AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (98)

•Diagnostic Errors (81)

•Identification Errors (51)

•Discontinuities, Gaps, and Hand-Off Problems (348)

•Fatigue and Sleep Deprivation (74)

•Medication Safety (641)

•Medical Complications (335)

•Nonsurgical Procedural Complications (40)

•Surgical Complications (183)

•Transfusion Complications (13)

•Psychological and Social Complications (137)

Origin/Sponsor
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United States of America

•United States Federal Government (140)

•State Governments and Agencies (16)

Resource Types

•Audiovisual (37)

•Book/Report (153)

•Clinical Guideline (3)

•Journal Article (1685)

•Legislation/Regulation (30)

•Meeting/Conference (14)

•Newspaper/Magazine Article (414)

•Press Release/Announcement (7)

•Special or Theme Issue (30)

•Tools/Toolkit (44)

•Web Resource (42)

Error Types

•Epidemiology of Errors and Adverse Events (476)

•Active Errors (288)

•Latent Errors (168)

•Near Miss (32)

Approach to Improving Safety

•Quality Improvement Strategies (631)

•Legal and Policy Approaches (278)

•Error Reporting and Analysis (659)

•Communication Improvement (650)

•Human Factors Engineering (259)

•Teamwork (336)

•Specialization of Care (209)

•Logistical Approaches (233)

•Culture of Safety (444)

•Technologic Approaches (429)

•Education and Training (487)

Clinical Areas

•Allied Health Services (5)

•Dentistry (1)

•Medicine (1714)

•Nursing (258)

•Pharmacy (274)

Target Audience

•Health Care Providers (1506)

•Health Care Executives and Administrators (1843)

•Non-Health Care Professionals (1041)

•Patients (245)

Setting of Care

•Hospitals (2123)

•Psychiatric Facilities (8)

•Residential Facilities (33)

•Ambulatory Care (228)

•Outpatient Surgery (18)

•Patient Transport (11)

1 - 20 of 2481

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NEWSPAPER/MAGAZINE ARTICLE

Disruptive physicians.

Sandrick K. Trustee. November 2009.

STUDY

Improving teamwork on general medical units: when teams do not work face-to-face.

McComb SA, Henneman EA, Hinchey KT, et al. Jt Comm J Qual Patient Saf. 2012;38:471-478.

STUDY

Physicians' needs in coping with emotional stressors: the case for peer support.

Hu YY, Fix ML, Hevelone ND, et al. Arch Surg. 2012;147:212-217.

STUDY

Assessment of teamwork during structured interdisciplinary rounds on medical units.

O'Leary KJ, Boudreau YN, Creden AJ, Slade ME, Williams MV. J Hosp Med. 2012;7:679-683.

STUDY

Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting.

Makowsky MJ, Schindel TJ, Rosenthal M, Campbell K, Tsuyuki RT, Madill HM. J Interprof Care. 2009;23:169-84.

COMMENTARY

Integrating CUSP and TRIP to improve patient safety.

Romig M, Goeschel C, Pronovost P, Berenholtz SM. Hosp Pract (Minneap). 2010;38:114-121.

REVIEW

What is patient safety culture? A review of the literature.

Sammer CE, Lykens K, Singh KP, Mains DA, Lackan NA. J Nurs Scholarsh. 2010;42:156-165.

MULTI-USE WEBSITE

BOOSTing Care Transitions Resource Room.

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

COMMENTARY

A new frontier in patient safety.

McCannon J, Berwick DM. JAMA. 2011;305:2221-2222.

STUDY

A theory-driven, longitudinal evaluation of the impact of team training on safety culture in 24 hospitals.

Jones KJ, Skinner AM, High R, Reiter-Palmon R. BMJ Qual Saf. 2013;22:394-404.

MISSOURI MEETING/CONFERENCE

The Second Victim Experience: Train-the-Trainer Workshop.

Center for Patient Safety. June 11, 2013; University of Missouri Health System Health System, Columbia, MO.

STUDY

Health care workers as second victims of medical errors.

Edrees HH, Paine LA, Feroli ER, Wu AW. Pol Arch Med Wewn. 2011;121:101-108.

NEWSPAPER/MAGAZINE ARTICLE

Strengthening the core. Middle managers play a vital role in improving safety.

Federico F, Bonacum D. Healthc Exec. January/February 2010;25:68-70.

REVIEW

Interdisciplinary teamwork in hospitals: a review and practical recommendations for improvement.

O'Leary KJ, Sehgal NL, Terrell G, Williams MV; High Performance Teams and the Hospital of the Future Project Team. J Hosp Med. 2011 Oct 31; [Epub ahead of print].

BOOK/REPORT

Speaking Up Constructively: Managerial Practices that Elicit Solutions from Front-Line Employees.

Adler-Milstein JR, Singer SJ, Toffel MW. Cambridge, MA: Harvard Business School; August 25, 2010. HBS Working Paper No. 11-005.

BOOK/REPORT

Tennessee Center for Patient Safety Annual Report 2010.

Nashville, TN: Tennessee Center for Patient Safety; August 2011.

COMMENTARY

Learning accountability for patient outcomes.

Pronovost PJ. JAMA. 2010;304:204-205.

COMMENTARY

The competitive imperative of learning.

Edmondson AC. Harv Bus Rev. 2008;86:60-67, 160.

MEETING/CONFERENCE PROCEEDINGS

The 2012 Fifth International High Reliability Conference Proceedings.

Oakbrook Terrace, IL: Joint Commission; May 21–23, 2012.

STUDY

Medical error reduction: the effect of employee satisfaction with organizational support.

Lee D, Lee SM, Schniederjans MJ. Serv Ind J. 2011;31:1311-1325.

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