/REPORT
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2012.
Oakbrook Terrace, IL: The Joint Commission; September 2012.
MULTI-USE WEBSITE
Patient Safety Reporting Initiative.
New Jersey Department of Health and Senior Services.
STUDY
Use of electronic health records in US hospitals.
Jha AK, Desroches CM, Campbell EG, et al. N Engl J Med. 2009;360:1628-1638.
COMMENTARY
Moving beyond readmission penalties: creating an ideal process to improve transitional care.
Burke RE, Kripalani S, Vasilevskis EE, Schnipper JL. J Hosp Med. 2013;8:102-109.
BOOK/REPORT
Serious Reportable Events in Massachusetts Acute Care Hospitals: January 1, 2008–December 31, 2008.
Executive Office of Health and Human Services, Department of Public Health, Bureau of Health Care Safety and Quality. Boston, MA: Commonwealth of Massachusetts; 2009.
REVIEW
Hospital-based medication reconciliation practices: a systematic review.
Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Arch Intern Med. 2012;172:1057-1069.
REVIEW
The economic burden of patient safety targets in acute care: a systematic review.
Mittmann N, Koo M, Daneman N, et al. Drug Healthc Patient Saf. 2012;4:141-165.
COMMENTARY
Building physician work hour regulations from first principles and best evidence.
Volpp KG, Landrigan CP. JAMA. 2008;300:1197-1199.
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