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 (66)

•Diagnostic Errors (125)

•Identification Errors (58)

•Discontinuities, Gaps, and Hand-Off Problems (177)

•Fatigue and Sleep Deprivation (27)

•Medication Safety (600)

•Medical Complications (191)

•Nonsurgical Procedural Complications (25)

•Surgical Complications (233)

•Transfusion Complications (14)

•Psychological and Social Complications (34)

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•Africa (4)

•Asia (37)

•Australia and New Zealand (56)

•Central and South America (7)

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Resource Types

•Audiovisual (4)

•Book/Report (42)

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•Press Release/Announcement (3)

•Special or Theme Issue (3)

•Tools/Toolkit (1)

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Error Types
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Epidemiology of Errors and Adverse Events

Approach to Improving Safety

•Quality Improvement Strategies (268)

•Legal and Policy Approaches (77)

•Error Reporting and Analysis (644)

•Communication Improvement (248)

•Human Factors Engineering (134)

•Teamwork (48)

•Specialization of Care (94)

•Logistical Approaches (103)

•Culture of Safety (91)

•Technologic Approaches (257)

•Education and Training (178)

Clinical Areas

•Allied Health Services (5)

Target Audience

•Health Care Providers (1074)

•Health Care Executives and Administrators (1154)

•Non-Health Care Professionals (395)

•Patients (62)

Setting of Care

•Hospitals (1039)

•Psychiatric Facilities (6)

•Residential Facilities (40)

•Ambulatory Care (186)

•Outpatient Surgery (22)

•Patient Transport (18)

1 - 20 of 1471

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STUDY

Paid malpractice claims for adverse events in inpatient and outpatient settings.

Bishop TF, Ryan AK, Casalino LP. JAMA. 2011;305:2427-2431.

STUDY

Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality.

Anderson CI, Nelson CS, Graham CF, et al. J Surg Res. 2012;177:43-48.

STUDY

Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.

Weiser TG, Haynes AB, Dziekan G, et al; Safe Surgery Saves Lives Investigators and Study Group. Ann Surg. 2010;251:976-980.

STUDY

Classification of adverse events occurring in a surgical intensive care unit.

Frankel H, Sperry J, Kaplan L, Foley A, Rabinovici R. Am J Surg. 2007;194:328-332.

STUDY

Iatrogenic events resulting in intensive care admission: frequency, cause, and disclosure to patients and institutions.

Lehmann LS, Puopolo AL, Shaykevich S, Brennan TA. Am J Med. 2005;118:409-413.

STUDY

Novel use of electronic whiteboard in the operating room increases surgical team compliance with pre-incision safety practices.

Mainthia R, Lockney T, Zotov A, et al. Surgery. 2012;151:660-666.

STUDY

Surgeon age and operative mortality in the United States.

Waljee JF, Greenfield LJ, Dimick JB, Birkmeyer JD. Ann Surg. 2006;244:353-362.

STUDY

Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers.

Kachalia A, Gandhi TK, Puopolo AL, et al. Ann Emerg Med. Ann Emerg Med. 2007;49:196-205.

STUDY

The American College of Surgeons' closed claims study: new insights for improving care.

Griffen FD, Stephens LS, Alexander JB, et al. J Am Coll Surg. 2007;204:561-569.

STUDY

Infection control assessment of ambulatory surgical centers.

Schaefer MK, Jhung M, Dahl M, et al. JAMA. 2010;303:2273-2279.

STUDY

Impact of resident participation in surgical operations on postoperative outcomes: National Surgical Quality Improvement Program.

Kiran RP, Ahmed Ali U, Coffey JC, Vogel JD, Pokala N, Fazio VW. Ann Surg. 2012;256:469-475.

STUDY

Ambulatory care adverse events and preventable adverse events leading to a hospital admission.

Woods DM, Thomas EJ, Holl JL, Weiss KB, Brennan TA. Qual Saf Health Care. 2007;16:127-131.

STUDY

Cause and effect analysis of closed claims in obstetrics and gynecology.

White AA, Pichert JW, Bledsoe SH, Irwin C, Entman SS. Obstet Gynecol. 2005;105:1031-1038.

STUDY

The 80-hour work guidelines and resident survey perceptions of quality.

Biller CK, Antonacci AC, Pelletier S, et al. J Surg Res. 2006;135:275-281.

STUDY

Relationship between patient complaints and surgical complications.

Murff HJ, France DJ, Blackford J, et al. Qual Saf Health Care. 2006;15:13-16.

STUDY

Surgical skill is predicted by the ability to detect errors.

Bann S, Khan M, Datta V, Darzi A. Am J Surg. 2005;189:412-415.

STUDY

Probabilistic risk assessment of accidental ABO-incompatible thoracic organ transplantation before and after 2003.

Cook RI, Wreathall J, Smith A, et al. Transplantation. 2007;84:1602-1609.

STUDY

Safety culture and complications after bariatric surgery.

Birkmeyer NJ, Finks JF, Greenberg CK, et al. Ann Surg. 2013;257:260-265.

REVIEW

Epidemiology of medication-related adverse events in nursing homes.

Handler SM, Wright RM, Ruby CM, Hanlon JT. Am J Geriatr Pharmacother. 2006;4:264-272.

STUDY

Analysis of risk factors for adverse drug events in critically ill patients.

Kane-Gill SL, Kirisci L, Verrico MM, Rothschild JM. Crit Care Med. 2012;40:823-828.

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