AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (4)

•Diagnostic Errors (1)

•Identification Errors (4)

•Discontinuities, Gaps, and Hand-Off Problems (4)

•Fatigue and Sleep Deprivation (1)

•Medication Safety (12)

•Medical Complications (7)

•Nonsurgical Procedural Complications (2)

•Surgical Complications (17)

•Psychological and Social Complications (4)

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•Australia and New Zealand (3)

•North America (44)

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•Book/Report (6)

•Journal Article (45)

•Legislation/Regulation (1)

•Newspaper/Magazine Article (12)

•Special or Theme Issue (1)

Error Types

•Epidemiology of Errors and Adverse Events (9)

•Active Errors (14)

•Latent Errors (10)

Approach to Improving Safety
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Credentialing, Licensure, and Discipline

Clinical Areas

•Medicine (32)

•Nursing (10)

•Pharmacy (5)

Target Audience

•Health Care Providers (39)

•Health Care Executives and Administrators (49)

•Non-Health Care Professionals (31)

•Patients (10)

Setting of Care

•Hospitals (33)

•Residential Facilities (4)

•Ambulatory Care (6)

•Outpatient Surgery (5)

1 - 20 of 65

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COMMENTARY

Liposuction Gone Awry

Yates JA. AHRQ WebM&M [serial online]. March 2006.

STUDY

Persistent next-day effects of excessive alcohol consumption on laparoscopic surgical performance.

Gallagher AG, Boyle E, Toner P, et al. Arch Surg. 2011;146:419-426.

ORGANIZATIONAL POLICY/GUIDELINES

Recommendations for quality assurance and improvement in surgical and autopsy pathology.

Association of Directors of Anatomic and Surgical Pathology. Hum Pathol. 2006;37:985-988.

COMMENTARY

Collegiality vs. Competence

Sagin T. AHRQ WebM&M [serial online]. March 2006.

STUDY

Adverse event reporting: lessons learned from 4 years of Florida office data.

Coldiron B, Fisher AH, Adelman E, et al. Dermatol Surg. 2005;31(pt 1):1079-1092; discussion 1093.

COMMENTARY

Integrating simulation in surgery as a teaching tool and credentialing standard.

Rehrig ST, Powers K, Jones DB. J Gastrointest Surg. 2007;12:222-233.

STUDY

What is the measure of a safe hospital? Medication errors missed by risk management, clinical staff, and surveyors.

Grasso BC, Rothschild JM, Jordan CW, Jayaram G. J Psychiatr Pract. 2005;11:268-273.

COMMENTARY classic

classic

Balancing "no blame" with accountability in patient safety.

Wachter RM, Pronovost PJ. N Engl J Med. 2009;361:1401-1406.

STUDY

classic

Disciplinary action by medical boards and prior behavior in medical schools.

Papadakis MA, Teherani A, Banach MA, et al. N Engl J Med. 2005;353:2673-2682.

NEWSPAPER/MAGAZINE ARTICLE

State: nurse error caused death.

Wahlberg D. Wisconsin State Journal. July 22, 2006:A1.

STUDY

Professional values and reported behaviours of doctors in the USA and UK: quantitative survey.

Roland M, Rao SR, Sibbald B, et al. BMJ Qual Saf. 2011;20:515-521.

REVIEW

Patient safety and office-based anesthesia.

Urman RD, Punwani N, Shapiro FE. Curr Opin Anaesthesiol. 2012;25:648-653.

COMMENTARY

Excellent review scheme for critical incidents but insufficient for revalidation.

Lakhani M. BMJ. 2005;330:1143.

REVIEW

Office-based anesthesia.

Kurrek MM, Twersky RS. Can J Anaesth. 2010;57:256-272.

COMMENTARY

Medical errors: mandatory reporting, voluntary reporting, or both?

Grepperud S. Eur J Law Econ. 2005;20:99-112.

COMMENTARY

We're not your enemy: an appeal from a consumer to re-imagine tort reform.

Sheridan SS, Hatlie MJ. Patient Saf Qual Healthc. July/August 2007;4:22-26.

NEWSPAPER/MAGAZINE ARTICLE

Collaboration focused on priority issues promotes safety.

ISMP Medication Safety Alert! Acute Care Edition. October 10, 2008;13:1-3.

STUDY

Relationship between performance measurement and accreditation: implications for quality of care and patient safety.

Miller MR, Pronovost P, Donithan M, et al. Am J Med Qual. 2005;20:239-252.

COMMENTARY

Implementing a systematic response to medication errors.

Larsen D, Cole R, Higton P. Nurs Stand. 2007;21:35-40.

STUDY

Policies and practices related to the role of board certification and recertification of pediatricians in hospital privileging.

Freed GL, Uren RL, Hudson EJ, Lakhani I, Wheeler JRC, Stockman JA III; Research Advisory Committee of the American Board of Pediatrics. JAMA. 2006;295:905-912.

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