AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (10)

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•Identification Errors (18)

•Discontinuities, Gaps, and Hand-Off Problems (56)

•Fatigue and Sleep Deprivation (6)

•Medication Safety (63)

•Medical Complications (60)

•Nonsurgical Procedural Complications (16)

•Surgical Complications (139)

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Error Types

•Epidemiology of Errors and Adverse Events (49)

•Active Errors (43)

•Latent Errors (25)

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Approach to Improving Safety
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Teamwork

•Teamwork Training (123)

Clinical Areas

•Allied Health Services (3)

•Medicine (391)

•Nursing (79)

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Target Audience

•Health Care Providers (403)

•Health Care Executives and Administrators (439)

•Non-Health Care Professionals (275)

•Patients (17)

Setting of Care

•Hospitals (381)

•Psychiatric Facilities (1)

•Residential Facilities (5)

•Ambulatory Care (26)

•Outpatient Surgery (5)

•Patient Transport (6)

1 - 20 of 542

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STUDY

Improved operating room teamwork via SAFETY prep: a rural community hospital's experience.

Paige JT, Aaron DL, Yang T, Howell DS, Chauvin SW. World J Surg. 2009;33:1181-1187.

STUDY

A surgical safety checklist to reduce morbidity and mortality in a global population.

Haynes AB, Weiser TG, Berry WR, et al; for the Safe Surgery Saves Lives Study Group. N Engl J Med. 2009;360:491-499.

COMMENTARY

Executive summary of the American College of Obstetricians and Gynecologists Presidential Task Force on Patient Safety in the Office Setting: reinvigorating safety in office-based gynecologic surgery.

Erickson TB, Kirkpatrick DH, DeFrancesco MS, Lawrence HC III. Obstet Gynecol. 2010;115:147-151.

STUDY

Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention.

Haynes AB, Weiser TG, Berry WR, et al; Safe Surgery Saves Lives Study Group. BMJ Qual Saf. 2011;20:102-107.

STUDY

Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR.

Lingard L, Espin S, Rubin B, et al. Qual Saf Health Care. 2005;14:340-346.

STUDY

Interruptions and miscommunications in surgery: an observational study.

Gillespie BM, Chaboyer W, Fairweather N. AORN J. 2012;95:576-590.

COMMENTARY

Reducing surgical complications.

Griffin FA. Jt Comm J Qual Patient Saf. 2007;33:660-665.

REVIEW

Determining the state of knowledge for implementing the Universal Protocol recommendations: an integrative review of the literature.

Conrardy JA, Brenek B, Myers S. AORN J. 2010;92:194-207.

STUDY

Development and pilot evaluation of a preoperative briefing protocol for cardiovascular surgery.

Henrickson SE, Wadhera RK, ElBardissi AW, Wiegmann DA, Sundt TM. J Am Coll Surg. 2009;208:1115-1123.

SPECIAL OR THEME ISSUE

Quality of Anesthesia Care.

Neuman MD, Martinez EA, eds. Anesthesiol Clin. 2011;29:1-178.

STUDY

Can aviation-based team training elicit sustainable behavioral change?

Sax HC, Browne P, Mayewski RJ, et al. Arch Surg. 2009;144:1133-1137.

COMMENTARY

Increasing patient safety and surgical team communication by using a count/time out board.

Edel EM. AORN J. 2010;92:420-424.

REVIEW

Enhancing communication in surgery through team training interventions: a systematic literature review.

Gillespie BM, Chaboyer W, Murray P. AORN J. 2010;92:642-657.

STUDY

Surgical team training: the Northwestern Memorial Hospital experience.

Halverson AL, Andersson JL, Anderson K, et al. Arch Surg. 2009;144:107-112.

REVIEW

Patient safety in surgery: non-technical aspects of safe surgical performance.

Youngson GG, Flin R. Patient Saf Surg. 2010;4:4.

COMMENTARY

Retained surgical items and minimally invasive surgery.

Gibbs VC. World J Surg. 2011;35:1532-1539.

STUDY

Operating room briefings and wrong-site surgery.

Makary MA, Mukherjee A, Sexton BJ, et al. J Am Coll Surg. 2007;204:236-243.

STUDY

Identifying opportunities for quality improvement in surgical site infection prevention.

Gagliardi AR, Eskicioglu C, McKenzie M, Fenech D, Nathens A, McLeod R. Am J Infect Control. 2009;37:398-402.

STUDY

Causes of near misses: perceptions of perioperative nurses.

Cohoon B. AORN J. 2011;93:551-565.

NEWSPAPER/MAGAZINE ARTICLE

Hospitals collaborate to prevent wrong-site surgery.

Pelczarski KM, Braun PA, Young E. Patient Saf Qual Healthc. Sept/Oct 2010;7:20-22,25-26.

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