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Approach to Improving Safety
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STUDY
Stories from the sharp end: case studies in safety improvement.
McCarthy D, Blumenthal D. Milbank Q. 2006;84:165-200.
BOOK/REPORT
Adverse Events in Hospitals: Overview of Key Issues.
Levinson DR. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; December 2008. Report No. OEI-06-07-00470.
BOOK/REPORT
Never Events: Framework 2009/10.
National Patient Safety Agency. London, UK: National Reporting and Learning Service; 2009.
COMMENTARY
Making the Patient Safety and Quality Improvement Act of 2005 work.
Vemula R, Assaf RR, Al-Assaf AF. J Healthc Qual. 2007;29:6-10.
CONGRESSIONAL TESTIMONY
Statement of The Hospital & Healthsystem Association of Pennsylvania.
Hearings before the House Insurance Committee of the Pennsylvania General Assembly. (April 22, 2004) (statement of James R. Combes, MD, senior medical advisor, HAP).
COMMENTARY
Path to safety: benefits of the 2005 Patient Safety and Quality Improvement Act.
McBride D, Greening A, Redmond D. Healthc Financ Manage. June 2006;60:84-88.
BOOK/REPORT
Health Care Opinion Leaders' Views on the Quality and Safety of Health Care in the United States.
Shea KK, Shih A, Davis K. New York, NY: The Commonwealth Fund; July 2007.
COMMENTARY
Sidelining safety — the FDA's inadequate response to the IOM.
Smith SW. N Engl J Med. 2007;10:960-963.
NEWSPAPER/MAGAZINE ARTICLE
Preventing fatal errors.
Bailey B, Sevrens Lyons J. The Mercury News. November 27, 2005.
FEDERAL LEGISLATIONclassic
Patient Safety and Quality Improvement Act of 2005.
Pub L No. 109-41.
COMMENTARY
Patient Safety and Quality Improvement Act of 2005.
Fassett WE. Ann Pharmacother. 2006;40:917-924.
BOOK/REPORT
Hospital Reporting of Deaths Related to Restraint and Seclusion. 
Office of the Inspector General. Washington, DC: US Department of Health and Human Services; September 2006. Report No. OEI-09-04-00350.
AUDIOVISUAL PRESENTATION
Patient safety: why it's getting more visibility.
Washington, DC: Alliance for Health Reform; April 7, 2006.
COMMENTARY
The Patient Safety and Quality Improvement Act of 2005: provisions and potential opportunities.
Liang BA, Riley W, Rutherford W, Hamman W. Am J Med Qual. 2007;22:8-12.
COMMENTARY
Patient Safety and Quality Improvement Act of 2005: what you need to know.
Rohrich RJ. Plast Reconstr Surg. 2006;117:671-672.
STUDY
Exploring the causes of adverse events in hospitals and potential prevention strategies.
Smits M, Zegers M, Groenewegen PP, et al. Qual Saf Health Care. 2010;19:e5.
COMMENTARY
Error reporting as a preventive force.
Simpson RL. Nurs Manage. June 2005;36:21-24,56.  
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