Systems approaches to surgical quality and safety: from concept to measurement.

Charles A. Vincent; Krishna Moorthy; Sudip K. Sarker; Avril Chang; Ara Darzi

Review

Systems approaches to surgical quality and safety: from concept to measurement.

March 6, 2005

Vincent CA, Moorthy K, Sarker SK, et al. Ann Surg. 2004;239(4):475-82.

View more articles from the same authors.

PubMed citation

Available at

Free full text

Related Resources From the Same Author(s)

Do safety checklists improve teamwork and communication in the operating room? A systematic review.

January 29, 2014

Surgical crisis management skills training and assessment: a stimulation-based approach to enhancing operating room performance.

August 2, 2006

The WHO surgical safety checklist: survey of patients' views.

August 6, 2014

Measuring variation in use of the WHO surgical safety checklist in the operating room: a multicenter prospective cross-sectional study.

December 17, 2014

A qualitative evaluation of the barriers and facilitators toward implementation of the WHO surgical safety checklist across hospitals in England: lessons from the "Surgical Checklist Implementation Project."

August 20, 2014

A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre.

December 7, 2005

Surgical technology and operating-room safety failures: a systematic review of quantitative studies.

August 7, 2013

Engineering the system of communication for safer surgery.

February 23, 2011

Surgical checklist implementation project: the impact of variable WHO checklist compliance on risk-adjusted clinical outcomes after national implementation: a longitudinal study.

April 1, 2015

The problem of engaging hospital doctors in promoting safety and quality in clinical care.

March 21, 2007

Practical challenges of introducing WHO surgical checklist: UK pilot experience.

January 27, 2010

An evaluation of information transfer through the continuum of surgical care: a feasibility study.

August 11, 2010

A qualitative exploration of patients' attitudes towards the 'Participate Inform Notice Know' (PINK) patient safety video.

April 17, 2013

Observational assessment of surgical teamwork: a feasibility study.

October 4, 2006

An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery.

October 24, 2012

How reliable are clinical systems in the UK NHS? A study of seven NHS organisations.

April 25, 2012

Patients' attitudes towards patient involvement in safety interventions: results of two exploratory studies.

February 1, 2012

Safety skills training for surgeons: a half-day intervention improves knowledge, attitudes and awareness of patient safety.

May 9, 2012

Information transfer and communication in surgery: a systematic review.

August 11, 2010

Teamwork in the operating theatre: cohesion or confusion?

March 29, 2006

Failures in communication and information transfer across the surgical care pathway: interview study.

July 25, 2012

Patients' and health care professionals' attitudes towards the PINK patient safety video.

June 29, 2011

The impact of nontechnical skills on technical performance in surgery: a systematic review.

January 30, 2005

Observational teamwork assessment for surgery: feasibility of clinical and nonclinical assessor calibration with short-term training.

May 30, 2012

Reliability of a revised NOTECHS scale for use in surgical teams.

July 16, 2008

Is health care getting safer?

November 26, 2008

A systematic quantitative assessment of risks associated with poor communication in surgical care.

June 30, 2010

Postoperative handover: problems, pitfalls, and prevention of error.

June 16, 2010

The human face of simulation: patient-focused simulation training.

October 18, 2006

Multidisciplinary crisis simulations: the way forward for training surgical teams.

July 18, 2007

Simulation to enhance patient safety: why aren't we there yet?

October 19, 2011

Qualities and attributes of a safe practitioner: identification of safety skills in healthcare.

January 26, 2011

Science and patient safety.

October 17, 2012

Understanding and responding to adverse events.

March 6, 2005

Simulation for ward processes of surgical care.

April 17, 2013

Surgical ward round quality and impact on variable patient outcomes.

March 19, 2014

Patient-safety–related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010–2012.

August 27, 2014

Managing risk in hazardous conditions: improvisation is not enough.

