Patient Safety.

James P Bagian

Special or Theme Issue

Patient Safety.

February 8, 2012

Bagian JP. Human Factors and Ergonomics in Manufacturing & Service Industries. 2011;22(1).

View more articles from the same authors.

Articles in this special issue detail how human factors and ergonomics concepts can contribute to patient safety efforts through improving design, training, and equipment usability.

Table of contents

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March 1, 2006

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March 6, 2005

Rare adverse medical events in VA inpatient care: reliability limits to using patient safety indicators as performance measures.

February 6, 2008

Hand-off Communications.

October 27, 2010

Using Health Care Failure Mode and Effect Analysis: the VA National Center for Patient Safety's prospective risk analysis system.

March 27, 2005

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October 18, 2017

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August 17, 2011

Systemic vulnerabilities to suicide among veterans from the Iraq and Afghanistan conflicts: review of case reports from a national Veterans Affairs database.

April 20, 2011

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March 6, 2005

Improving perceptions of teamwork climate with the Veterans Health Administration medical team training program.

September 14, 2011

The effect of facility complexity on perceptions of safety climate in the operating room: size matters.

June 16, 2010

Using proactive risk assessment (HFMEA) to improve patient safety and quality associated with intraocular lens selection and implantation in cataract surgery.

September 18, 2019

Counterheroism, common knowledge, and ergonomics: concepts from aviation that could improve patient safety.

April 6, 2011

Improving the bar-coded medication administration system at the Department of Veterans Affairs.

August 9, 2006

Inpatient suicide and suicide attempts in Veterans Affairs hospitals.

August 20, 2008

Comparing the variability of ingredient, strength, and dose form information from electronic prescriptions with RxNorm drug product descriptions.

August 31, 2022

Predictors of successful implementation of preoperative briefings and postoperative debriefings after medical team training.

November 18, 2009

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February 17, 2010

The Veterans Affairs root cause analysis system in action.

March 27, 2005

Awareness and use of a cognitive aid for anesthesiology.

September 19, 2007

Medical team training: applying crew resource management in the Veterans Health Administration.

May 30, 2007

The Pursuing Excellence Collaborative: engaging first-year residents and fellows in patient safety event investigations.

August 30, 2023

No excuses: the reality that demands action.

September 1, 2005

Incorrect surgical procedures within and outside of the operating room: a follow-up report.

July 27, 2011

Incorrect surgical procedures within and outside of the operating room.

November 25, 2009

Effective followership: a standardized algorithm to resolve clinical conflicts and improve teamwork.

August 12, 2015

Root cause analysis and actions for the prevention of medical errors: quality improvement and resident education.

May 17, 2017

Medical team training and coaching in the veterans health administration; assessment and impact on the first 32 facilities in the programme.

August 18, 2010

Association between implementation of a medical team training program and surgical morbidity.

January 4, 2012

Association between implementation of a medical team training program and surgical mortality.

October 20, 2010

Sex differences in operating room care giver perceptions of patient safety: a pilot study from the Veterans Health Administration Medical Team Training Program.

March 3, 2010

Comparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York.

February 27, 2008

How I minimize mistransfusion risk in my hospital.

July 26, 2006

Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system.

February 20, 2008

Developing and deploying a patient safety program in a large health care delivery system: you can't fix what you don't know about.

October 21, 2015

Handoff checklists improve the reliability of patient handoffs in the operating room and postanesthesia care unit.

June 12, 2013

ADVERSE drug events: incidence and risk reduction across the care continuum.

February 10, 2016

Pediatric patient safety events during hospitalization: approaches to accounting for institution-level effects.

November 28, 2007

Operating manual-based usability evaluation of medical devices: an effective patient safety screening method.

April 5, 2006

Evaluation of a problem-specific SBAR tool to improve after-hours nurse-physician phone communication: a randomized trial.

October 30, 2013

Errors in after-hours phone consultations: a simulation study.

March 5, 2014

A contemporary medicolegal analysis of outpatient medication management in chronic pain.

November 8, 2017

Effect of social influences on pharmacists' intention to report adverse drug events.

