Committed to Safety: Ten Case Studies on Reducing Harm to Patients.
This report presents ten case studies to illustrate interventions that address prominent and targeted areas for patient safety improvement. The five areas of focus include promoting an organizational safety culture, improving teamwork and communication, enhancing rapid response to inpatient crises, preventing health care–associated infections in intensive care units, and preventing hospital-based adverse drug events. The collection of stories represents a diverse group of health care organizations, with each sharing their approach to a given safety issue, the results achieved, and the lessons learned to assist others making similar efforts at their own institution. The authors also published an article about case studies in safety improvement.
McCarthy D, Blumenthal D. New York, NY: Commonwealth Fund; 2006.