AHRQ Patient Safety Network

The Collection > Epidemiology of Errors and Adverse Events

PATIENT SAFETY PRIMERS
Never Events
Adverse Events after Hospital Discharge

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Safety Target

•Device-related Complications (73)

•Diagnostic Errors (120)

•Identification Errors (56)

•Discontinuities, Gaps, and Hand-Off Problems (186)

•Fatigue and Sleep Deprivation (27)

•Medication Safety (642)

•Medical Complications (201)

•Nonsurgical Procedural Complications (25)

•Surgical Complications (221)

•Transfusion Complications (12)

•Psychological and Social Complications (34)

Origin/Sponsor

•Africa (3)

•Asia (42)

•Australia and New Zealand (66)

•Central and South America (8)

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•North America (1115)

Resource Types

•Audiovisual (4)

•Book/Report (48)

•Clinical Guideline (1)

•Journal Article (1412)

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•Newspaper/Magazine Article (52)

•Press Release/Announcement (2)

•Special or Theme Issue (3)

•Tools/Toolkit (1)

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Epidemiology of Errors and Adverse Events

Approach to Improving Safety

•Quality Improvement Strategies (276)

•Legal and Policy Approaches (78)

•Error Reporting and Analysis (670)

•Communication Improvement (253)

•Human Factors Engineering (135)

•Teamwork (47)

•Specialization of Care (96)

•Logistical Approaches (99)

•Culture of Safety (100)

•Technologic Approaches (271)

•Education and Training (180)

Clinical Areas

•Allied Health Services (5)

Target Audience

•Health Care Providers (1058)

•Health Care Executives and Administrators (1215)

•Non-Health Care Professionals (445)

•Patients (56)

Setting of Care

•Hospitals (1098)

•Psychiatric Facilities (6)

•Residential Facilities (34)

•Ambulatory Care (196)

•Outpatient Surgery (22)

•Patient Transport (18)

1 - 20 of 1537

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STUDY

Patient perceptions of mistakes in ambulatory care.

Kistler CE, Walter LC, Mitchell CM, Sloane PD. Arch Intern Med. 2010;170:1480-1487.

STUDY

Diagnostic errors in primary care: lessons learned.

Ely JW, Kaldjian LC, D'Alessandro DM. J Am Board Fam Med. 2012;25:87-97.

STUDY

Types and origins of diagnostic errors in primary care settings.

Singh H, Giardina TD, Meyer AND, Forjuoh SN, Reis MD, Thomas EJ. JAMA Intern Med. 2013;173:418-425.

STUDY

Patient safety perceptions of primary care providers after implementation of an electronic medical record system.

McGuire MJ, Noronha G, Samal L, Yeh HC, Crocetti S, Kravet S. J Gen Intern Med. 2013;28:184-192.

STUDY

The frequency of missed test results and associated treatment delays in a highly computerized health system.

Wahls TL, Cram PM. BMC Fam Pract. 2007;8:32.

STUDY

Exploring situational awareness in diagnostic errors in primary care.

Singh H, Davis Giardina T, Petersen LA, et al. BMJ Qual Saf. 2012;21:30-38.

STUDY

Electronic health record-based surveillance of diagnostic errors in primary care.

Singh H, Giardina TD, Forjuoh SN, et al. BMJ Qual Saf. 2012;22:93-100.

STUDY

Missed opportunities in the primary care management of early acute ischemic heart disease.

Sequist TD, Marshall R, Lampert S, Buechler EJ, Lee TH. Arch Intern Med. 2006;166:2237-2243.

STUDY

Ambulatory prescribing errors among community-based providers in two states.

Abramson EL, Bates DW, Jenter C, et al. J Am Med Inform Assoc. 2012;19:644-648.

STUDY

Confidential reporting of patient safety events in primary care: results from a multilevel classification of cognitive and system factors.

Kostopoulou O, Delaney B. Qual Saf Health Care. 2007;16:95-100.

STUDY

Pharmacist-supported medication review training for general practitioners: feasibility and acceptability.

Krska J, Gill D, Hansford D. Med Educ. 2006;40:1217-1225.

STUDY

Direct reporting of laboratory test results to patients by mail to enhance patient safety.

Sung S, Forman-Hoffman V, Wilson MC, Cram P. J Gen Intern Med. 2006;21:1075-78.

STUDY

Electronic medical record availability and primary care depression treatment.

Harman JS, Rost KM, Harle CA, Cook RL. J Gen Intern Med. 2012;27:962-967.

STUDY

Adverse drug events in general practice patients in Australia.

Miller GC, Britt HC, Valenti L. Med J Aust. 2006;184:321-324.

STUDY

Residents' perceptions of professionalism in training and practice: barriers, promoters, and duty hour requirements.

Ratanawongsa N, Bolen S, Howell EE, Kern DE, Sisson SD, Larriviere D. J Gen Intern Med. 2006;21:758-763.

STUDY

Outside case review of surgical pathology for referred patients: the impact on patient care.

Swapp RE, Aubry MC, Salomão DR, Cheville JC. Arch Pathol Lab Med. 2013;137:233-240.

STUDY

Diagnostic errors in orthopedic surgery: evaluation of resident documentation of neurovascular examinations for orthopedic trauma patients.

Tan EW, Ting BL, Jia XF, Skolasky RL, McFarland EG. Am J Med Qual. 2013;28:60-68.

STUDY

Signal and noise: applying a laboratory trigger tool to identify adverse drug events among primary care patients.

Brenner S, Detz A, López A, Horton C, Sarkar U. BMJ Qual Saf. 2012;21:670-675.

STUDY

Literacy and misunderstanding prescription drug labels.

Davis TC, Wolf MS, Bass PF III, et al. Ann Intern Med. 2006;145:887-94.

STUDY

Problems after discharge and understanding of communication with their primary care physicians (PCPs) among hospitalized seniors: a mixed methods study.

Arora VM, Prochaska ML, Farnan JM, et al. J Hosp Med. 2010;5:385-391.

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