U.S. Department of Health & Human Services
PATIENT SAFETY PRIMERS
2014 ANNUAL PERSPECTIVES
Device-related Complications (17)
Diagnostic Errors (58)
Identification Errors (6)
Discontinuities, Gaps, and Hand-Off Problems (18)
Medication Safety (6)
Medical Complications (7)
Nonsurgical Procedural Complications (38)
Surgical Complications (9)
Psychological and Social Complications (3)
Australia and New Zealand (5)
Central and South America (1)
North America (124)
Clinical Guideline (1)
Journal Article (115)
Newspaper/Magazine Article (16)
Press Release/Announcement (5)
Special or Theme Issue (2)
Web Resource (2)
Epidemiology of Errors and Adverse Events (34)
Active Errors (55)
Latent Errors (17)
Near Miss (8)
Approach to Improving Safety
Quality Improvement Strategies (39)
Legal and Policy Approaches (14)
Error Reporting and Analysis (53)
Communication Improvement (27)
Human Factors Engineering (26)
Specialization of Care (6)
Logistical Approaches (10)
Culture of Safety (16)
Technologic Approaches (21)
Education and Training (26)
Health Care Providers (128)
Health Care Executives and Administrators (100)
Non-Health Care Professionals (37)
Setting of Care
Ambulatory Care (14)
Outpatient Surgery (2)
Patient Transport (2)
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Accuracy of radiographic readings in the emergency department.
Petinaux B, Bhat R, Boniface K, Aristizabal J. Am J Emerg Med. 2011;29:18-25.
Emergency department image interpretation accuracy: the influence of immediate reporting by radiology.
Snaith B, Hardy M. Int Emerg Nurs. 2014;22:63-68.
Shapiro MJ. AHRQ WebM&M [serial online]. February 2004.
Radiation risks of diagnostic imaging.
Sentinel Event Alert #47. August 24, 2011.
The Dropped Lung.
Heffner JE. AHRQ WebM&M [serial online]. May 2003.
Profiles in patient safety: misplaced femoral line guidewire and multiple failures to detect the foreign body on chest radiography.
Lum TE, Fairbanks RJ, Pennington EC, Zwemer FL. Acad Emerg Med. 2005;12:658-662.
Operational rounds: a practical administrative process to improve safety and clinical services in radiology.
Donnelly LF, Dickerson JM, Lehkamp TW, Gessner KE, Moskovitz J, Hutchinson S. J Am Coll Radiol. 2008;5:1142-1149.
Improving patient safety in radiology: concepts for a comprehensive patient safety program.
Donnelly LF, Dickerson JM, Goodfriend MA, Muething SE. Semin Ultrasound CT MRI. 2010;31:67-70.
Quality initiatives: developing a radiology quality and safety program: a primer.
Johnson CD, Krecke KN, Roberts RM, Denham C. Radiographics. 2009;29:951-959.
A 60-year-old man with delayed care for a renal mass.
Schiff GD. JAMA. 2011;305:1890-1898.
Image Gently, Step Lightly: promoting radiation safety in pediatric interventional radiology.
Sidhu M, Goske MJ, Connolly B, et al. AJR Am J Roentgenol. 2010;195:W299-W301.
Flying Object Hits MRI.
Gosbee J, Gosbee LL. AHRQ WebM&M [serial online]. February 2003.
At VA hospital, a rogue cancer unit.
Bogdanich W. New York Times. June 20, 2009;National Desk:1.
The hidden dangers of outsourcing radiology.
Eban K. Self Magazine. November 2011.
Patient safety event reporting in a large radiology department.
Schultz SR, Watson RE Jr, Prescott SL, et al. AJR Am J Roentgenol. 2011;197:684-688.
Preventing accidents and injuries in the MRI suite.
Sentinel Event Alert. February 14, 2008;(38):1-3.
Using information to optimize medical outcomes.
Duncan JR, Evens RG. JAMA. 2009;301:2383-2385.
Body CT: technical advances for improving safety.
Marin D, Nelson RC, Rubin GD, Schindera ST. AJR Am J Roentgenol. 2011;197:33-41.
Application of failure mode and effect analysis in a radiology department.
Thornton E, Brook OR, Mendiratta-Lala M, Hallett DT, Kruskal JB. Radiographics. 2011;31:281-293.
Spike in MR imaging accidents underscores need for regulation.
Radiological Society of North America. RSNA News; October 2010.
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