AHRQ Patient Safety Network

The Collection > Communication between Providers

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Safety Target

•Device-related Complications (15)

•Diagnostic Errors (42)

•Identification Errors (24)

•Discontinuities, Gaps, and Hand-Off Problems (378)

•Fatigue and Sleep Deprivation (8)

•Medication Safety (227)

•Medical Complications (42)

•Nonsurgical Procedural Complications (8)

•Surgical Complications (79)

•Transfusion Complications (2)

•Psychological and Social Complications (43)

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•Asia (4)

•Australia and New Zealand (29)

Resource Types

•Journal Article (562)

•Legislation/Regulation (10)

•Newspaper/Magazine Article (84)

•Special or Theme Issue (10)

•Tools/Toolkit (8)

•Web Resource (10)

•Grant (1)

Error Types

•Epidemiology of Errors and Adverse Events (127)

•Active Errors (137)

•Latent Errors (84)

•Near Miss (12)

Approach to Improving Safety
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Communication between Providers

•Read Back Protocols (28)

•Structured Hand-offs (134)

•SBAR (15)

•Medication Reconciliation (130)

Clinical Areas

•Allied Health Services (4)

•Medicine (562)

•Nursing (74)

•Pharmacy (102)

Target Audience

•Health Care Providers (575)

•Health Care Executives and Administrators (557)

•Non-Health Care Professionals (241)

•Patients (33)

Setting of Care

•Hospitals (576)

•Psychiatric Facilities (3)

•Residential Facilities (16)

•Ambulatory Care (79)

•Outpatient Surgery (7)

•Patient Transport (10)

1 - 20 of 724

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COMMENTARY

Revisiting duty-hour limits — IOM recommendations for patient safety and resident education.

Iglehart JK. N Engl J Med. 2008;359:2633-2635.

STUDY

Use of an appreciative inquiry approach to improve resident sign-out in an era of multiple shift changes.

Helms AS, Perez TE, Baltz J, et al. J Gen Intern Med. 2012;27:287-291.

STUDY

Consequences of inadequate sign-out for patient care.

Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Arch Intern Med. 2008;168:1755-1760.

ORGANIZATIONAL POLICY/GUIDELINES

Health care worker fatigue and patient safety.

Sentinel Event Alert. December 14, 2011;(48):1-4.

STUDY

"Did I do as best as the system would let me?" Healthcare professional views on hospital to home care transitions.

Davis MM, Devoe M, Kansagara D, Nicolaidis C, Englander H. J Gen Intern Med. 2012;27:1649-1656.

COMMENTARY

Do Not Disturb!

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

STUDY

What do patients think about year-end resident continuity clinic handoffs?: a qualitative study.

Pincavage AT, Lee WW, Beiting KJ, Arora VM. J Gen Intern Med. 2013 Apr 18; [Epub ahead of print].

STUDY

Effects of a multicentre teamwork and communication programme on patient outcomes: results from the Triad for Optimal Patient Safety (TOPS) project.

Auerbach AD, Sehgal NL, Blegen MA, et al. BMJ Qual Saf. 2012;22:118-126.

STUDY

Faculty member review and feedback using a sign-out checklist: improving intern written sign-out.

Bump GM, Bost JE, Buranosky R, Elnicki M. Acad Med. 2012;87;1125-1131.

STUDY

The effect of workload reduction on the quality of residents' discharge summaries.

Coit MH, Katz JT, McMahon GT. J Gen Intern Med. 2011;26:28-32.

STUDY

Gaps in pediatric clinician communication and opportunities for improvement.

Woods DM, Holl JL, Angst DB, et al. J Healthc Qual. 2008;30:43-54.

COMMENTARY

Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps.

Greenwald JL, Halasyamani L, Greene J, et al. J Hosp Med. 2010;5:477-485.

COMMENTARY

Handoffs in the era of duty hours reform: a focused review and strategy to address changes in the Accreditation Council for Graduate Medical Education Common Program Requirements.

DeRienzo CM, Frush K, Barfield ME, et al. Acad Med. 2012;87:403-410.

ORGANIZATIONAL POLICY/GUIDELINES

Preventing errors relating to commonly used anticoagulants.

Sentinel Event Alert. September 24, 2008;(41):1-4.

STUDY

Perspective: a business school view of medical interprofessional rounds: transforming rounding groups into rounding teams.

Bharwani AM, Harris GC, Southwick FS. Acad Med. 2012;87:1768-1771.

COMMENTARY

Academic year-end transfers of outpatients from outgoing to incoming residents: an unaddressed patient safety issue.

Young JQ, Wachter RM. JAMA. 2009;302:1327-1329.

STUDY

The care transitions intervention: translating from efficacy to effectiveness.

Voss R, Gardner R, Baier R, Butterfield K, Lehrman S, Gravenstein S. Arch Intern Med. 2011;171:1232-1237.

COMMENTARY

Utilizing information technology to mitigate the handoff risks caused by resident work hour restrictions.

Bernstein J, MacCourt DC, Jacob DM, Mehta S. Clin Orthop Relat Res. 2010;468:2627-2732.

STUDY

Avoiding handover fumbles: a controlled trial of a structured handover tool versus traditional handover methods.

Payne CE, Stein JM, Leong T, Dressler DD. BMJ Qual Saf. 2012;21:925-932.

NEWSPAPER/MAGAZINE ARTICLE

Discharge missteps can send seniors back to hospital.

Korc B, Landers SJ. American Medical News. February 15, 2010.

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