AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (5)

•Diagnostic Errors (11)

•Identification Errors (1)

•Discontinuities, Gaps, and Hand-Off Problems (17)

•Fatigue and Sleep Deprivation (3)

•Medication Safety (21)

•Medical Complications (24)

•Nonsurgical Procedural Complications (5)

•Surgical Complications (6)

•Psychological and Social Complications (1)

Origin/Sponsor

•Australia and New Zealand (2)

•North America (55)

Resource Types

•Book/Report (1)

•Clinical Guideline (1)

•Journal Article (62)

•Legislation/Regulation (1)

•Newspaper/Magazine Article (3)

•Web Resource (1)

Error Types

•Epidemiology of Errors and Adverse Events (27)

•Active Errors (25)

•Latent Errors (6)

Approach to Improving Safety

•Quality Improvement Strategies (14)

•Legal and Policy Approaches (2)

•Error Reporting and Analysis (9)

•Communication Improvement (17)

•Human Factors Engineering (7)

•Teamwork (3)

•Specialization of Care (17)

•Logistical Approaches (6)

•Culture of Safety (5)

•Technologic Approaches (10)

•Education and Training (16)

Clinical Areas
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Cardiology

Target Audience

•Health Care Providers (63)

•Health Care Executives and Administrators (55)

•Non-Health Care Professionals (16)

•Patients (2)

Setting of Care

•Hospitals (53)

•Residential Facilities (1)

•Ambulatory Care (6)

•Patient Transport (1)

1 - 20 of 69

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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.

NEWSPAPER/MAGAZINE ARTICLE

Saving lives: hospitals have signed on to a six-part plan to avoid a multitude of unnecessary deaths.

Comarow A. US News & World Report. July 18, 2005;139:74,76,79.

STUDY

Using in situ simulation to improve in-hospital cardiopulmonary resuscitation.

Lighthall GK, Poon T, Harrison TK. Jt Comm J Qual Patient Saf. 2010;36:209-216.

COMMENTARY

Latency of ECG displays of hospital telemetry systems: a science advisory from the American Heart Association.

Turakhia MP, Estes NA 3rd, Drew BJ, et al; Electrocardiography and Arrhythmias Committee of the American Heart Association Council on Clinical Cardiology and Council on Cardiovascular Nursing. Circulation. 2012;126:1665-1669.

COMMENTARY

Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution.

Kanwar M, Irvin CB, Frank JJ, Weber K, Rosman H. Ann Emerg Med. 2010;55:341-344.

BOOK/REPORT

Hospital Performance Report.

Trenton, NJ: New Jersey Department of Health and Senior Services; March 2012.

CLINICAL GUIDELINE classic

classic

Medication errors in acute cardiovascular and stroke patients. A scientific statement from the American Heart Association.

Michaels AD, Spinler SA, Leeper B, et al; American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, Council on Quality of Care and Outcomes Research, Council on Cardiopulmonary, Critical Care, Perioperative, and Resuscitation, Council on Cardiovascular Nursing, Stroke Council. Circulation. 2010;121:1664-1682.

STUDY

Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database.

Andersen PO, Maaløe R, Andersen HB. Resuscitation. 2010;81:312-316.

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

Epidemiology and patient outcome after medical emergency team calls triggered by atrial fibrillation.

Schneider A, Calzavacca P, Jones D, Bellomo R. Resuscitation. 2011;82:410-414.

COMMENTARY

Eptifibatide Epilogue

Churchill WW, Fiumara K. AHRQ WebM&M [serial online]. April 2009.

STUDY

Physician implicit review to identify preventable errors during in-hospital cardiac arrest.

Jain R, Kuhn L, Repaskey W, et al. Arch Intern Med. 2011;171:89-90.

STUDY

Perceptions of hospital safety climate and incidence of readmission.

Hansen LO, Williams MV, Singer SJ. Health Serv Res. 2011;46:596-616.

STUDY

Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction.

Salisbury AC, Reid KJ, Alexander KP, et al. Arch Intern Med. 2011;171:1646-1653.

STUDY

Mortality among patients with acute myocardial infarction: the influences of patient-centered care and evidence-based medicine.

Meterko M, Wright S, Lin H, Lowy E, Cleary PD. Health Serv Res. 2010;45:1188-1204.

STUDY

Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls.

Stauffer BD, Fullerton C, Fleming N, et al. Arch Intern Med. 2011;171:1238-1243.

STUDY

A reduction in cardiac arrests and duration of clinical instability after implementation of a paediatric rapid response system.

Hanson CC, Randolph GD, Erickson JA, et al. Qual Saf Health Care. 2009;18:500-504.

STUDY

Retrospective review of emergency response activations during a 13-year period at a tertiary care children's hospital.

Wang GS, Erwin N, Zuk J, Henry DB, Dobyns EL. J Hosp Med. 2011;6:131-135.

STUDY

Introduction of a rapid response system at a United States Veterans Affairs hospital reduced cardiac arrests.

Lighthall GK, Parast LM, Rapoport L, Wagner TH. Anesth Analg. 2010;111:679-686.

COMMENTARY

Don't Push.

Meltzer HY. AHRQ WebM&M [serial online]. November 2003.

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