July 24, 2019

Learning from failure: the need for independent safety investigation in healthcare.

November 19, 2014

Patients' willingness and ability to identify and respond to errors in their personal health records: mixed methods analysis of cross-sectional survey data.

July 27, 2022

Impact of providing patients access to electronic health records on quality and safety of care: a systematic review and meta-analysis.

July 8, 2020

Surgical skill is predicted by the ability to detect errors.

May 25, 2005

International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process.

February 1, 2017

Enhancing safety culture through improved incident reporting: a case study in translational research.

December 12, 2018

Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature.

February 14, 2018

Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis.

April 5, 2023

How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory.

October 19, 2022

Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights.

February 26, 2020

Multidisciplinary centres for safety and quality improvement: learning from climate change science.

April 27, 2011

The role of chief executive officers in a quality improvement: a qualitative study.

February 20, 2013

Patient involvement in patient safety: the health-care professional's perspective.

November 7, 2012

Managing the after effects of serious patient safety incidents in the NHS: an online survey study.

October 31, 2012

Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety.

May 21, 2014

Embracing multiple aims in healthcare improvement and innovation.

March 23, 2022

Distracting communications in the operating theatre.

June 6, 2007

Assessment of patients' ability to review electronic health record information to identify potential errors: cross-sectional web-based survey.

March 10, 2021

Making health care safer: what is the contribution of health psychology?

November 11, 2015

How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions.

July 10, 2013

Practising safely in the foundation years.

April 22, 2009

Moving beyond the weekend effect: how can we best target interventions to improve patient care?

June 30, 2021

Safety skills for clinicians: an essential component of patient safety.

August 20, 2008

Use and impact of virtual primary care on quality and safety: the public's perspectives during the COVID-19 pandemic.

January 12, 2022

Escalation of care and failure to rescue: a multicenter, multiprofessional qualitative study.

July 23, 2014

The impact of electronic health record interoperability on safety and quality of care in high-income countries: systematic review.

October 5, 2022

Five reasons for optimism on World Patient Safety Day.

October 23, 2019

Rethinking medical ward quality.

November 9, 2016

Measurement and monitoring of safety: impact and challenges of putting a conceptual framework into practice.

April 11, 2018

Safety analysis over time: seven major changes to adverse event investigation.

January 24, 2018

An examination of opportunities for the active patient in improving patient safety.

February 22, 2012

'The ABC of Handover': impact on shift handover in the emergency department.

February 8, 2012

Development and validation of a tool to assess emergency physicians' nontechnical skills.

April 18, 2012

Identifying nontechnical skills associated with safety in the emergency department: a scoping review of the literature.

April 18, 2012

Patient safety in community dementia services: what can we learn from the experiences of caregivers and healthcare professionals?

February 15, 2017

The role of hospital managers in quality and patient safety: a systematic review.

September 17, 2014

Patient involvement in patient safety: what factors influence patient participation and engagement?

August 22, 2007

Communication patterns in a UK emergency department.

October 10, 2007

The impact of stress on surgical performance: a systematic review of the literature.

February 3, 2010

Effectiveness of interventions to improve patient handover in surgery: a systematic review.

June 17, 2015

Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis.

August 5, 2015

The impact of mobile technology on teamwork and communication in hospitals: a systematic review.

March 20, 2019

Identifying quality markers of a safe surgical ward: an interview study of patients, clinical staff, and administrators.

May 2, 2018

Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: a systematic review.

June 12, 2019

Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool.

June 29, 2011

Carers' medication administration errors in the domiciliary setting: a systematic review.

February 8, 2017

Surgical adverse events: a systematic review.

June 26, 2013

A systematic proactive risk assessment of hazards in surgical wards: a quantitative study.

May 2, 2012

Exploring the "Black Box" of recommendation generation in local health care incident investigations: a scoping review.

