AHRQ Patient Safety Network

PATIENT SAFETY PRIMERS
Safety Culture

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Safety Culture: High-reliability organizations consistently minimize adverse events despite carrying out intrinsically hazardous work... Read Full Glossary Entry >

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Safety Target

•Device-related Complications (31)

•Diagnostic Errors (19)

•Identification Errors (16)

•Discontinuities, Gaps, and Hand-Off Problems (47)

•Fatigue and Sleep Deprivation (6)

•Medication Safety (136)

•Medical Complications (104)

•Nonsurgical Procedural Complications (23)

•Surgical Complications (93)

•Transfusion Complications (2)

•Psychological and Social Complications (41)

Origin/Sponsor

•Africa (1)

•Asia (5)

•Australia and New Zealand (22)

•Central and South America (2)

Resource Types

•Clinical Guideline (1)

•Journal Article (614)

•Legislation/Regulation (13)

•Meeting/Conference (18)

•Newspaper/Magazine Article (97)

•Press Release/Announcement (4)

•Special or Theme Issue (38)

•Tools/Toolkit (18)

•Web Resource (29)

•Grant (6)

Error Types

•Epidemiology of Errors and Adverse Events (90)

•Active Errors (72)

•Latent Errors (82)

•Near Miss (14)

Approach to Improving Safety
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Culture of Safety

•Learning Organization (51)

•Red Rules (3)

•Institutional Patient Safety Plan (20)

•Just Culture (22)

Clinical Areas

•Allied Health Services (4)

Target Audience

•Health Care Providers (586)

•Health Care Executives and Administrators (839)

•Non-Health Care Professionals (451)

•Patients (58)

Setting of Care

•Hospitals (544)

•Psychiatric Facilities (4)

•Residential Facilities (27)

•Ambulatory Care (62)

•Outpatient Surgery (5)

•Patient Transport (8)

1 - 20 of 973

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SPECIAL OR THEME ISSUE

Patient Safety and Quality.

Lyndon A, Simpson KR, Bakewell-Sachs S, eds. J Perinat Neonat Nurs. 2010;24:1-89.

AUDIOVISUAL

Eye to eye: Donald Berwick.

"Eye to Eye with Katie Couric." CBS News Video. February 6, 2007.

NEWSPAPER/MAGAZINE ARTICLE

A hospital races to learn lessons of Ferrari pit stop.

Naik G. Wall Street Journal. November 14, 2006:A1. [reprinted on Post-gazette.com].

BOOK/REPORT

Safer Hospital Care: Strategies for Continuous Innovation.

Raheja D. New York, NY: Productivity Press; 2011. ISBN: 9781439821022.

BOOK/REPORT

Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care.

Roundtable on Joy and Meaning in Work and Workforce Safety, The Lucian Leape Institute. Boston, MA: National Patient Safety Foundation; 2013.

AWARD RECIPIENT

An interview with Lucian Leape.

Leape LL. Jt Comm J Qual Saf. 2004;30:653-658.

BOOK/REPORT classic

Patient Safety in Emergency Medicine.

Croskerry P, Cosby KS, Schenkel SM, Wears RL, eds. Philadelphia, PA: Lippincott Williams & Wilkins; 2009. ISBN: 9780781777278.

TOOLKIT

Making Strides in Safety.

Chicago, IL: American Medical Association.

NEWSPAPER/MAGAZINE ARTICLE

Doctor uses 'pre-flight' checklist.

Bernhard B. The Orange County Register. April 19, 2006.

BOOK/REPORT

Patient Safety: A Human Factors Approach.

Dekker S. New York, NY: CRC Press; 2011. ISBN: 1439852251.

STUDY

Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel.

Sexton JB, Makary MA, Tersigni AR, et al. Anesthesiology. 2006;105:877-884.

STUDY

Patient safety climate in primary care: age matters.

Holden LM, Watts DD, Hinton WP. J Patient Saf. 2009;5:23-28.

BOOK/REPORT

What We've Learned: Stories and Milestones from the Patient Safety Journey.

Minneapolis, MN: Children's Hospitals and Clinics of Minnesota; April 2006.

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.

SPECIAL OR THEME ISSUE

Quality of Anesthesia Care.

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

MEETING/CONFERENCE PROCEEDINGS

Safety in the NICU: preventing medical errors.

Stokowski LA. Highlights of the National Association of Neonatal Nurses 22nd Annual Conference [Medscape.com]. March 8, 2007.

COMMENTARY

Tips to reduce dangerous interruptions by healthcare staff.

Lewis TP, Smith CB, Williams-Jones P. Nursing. 2012;42:65-67.

COMMENTARY

Ambiguity and workarounds as contributors to medical error.

Spear SJ, Schmidhofer M. Ann Intern Med. 2005;142:627-630.

SPECIAL OR THEME ISSUE

Patient Safety.

Matlow A, Laxer RM, eds. Pediatr Clin North Am. 2006;53:1053-1267.

STUDY

Michigan Health & Hospital Association Keystone Obstetrics: a statewide collaborative for perinatal patient safety in Michigan.

Simpson KR, Knox GE, Martin M, George C, Watson SR. Jt Comm J Qual Patient Saf. 2011;37:544-551.

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