2010 Annual National Patient Safety Foundation Congress: conference proceedings.

Diane C. Pinakiewicz; Doug Bonacum; Barbara J. Youngberg; Larry Stepnick; Manisha Shah

Commentary

2010 Annual National Patient Safety Foundation Congress: conference proceedings.

September 8, 2010

Pinakiewicz DC, Bonacum D, Youngberg BJ, et al. J Patient Saf. 2010;6(3):128-36.

View more articles from the same authors.

This piece summarizes plenary talks and panel discussions on health care teamwork issues and the need for medical education reform.

PubMed citation

Available at

Related Resources From the Same Author(s)

2008 Annual National Patient Safety Foundation Congress: conference proceedings.

September 24, 2008

"To Err Is Human" Report Retrospective and the Decade Ahead.

October 21, 2009

Event reporting: the value of a nonpunitive approach.

November 26, 2008

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

January 6, 2010

A qualitative analysis of physician perspectives on missed and delayed outpatient diagnosis: the focus on system-related factors.

September 24, 2014

Organizational factors associated with high performance in quality and safety in academic medical centers.

February 27, 2008

Surgical team behaviors and patient outcomes.

October 1, 2008

Challenges of making a diagnosis in the outpatient setting: a multi-site survey of primary care physicians.

June 6, 2012

Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015.

March 29, 2017

Improving acceptance of computerized prescribing alerts in ambulatory care.

November 9, 2005

How to deliver safer and effective patient care: tips for team leaders and educators.

April 17, 2019

Communicating in the "gray zone": perceptions about emergency physician-hospitalist handoffs and patient safety.

October 17, 2007

Renal medication-related clinical decision support (CDS) alerts and overrides in the inpatient setting following implementation of a commercial electronic health record: implications for designing more effective alerts.

February 17, 2021

How will state medical boards handle cases involving disclosure and apology for medical errors?

April 27, 2022

Triggers, bundles, protocols, and checklists—what every maternal care provider needs to know.

April 13, 2016

Patterns of disrespectful physician behavior at an academic medical center: implications for training, prevention, and remediation.

December 12, 2018

Physician practice patterns resemble ACGME duty hours.

July 8, 2009

Failure events in transition of care for surgical patients.

March 5, 2014

Patient safety and diagnostic error: tips for your next shift.

February 3, 2010

Getting to havarti: moving toward patient safety in obstetrics.

November 21, 2007

A leadership challenge: staff nurse perceptions after an organizational TeamSTEPPS initiative.

October 17, 2012

Transforming healthcare: a safety imperative.

December 9, 2009

Trust and medical AI: the challenges we face and the expertise needed to overcome them.

April 21, 2021

Where should patient safety be installed?

November 29, 2017

Exploring emergency physician–hospitalist handoff interactions: development of the Handoff Communication Assessment.

March 17, 2010

Adherence to black box warnings for prescription medications in outpatients.

February 22, 2006

No more blame & shame: developing event-reporting systems may go a long way to reducing patient care errors in EMS.

October 1, 2008

Clinical perspective: creating an effective practice peer review process—a primer.

March 29, 2017

The Sorry Works! Coalition: making the case for full disclosure.

June 7, 2006

Electronic health record challenges, workarounds, and solutions observed in practices integrating behavioral health and primary care.

October 21, 2015

Harmful medication errors in children: a 5-year analysis of data from the USP's MEDMARX(R) program.

August 2, 2006

Communication in critical care environments: mobile telephones improve patient care.

February 8, 2006

Quality and strength of patient safety climate on medical–surgical units.

March 11, 2009

The impact of electronic health records on diagnosis.

October 4, 2017

Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors.

August 31, 2011

Emergency medical services provider perceptions of the nature of adverse events and near-misses in out-of-hospital care: an ethnographic view.

July 16, 2008

Exploration of a rapid response team model of care: a descriptive dual methods study.

September 21, 2022

Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.

May 8, 2019

Medical and nursing staff highly value clinical pharmacists in the emergency department.

December 19, 2007

Speaking up about patient-perceived serious visit note errors: patient and family experiences and recommendations.

