U.S. Department of Health & Human Services
Culture of Safety
PATIENT SAFETY PRIMERS
2014 ANNUAL PERSPECTIVES
High-reliability organizations consistently minimize adverse events despite carrying out intrinsically hazardous work...
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Device-related Complications (30)
Diagnostic Errors (18)
Identification Errors (16)
Discontinuities, Gaps, and Hand-Off Problems (44)
Fatigue and Sleep Deprivation (5)
Medication Safety (116)
Medical Complications (98)
Nonsurgical Procedural Complications (21)
Surgical Complications (92)
Transfusion Complications (2)
Psychological and Social Complications (44)
Australia and New Zealand (15)
Central and South America (2)
North America (764)
Clinical Guideline (1)
Journal Article (583)
Newspaper/Magazine Article (86)
Press Release/Announcement (4)
Special or Theme Issue (33)
Web Resource (29)
Epidemiology of Errors and Adverse Events (94)
Active Errors (76)
Latent Errors (96)
Near Miss (12)
Approach to Improving Safety
Culture of Safety
Learning Organization (13)
Red Rules (2)
Institutional Patient Safety Plan (10)
Just Culture (14)
Allied Health Services (3)
Health Care Providers (592)
Health Care Executives and Administrators (751)
Non-Health Care Professionals (418)
Setting of Care
Psychiatric Facilities (2)
Residential Facilities (24)
Ambulatory Care (60)
Outpatient Surgery (4)
Patient Transport (10)
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A hospital races to learn lessons of Ferrari pit stop.
Naik G. Wall Street Journal. November 14, 2006:A1. [reprinted on Post-gazette.com].
Pediatric patient safety in the prehospital/emergency department setting.
Barata IA, Benjamin LS, Mace SE, Herman MI, Goldman RD. Pediatr Emerg Care. 2007;23:412-418.
Pediatric patient safety in emergency departments: unit characteristics and staff perceptions.
Shaw KN, Ruddy RM, Olsen CS, et al; Pediatric Emergency Care Applied Research Network. Pediatrics. 2009;124:485-493.
Patient Safety in Emergency Medicine.
Croskerry P, Cosby KS, Schenkel SM, Wears RL, eds. Philadelphia, PA: Lippincott Williams & Wilkins; 2009. ISBN: 9780781777278.
The Emergency Medical Services Safety Attitudes Questionnaire.
Patterson PD, Huang DT, Fairbanks RJ, Wang HE. Am J Med Qual. 2010;25:109-115.
Pediatric Patient Safety in the Emergency Department.
Krug SE, ed. Oak Brook, IL: Joint Commission Resources and the American Academy of Pediatrics; 2010. ISBN: 9781599402123.
SPECIAL OR THEME ISSUE
Safety in EMS.
Brice JH, Patterson PD, eds. Prehosp Emerg Care. 2012;16:1-108.
Strategy for a National EMS Culture of Safety.
Irving, TX: American College of Emergency Physicians; 2013.
Creating a culture of safety in the emergency department: the value of teamwork training.
Jones F, Podila P, Powers C. J Nurs Adm. 2013;43:194-200.
Shapiro MJ. AHRQ WebM&M [serial online]. February 2004.
To LP or not LP.
Landrigan CP. AHRQ WebM&M [serial online]. October 2003.
Shojania KG. AHRQ WebM&M [serial online]. March 2004.
Delay in Initiating Antibiotics Leads to Fatal Error.
Bellini LM. AHRQ WebM&M [serial online]. February 2004.
Creating an integrated patient safety team.
Gandhi TK, Graydon-Baker E, Barnes JN, et al. Jt Comm J Qual Saf. 2003;29:383-390.
An interview with Lucian Leape.
Leape LL. Jt Comm J Qual Saf. 2004;30:653-658.
Aviation's gift to health care.
Nance JJ. ABC News. November 16, 2005.
Patient safety in women's health care: a framework for progress.
Gluck PA. Best Pract Res Clin Obstet Gynaecol. 2007;21:525-36.
Doctor uses 'pre-flight' checklist.
Bernhard B. The Orange County Register. April 19, 2006.
What We've Learned: Stories and Milestones from the Patient Safety Journey.
Minneapolis, MN: Children's Hospitals and Clinics of Minnesota; April 2006.
Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder.
Makary MA, Sexton JB, Freischlag JA, et al. J Am Coll Surg. 2006;202:746-752.
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