U.S. Department of Health & Human Services
PATIENT SAFETY PRIMERS
2014 ANNUAL PERSPECTIVES
Device-related Complications (1)
Diagnostic Errors (3)
Identification Errors (6)
Fatigue and Sleep Deprivation (2)
Medication Safety (1)
Surgical Complications (23)
North America (23)
Journal Article (23)
Newspaper/Magazine Article (3)
Special or Theme Issue (2)
Epidemiology of Errors and Adverse Events (12)
Active Errors (6)
Latent Errors (2)
Approach to Improving Safety
Quality Improvement Strategies (4)
Legal and Policy Approaches (3)
Error Reporting and Analysis (10)
Communication Improvement (4)
Human Factors Engineering (9)
Specialization of Care (1)
Logistical Approaches (3)
Technologic Approaches (2)
Education and Training (5)
Health Care Providers (21)
Health Care Executives and Administrators (19)
Non-Health Care Professionals (6)
Setting of Care
Outpatient Surgery (1)
Patient Transport (1)
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Medical errors in neurosurgery.
Rolston JD, Zygourakis CC, Han SJ, Lau CY, Berger MS, Parsa AT. Surg Neurol Int. 2014;5(suppl 10):S435-S440.
When the bone flap hits the floor.
Jankowitz BT, Kondziolka DS. Neurosurgery. 2006;59:585-590.
Spinal surgery and patient safety: a systems approach.
Wong DA. J Am Acad Orthop Surg. 2006;14:226-232.
Save a brain, make a checklist.
Hamblin J. The Atlantic. March 17, 2014.
Feud between Cedars-Sinai and surgeon puts focus on patient safety.
Zarembo A. Los Angeles Times. April 6, 2010.
Third wrong-sided brain surgery at R.I. hospital.
Associated Press. MSNBC. November 27, 2007.
"Team time-out" and surgical safety—experiences in 12,390 neurosurgical patients.
Oszvald Á, Vatter H, Byhahn C, Seifert V, Güresir E. Neurosurg Focus. 2012;33:E6.
Do No Harm: Stories of Life, Death, and Brain Surgery.
Marsh H. New York, NY: Thomas Dunne Books; 2015. ISBN: 9781250065810.
Resident duty hour regulation and patient safety: establishing a balance between concerns about resident fatigue and adequate training in neurosurgery.
Grady MS, Batjer HH, Dacey RG. J Neurosurg. 2009;110:828-836.
Surgical checklists: a detailed review of their emergence, development, and relevance to neurosurgical practice.
McConnell DJ, Fargen KM, Mocco J. Surg Neurol Int. 2012;3:2.
Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity.
Jagannathan J, Vates GE, Pouratian N, et al. J Neurosurg. 2009;110:820-827.
Harvey Cushing's open and thorough documentation of surgical mishaps at the dawn of neurologic surgery.
Latimer K, Pendleton C, Olivi A, Cohen-Gadol AA, Brem H, Quiñones-Hinojosa A. Arch Surg. 2011;146:226-232.
Side errors in neurosurgery.
Mitchell P, Nicholson CL, Jenkins A. Acta Neurochir (Wien). 2006;148:1289-92.
Is there a "July phenomenon" in pediatric neurosurgery at teaching hospitals?
Smith ER, Butler WE, Barker FG 2nd. J Neurosurg. 2006;105(suppl 3):169-176.
SPECIAL OR THEME ISSUE
Risk Prevention and Surgical Checklists.
Neurosurg Focus. 2012;33:E1-E16.
Inappropriate surgeries resulting from misdiagnosis of early amyotrophic lateral sclerosis.
Srinivasan J, Scala S, Jones HR, Saleh F, Russell JA. Muscle Nerve. 2006;34:359-360.
Medication-error reporting and pharmacy resident experience during implementation of computerized prescriber order entry.
Weant KA, Cook AM, Armitstead JA. Am J Health Syst Pharm. 2007;64:526-530.
Wrong-site craniotomy: analysis of 35 cases and systems for prevention.
Cohen FL, Mendelsohn D, Bernstein M. J Neurosurg. 2010;113:461-473.
Prospective error recording in surgery: an analysis of 1108 elective neurosurgical cases.
Stone S, Bernstein M. Neurosurgery. 2007;60:1075-1080; discussion 1080-1082.
The prevalence of wrong level surgery among spine surgeons.
Mody MG, Nourbakhsh A, Stahl DL, Gibbs M, Alfawareh M, Garges KJ. Spine. 2008;33:194-198.
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