October 17, 2012

Reasons for after-hours calls by hospital floor nurses to on-call physicians.

May 30, 2007

Evaluating implementation of a rapid response team: considering alternative outcome measures.

May 7, 2014

Attitudes toward medical device use errors and the prevention of adverse events.

November 14, 2007

Interruptions in a level one trauma center: a case study.

July 4, 2007

Medication errors among acutely ill and injured children treated in rural emergency departments.

May 2, 2007

Telemedicine consultations and medication errors in rural emergency departments.

December 11, 2013

Measuring communication in the surgical ICU: better communication equals better care.

February 24, 2010

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March 21, 2013

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December 2, 2015

A piece of my mind. Despite my best intentions.

November 22, 2017

A new, evidence-based estimate of patient harms associated with hospital care.

August 7, 2013

A piece of my mind. I'm sorry.

July 1, 2015

Using information to optimize medical outcomes.

June 17, 2009

Getting boards on board: engaging governing boards in quality and safety.

April 2, 2008

Could it happen here? Learning from other organizations' safety errors.

November 12, 2008

The evolution of the apology.

February 7, 2007

When incidents happen.

August 2, 2006

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January 31, 2018

Medication-administration errors in an urban mental health hospital: a direct observation study.

March 11, 2015

Adverse events and comparison of systematic and voluntary reporting from a paediatric intensive care unit.

July 14, 2010

Random safety auditing, root cause analysis, failure mode and effects analysis.

May 19, 2010

Why stigma matters in addressing alcohol harm.

August 9, 2023

A learning health care system using computer-aided diagnosis.

March 22, 2017

Speaking up: an ethical action exercise.

April 11, 2018

The impact of transitioning from a 24-hour to a 16-hour call model amongst a cohort of Canadian anesthesia residents at McMaster University—a survey study.

October 7, 2015

The Swiss cheese model of adverse event occurrence—closing the holes.

January 13, 2016

Diagnostic errors in interpretation of pediatric musculoskeletal radiographs at common injury sites.

June 25, 2014

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April 1, 2009

Organisational failure: rethinking whistleblowing for tomorrow's doctors.

September 7, 2022

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December 5, 2007

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September 2, 2020

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July 24, 2019

Measuring the rate of manual transcription error in outpatient point-of-care testing.

March 13, 2019

Using a spare medication vial to store multiple medications: a potentially fatal in-home medication error.

March 6, 2019

Increasing trainee reporting of adverse events with monthly, trainee-directed review of adverse events.

January 31, 2018

Overuse of medical imaging and its radiation exposure: who’s minding our children?

September 28, 2016

Sharing the process of diagnostic decision making.

August 9, 2017

Using simulation to improve systems.

September 27, 2017

In-facility delirium programs as a patient safety strategy: a systematic review.

March 13, 2013

Investigating the safety of medication administration in adult critical care settings.

June 27, 2012

Finding antecedents of psychological safety: a step toward quality improvement.

September 2, 2015

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August 12, 2015

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July 16, 2014

Making polypharmacy safer for children with medical complexity.

April 5, 2023

Rounding to influence.

September 29, 2010

Medical errors education: a prospective study of a new educational tool.

April 7, 2010

Clinical care checklists: salvations or frustrations?

June 1, 2011

Influence of workplace demands on nurses' perception of patient safety.

June 18, 2008

The business case for patient safety.

February 14, 2007

Briefing and debriefing in the operating room using fighter pilot crew resource management.

July 25, 2007

The 100,000 Lives Campaign: crystallizing standards of care for hospitals.

November 23, 2005

Color coding to reduce errors.

September 7, 2005

The use of patient digital facial images to confirm patient identity in a children's hospital's anesthesia information management system.

January 15, 2020

Medication errors and trainees: advice for learners and organizations.

October 4, 2017

Duplication of surgical site marking.

September 19, 2012

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Facility and Group Administrators

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Medicine

Discontinuities, Gaps, and Hand-Off Problems

Fatigue and Sleep Deprivation

Patient Safety.

Patient Safety 101

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