AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (169)

•Diagnostic Errors (176)

•Identification Errors (113)

•Discontinuities, Gaps, and Hand-Off Problems (586)

•Fatigue and Sleep Deprivation (116)

•Medication Safety (1132)

•Medical Complications (480)

•Nonsurgical Procedural Complications (90)

•Surgical Complications (388)

•Transfusion Complications (19)

•Psychological and Social Complications (184)

Origin/Sponsor
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United States of America

•United States Federal Government (320)

•State Governments and Agencies (58)

Resource Types

•Audiovisual (68)

•Bibliography (3)

•Book/Report (287)

•Clinical Guideline (9)

•Journal Article (2805)

•Legislation/Regulation (64)

•Meeting/Conference (38)

•Newsletter/Journal (13)

•Newspaper/Magazine Article (616)

•Press Release/Announcement (32)

•Special or Theme Issue (61)

•Tools/Toolkit (94)

•Web Resource (137)

Error Types

•Epidemiology of Errors and Adverse Events (780)

•Active Errors (553)

•Latent Errors (280)

•Near Miss (67)

Approach to Improving Safety

•Quality Improvement Strategies (1054)

•Legal and Policy Approaches (522)

•Error Reporting and Analysis (1130)

•Communication Improvement (1139)

•Human Factors Engineering (482)

•Teamwork (350)

•Specialization of Care (315)

•Logistical Approaches (338)

•Culture of Safety (643)

•Technologic Approaches (725)

•Education and Training (861)

Clinical Areas

•Allied Health Services (10)

•Dentistry (3)

•Medicine (2662)

•Nursing (325)

•Pharmacy (448)

Target Audience

•Health Care Providers (3021)

•Health Care Executives and Administrators (3234)

•Non-Health Care Professionals (1666)

•Patients (464)

Setting of Care

•Hospitals (2783)

•Psychiatric Facilities (14)

•Residential Facilities (68)

•Ambulatory Care (377)

•Outpatient Surgery (43)

•Patient Transport (30)

1 - 20 of 4282

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NEWSPAPER/MAGAZINE ARTICLE

Survive your doctor.

Holt TE. Men's Health. November 3, 2006.

NEWSPAPER/MAGAZINE ARTICLE

Beware of basal opioid infusions with PCA therapy.

ISMP Medication Safety Alert! Acute Care Edition. March 12, 2009;14:1-3.

NEWSPAPER/MAGAZINE ARTICLE

Have you M.E.T. the future of better patient safety?

Larson L. Trustee. September 2005;58:6-10.

STUDY

A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.

Jack BW, Chetty VK, Anthony D, et al. Ann Intern Med. 2009;150:178-187.

STUDY

A 5-year analysis of rapid response system activation at an in-hospital haemodialysis unit.

Galhotra S, Devita MA, Dew MA, Simmons RL. Qual Saf Health Care. 2010;19:e38.

MULTI-USE WEBSITE

BOOSTing Care Transitions Resource Room.

Project BOOST (Better Outcomes for Older adults through Safe Transitions), Society of Hospital Medicine.

MULTI-USE WEBSITE

Safer Sign Out.

Emergency Medicine Patient Safety Foundation.

STUDY

Hospital discharge documentation and risk of rehospitalisation.

Hansen LO, Strater A, Smith L, et al. BMJ Qual Saf. 2011;20:773-778.

BOOK/REPORT

Patient-Centered Care Improvement Guide.

Frampton S, Guastello S, Brady C, et al. Derby, CT: Planetree; Camden, ME: Picker Institute; 2008.

BOOK/REPORT

Health Care Leader Action Guide to Reduce Avoidable Readmissions.

Osei-Anto A, Joshi M, Audet AJ, Berman A, Jencks SF. New York, NY: The Commonwealth Fund, The John Hartford Foundation, Health Research and Educational Trust; January 25, 2010.

ORGANIZATIONAL POLICY/GUIDELINES

Preventing errors relating to commonly used anticoagulants.

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

BOOK/REPORT

Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care.

Balik B, Conway J, Zipperer L, Watson J. Cambridge, MA: Institute for Healthcare Improvement; 2011.

STUDY

Hospitalized patients' understanding of their plan of care.

O'Leary KJ, Kulkarni N, Landler MP, et al. Mayo Clin Proc. 2010;85:47-52.

COMMENTARY

Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction.

Clancy CM. Am J Med Qual. 2009;24:344-346.

NEWSPAPER/MAGAZINE ARTICLE

Hospitals combat errors at the 'hand-off.'

Landro L. Wall Street Journal (Eastern edition). June 28, 2006:D1. [reprinted on Post-gazette.com].

NEWSPAPER/MAGAZINE ARTICLE

Teams quicken response in medical emergencies.

Srikameswaran A. Pittsburgh Post-Gazette. July 17, 2005;Health section.

STUDY

classic

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.

NEWSPAPER/MAGAZINE ARTICLE

JCAHO tightens leash on medication reconciliation.

Perry LE. Drug Topics: Health-System Edition. March 20, 2006.

REVIEW

Effective discharge communication in the emergency department.

Samuels-Kalow ME, Stack AM, Porter SC. Ann Emerg Med. 2012;60:152-159.

STUDY

Developing and evaluating a trigger response system.

Cherry K, Martinek J, Esleck S, Ivory A, Logan R, Ward J. Jt Comm J Qual Patient Saf. 2009;35:331-338.

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