AHRQ Patient Safety Network

The Collection > Error Analysis

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Safety Target

•Device-related Complications (22)

•Diagnostic Errors (78)

•Identification Errors (13)

•Discontinuities, Gaps, and Hand-Off Problems (54)

•Fatigue and Sleep Deprivation (13)

•Medication Safety (209)

•Medical Complications (46)

•Nonsurgical Procedural Complications (15)

•Surgical Complications (72)

•Transfusion Complications (4)

•Psychological and Social Complications (25)

Origin/Sponsor

•Asia (11)

•Australia and New Zealand (22)

Resource Types

•Journal Article (590)

•Legislation/Regulation (3)

•Meeting/Conference (1)

•Newsletter/Journal (3)

•Newspaper/Magazine Article (51)

•Press Release/Announcement (4)

•Special or Theme Issue (8)

•Tools/Toolkit (6)

•Web Resource (8)

Error Types

•Epidemiology of Errors and Adverse Events (284)

•Active Errors (99)

•Latent Errors (55)

•Near Miss (19)

Approach to Improving Safety
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Error Analysis

•Root Cause Analysis (61)

•Failure Mode Effects Analysis (18)

•Morbidity and Mortality Conferences (18)

•Narrative/Storytelling (17)

Clinical Areas

•Allied Health Services (3)

Target Audience

•Health Care Providers (474)

•Health Care Executives and Administrators (570)

•Non-Health Care Professionals (234)

•Patients (39)

Setting of Care

•Hospitals (410)

•Psychiatric Facilities (3)

•Residential Facilities (11)

•Ambulatory Care (64)

•Outpatient Surgery (5)

•Patient Transport (4)

1 - 20 of 723

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STUDY

Resident perceptions of the impact of work hour limitations.

Lin GA, Beck DC, Stewart AL, Garbutt JM. J Gen Intern Med. 2007;22:969-975.

STUDY

Resident fatigue: is there a patient safety issue?

Mitchell CD, Mooty CR, Dunn EL, Ramberger KC, Mangram AJ. Am J Surg. 2009;198:811-816.

STUDY

Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning system.

Wittich CM, Lopez-Jimenez F, Decker LK, et al. J Gen Intern Med. 2011;26:293-298.

STUDY

Resident uncertainty in clinical decision making and impact on patient care: a qualitative study.

Farnan JM, Johnson JK, Meltzer DO, Humphrey HJ, Arora VM. Qual Saf Health Care. 2008;17:122-126.

STUDY

Changing conversations: teaching safety and quality in residency training.

Voss JD, May NB, Schorling JB, et al. Acad Med. 2008;83:1080-1087.

STUDY

The association between frequency of self-reported medical errors and anesthesia trainee supervision: a survey of United States anesthesiology residents-in-training.

De Oliveira GS Jr, Rahmani R, Fitzgerald PC, Chang R, McCarthy RJ. Anesth Analg. 2013;116:892-897.

STUDY

Predicting future staffing needs at teaching hospitals: use of an analytical program with multiple variables.

Mitchell CC, Ashley SW, Zinner MJ, Moore FD. Arch Surg. 2007;142:329-334.

COMMENTARY

Do Not Disturb!

Duffy FD, Cassel CK. AHRQ WebM&M [serial online]. October 2007.

STUDY

Work patterns and fatigue-related risk among junior doctors.

Gander PH, Purnell HM, Garden A, Woodward A. Occup Environ Med. 2007;64:733-738.

STUDY

"Learning by Doing"—resident perspectives on developing competency in high-quality discharge care.

Greysen SR, Schiliro D, Curry L, Bradley EH, Horwitz LI. J Gen Intern Med. 2012;27:1188-1194.

STUDY

Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities.

Good VS, Saldaña M, Gilder R, Nicewander D, Kennerly DA. BMJ Qual Saf. 2011;20:25-30.

NEWSPAPER/MAGAZINE ARTICLE

Inquiry into reporter's death finds multiple failures in care.

Stout D. New York Times. June 17, 2006;National desk:9.

STUDY

Educational quality improvement report: outcomes from a revised morbidity and mortality format that emphasised patient safety.

Bechtold ML, Scott S, Nelson K, Cox KR, Dellsperger KC, Hall LW. Qual Saf Health Care. 2007;16:422-427.

STUDY

On the prospects for a blame-free medical culture.

Collins ME, Block SD, Arnold RM, Christakis NA. Soc Sci Med. 2009;69:1287-1290.

STUDY

Medication safety in the ambulatory chemotherapy setting.

Gandhi TK, Bartel SB, Shulman LN, et al. Cancer. 2005;104:2477-2483.

STUDY

Burnout and satisfaction with work-life balance among US physicians relative to the general US population.

Shanafelt TD, Boone S, Tan L, et al. Arch Intern Med. 2012;172:1377-1385.

COMMENTARY

Bringing diagnosis into the quality and safety equations.

Graber ML, Wachter RM, Cassel CK. JAMA. 2012;308:1211-1212.

STUDY

Causes of errors in the electrocardiographic diagnosis of atrial fibrillation by physicians.

Davidenko JM, Snyder LS. J Electrocardiol. 2007;40:450-457.

COMMENTARY

Overcoming barriers to patient safety.

Kalisch BJ, Aebersold M. Nurs Econ. May-June 2006;24:143-148, 155, 123.

NEWSPAPER/MAGAZINE ARTICLE

Are you a great diagnostician?

Yasgur BS. Medscape Business of Medicine. March 27, 2013.

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