January 13, 2021

A human factors subsystems approach to trauma care.

August 27, 2014

Integrating human factors research and surgery: a review.

January 16, 2013

Usability study of two common defibrillators reveals hazards.

January 2, 2008

Standardization of compounded oral liquids for pediatric patients in Michigan.

August 31, 2016

Drone delivery of medications: review of the landscape and legal considerations.

February 21, 2018

Nurses' role in medical error recovery: an integrative review.

April 20, 2016

Evaluation of perioperative medication errors and adverse drug events.

November 4, 2015

A system-wide initiative to prevent retained vaginal sponges.

September 14, 2011

Pharmacist outpatient prescription review in the emergency department: a pediatric tertiary hospital experience.

September 26, 2018

Quantification of anesthesia providers' hand hygiene in a busy metropolitan operating room: what would Semmelweis think?

December 12, 2012

Prejudice in perceptions of physicians?: The influence of race and gender on evaluations of medical errors.

August 8, 2018

Improving care teams' functioning: recommendations from team science.

June 14, 2017

Antibiotic prescribing in ambulatory pediatrics in the United States.

January 11, 2012

February 25, 2015

The development and piloting of the Ambulatory Electronic Health Record Evaluation Tool: lessons learned.

March 17, 2021

Use of simulation-based education to reduce catheter-related bloodstream infections.

August 19, 2009

Are we heeding the warning signs? Examining providers' overrides of computerized drug–drug interaction alerts in primary care.

January 22, 2014

Teaching nurses to make clinical judgments that ensure patient safety.

August 14, 2019

Ambulance personnel perceptions of near misses and adverse events in pediatric patients.

August 11, 2010

Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity.

May 4, 2022

Electronic prescribing and other forms of technology to reduce inappropriate medication use and polypharmacy in older people: a review of current evidence.

July 18, 2012

Developing perioperative Covid-19 testing protocols to restore surgical services.

July 22, 2020

Electronic health record–related events in medical malpractice claims.

January 6, 2016

Use of a novel, modified fishbone diagram to analyze diagnostic errors.

July 16, 2014

Out-of-hospital medication errors: a 6-year analysis of the national poison data system.

September 2, 2009

October 16, 2013

Emergency hospitalizations for unsupervised prescription medication ingestions by young children.

October 8, 2014

Lack of association between intraoperative handoff of care and postoperative complications: a retrospective observational study.

November 6, 2019

Tort claims and adverse events in emergency medical services.

May 7, 2008

More than a tick box: medical checklist development, design, and use.

August 23, 2017

Fatigue and safety in paramedicine.

December 18, 2019

Lessons learned from implementing a principled approach to resolution following patient harm.

January 9, 2019

Autopsy as a quality control measure for radiology, and vice versa.

November 7, 2012

Bedside shift reports: what does the evidence say?

September 24, 2014

The girl who cried pain: a bias against women in the treatment of pain.

January 2, 2001

Prescription for error: process defects in a community retail pharmacy.

December 19, 2007

From guideline to order set to patient harm.

April 4, 2018

Sleepy nurses: are we willing to accept the challenge today?

June 20, 2007

Recalls and safety alerts affecting automated external defibrillators.

August 23, 2006

Managing and mitigating conflict in healthcare teams: an integrative review.

March 2, 2016

Misgivings.

October 21, 2009

Causes of near misses: perceptions of perioperative nurses.

June 8, 2011

The nurse's role in medication safety.

April 22, 2015

Journal Article

Study

Reducing hospital harm: establishing a command centre to foster situational awareness.

March 29, 2023

When should a leader apologize—and when not?

April 19, 2006

Effect of residency duty-hour limits: views of key clinical faculty.

August 1, 2007

Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility.

July 21, 2021

The effect of provider characteristics on the responses to medication-related decision support alerts.

July 15, 2015

Cognitive error in an academic emergency department.

October 10, 2018

Impact of a commercial order entry system on prescribing errors amenable to computerised decision support in the hospital setting: a prospective pre–post study.

April 18, 2018

Patient characteristics and the occurrence of never events.

February 24, 2010

Using information technology to improve the quality and safety of emergency care.