October 25, 2023

Analysis of paediatric long-term ventilation incidents in the community

January 22, 2020

Raising the alarm: a cross-sectional study exploring the factors affecting patients' willingness to escalate care on surgical wards.

June 24, 2015

Identifying and addressing preventable process errors in trauma care.

June 26, 2013

Escalation of care in surgery: a systematic risk assessment to prevent avoidable harm in hospitalized patients.

June 18, 2014

Reducing the burden of surgical harm: a systematic review of the interventions used to reduce adverse events in surgery.

February 26, 2014

Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study.

September 27, 2023

The natural lifespan of a safety policy: violations and system migration in anaesthesia.

April 28, 2010

Predictors of the perceived impact of a patient safety collaborative: an exploratory study.

March 23, 2011

Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews.

November 16, 2016

Healthy life-years lost and excess bed-days due to 6 patient safety incidents: empirical evidence from English hospitals.

November 2, 2016

What is known about adverse events in older medical hospital inpatients? A systematic review of the literature.

September 4, 2013

Teams under pressure in the emergency department: an interview study.

January 25, 2012

The medical student as a patient: attitudes towards involvement in the quality and safety of health care.

October 30, 2013

Related Resources

Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.

February 3, 2021

Interventions to engage patients and families in patient safety: a systematic review.

January 20, 2021

WebM&M Cases

Lack of Sepsis Recognition Leads to Delay in Care Following Cesarean Delivery.

November 25, 2020

Opioid stewardship program and postoperative adverse events: a difference-in-differences cohort study.

September 16, 2020

Personal protective equipment (PPE) for surgeons during COVID-19 pandemic: a systematic review of availability, usage, and rationing.

June 3, 2020

WebM&M Cases

Is that solution for IV or irrigation?: Fluid administration errors in the operating room.

March 25, 2020

WebM&M Cases

“This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event

January 29, 2020

Reducing surgical mortality in Scotland by use of the WHO Surgical Safety Checklist.

May 8, 2019

Quality improvement in ambulatory surgery centers: a major national effort aimed at reducing infections and other surgical complications.

March 27, 2019

Identifying quality markers of a safe surgical ward: an interview study of patients, clinical staff, and administrators.

May 2, 2018

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review.

March 29, 2017

Statement on the prevention of retained foreign bodies after surgery.

October 1, 2016

Leading article: how can I optimise my role as a leader within the surgical team?

August 31, 2016

Situational awareness—what it means for clinicians, its recognition and importance in patient safety.

August 24, 2016

Guideline implementation: prevention of retained surgical items.

August 3, 2016

Improving Weekend Out Of Hours Surgical Handover (WOOSH).

May 25, 2016

Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward.

May 18, 2016

Surgical count process for prevention of retained surgical items: an integrative review.

May 11, 2016

How safe is primary care? A systematic review.

January 13, 2016

Barriers and facilitators related to the implementation of surgical safety checklists: a systematic review of the qualitative evidence.

August 5, 2015

Training situational awareness to reduce surgical errors in the operating room.

February 25, 2015

National pediatric anesthesia safety quality improvement program in the United States.

October 1, 2014

Using improvement science methods to increase accuracy of surgical consents.

September 17, 2014

The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings.

September 10, 2014

Interventions to reduce medication errors in pediatric intensive care.

August 20, 2014

Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program.

August 13, 2014

Effectiveness of the surgical safety checklist in correcting errors: a literature review applying Reason's Swiss cheese model.

July 30, 2014

Escalation of care and failure to rescue: a multicenter, multiprofessional qualitative study.

July 23, 2014

Avoiding potential harm by improving appropriateness of urinary catheter use in 18 emergency departments.

July 16, 2014

Distractions in the operating room.

June 18, 2014

See More About The Topic

Physicians

Nurses

Quality and Safety Professionals

Surgery

Quality Improvement Strategies

Systems approaches to surgical quality and safety: from concept to measurement.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Systems approaches to surgical quality and safety: from concept to measurement.

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