July 6, 2011

Exclusion of residents from surgery-intensive care team communication: a qualitative study.

April 27, 2016

Pediatric quality and safety: a nursing perspective.

May 11, 2016

Patient safety: break the silence.

May 9, 2012

A clinical nurse specialist intervention to facilitate safe transfer from ICU.

November 30, 2011

Promoting civility in the OR: an ethical imperative.

March 8, 2017

Leading your organization to high reliability.

April 22, 2009

Different roles, same goal: risk and quality management partnering for patient safety. By the ASHRM Monographs Task Force.

October 24, 2007

Adverse drug event surveillance and drug withdrawals in the United States, 1969-2002.

July 6, 2005

Related Resources

Annual Perspective

Communication During Transitions of Care

March 27, 2024

Interview

In Conversation With...Stephen Hines, PhD and Monika Haugstetter, MHA, MSN, RN, CPHQ about TeamSTEPPS 3.0

February 28, 2024

Interview

In Conversation with...Richard Ricciardi about Office-Based Patient Safety

January 31, 2024

Interview

In Conversation with... Cheryl Jones about Addressing Workplace Violence and Creating a Safer Workplace

October 31, 2023

Perspectives on Safety

Addressing Workplace Violence and Creating a Safer Workplace

October 31, 2023

Perspectives on Safety

Beyond the Pandemic: Creating Total Systems Safety

August 30, 2023

Perspectives on Safety

Interview

In Conversation with... Patricia McGaffigan about Beyond the Pandemic: Creating Total Systems Safety

August 30, 2023

Interview

In Conversation with... Kathleen Sanford and Sue Schuelke about Virtual Nursing

August 30, 2023

Perspectives on Safety

Virtual Nursing: Improving Patient Care and Meeting Workforce Challenges

August 30, 2023

The Safety Competencies Framework.

October 5, 2021

Emerging Concepts in Patient Safety.

September 18, 2019

PC standards for maternal safety.

September 11, 2019

The rise of human factors: optimising performance of individuals and teams to improve patients' outcomes.

July 10, 2019

Deprescribing Guidelines: Special Section on Symposium Results.

June 26, 2019

Reducing three infections across cardiac surgery programs: a multisite cross-unit collaboration.

May 22, 2019

Teamwork- Part 1: Divided We Fall; Part 2: Cursed By Knowledge: Building a Culture of Psychological Safety; and Part 3: The Not-My-Problem Problem.

March 6, 2019

The path to diagnostic excellence includes feedback to calibrate how clinicians think.

February 20, 2019

Importance of safety climate, teamwork climate and demographics: understanding nurses, allied health professionals and clerical staff perceptions of patient safety.

January 30, 2019

Challenges and opportunities for improving patient safety through human factors and systems engineering.

December 5, 2018

Managing alarm systems for quality and safety in the hospital setting.

November 14, 2018

Measuring shared mental models in healthcare.

November 7, 2018

The systems approach at the sharp end.

October 31, 2018

Patient Safety: A Health Affairs Briefing.

October 31, 2018

Distractions in the anesthesia work environment: impact on patient safety? Report of a meeting sponsored by the Anesthesia Patient Safety Foundation.

June 28, 2017

Unprofessional workplace conduct...defining and defusing it.

October 26, 2016

Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system.

January 27, 2016

2015 Rosenthal Symposium: Protecting Patients: Advances and Future Directions in Patient Safety.

November 11, 2015

Aiming higher to enhance professionalism: beyond accreditation and certification.

May 27, 2015

Principles supporting dynamic clinical care teams: an American College of Physicians position paper.

September 25, 2013

Achieving the 'perfect handoff' in patient transfers: building teamwork and trust.

August 8, 2012

See More About The Topic

Health Care Providers

Health Care Executives and Administrators

Teamwork

Education and Training

2010 Annual National Patient Safety Foundation Congress: conference proceedings.

Reducing hospital harm: establishing a command centre to foster situational awareness.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

2010 Annual National Patient Safety Foundation Congress: conference proceedings.

Reducing hospital harm: establishing a command centre to foster situational awareness.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site