AHRQ Patient Safety Network

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The Collection

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Safety Target

•Device-related Complications (46)

•Diagnostic Errors (60)

•Identification Errors (27)

•Discontinuities, Gaps, and Hand-Off Problems (128)

•Fatigue and Sleep Deprivation (25)

•Medication Safety (253)

•Medical Complications (92)

•Nonsurgical Procedural Complications (28)

•Surgical Complications (121)

•Transfusion Complications (5)

•Psychological and Social Complications (41)

Origin/Sponsor

•Asia (1)

•Australia and New Zealand (14)

•Central and South America (1)

•Europe (55)

•North America (818)

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Commentary

Error Types

•Epidemiology of Errors and Adverse Events (63)

•Active Errors (194)

•Latent Errors (106)

•Near Miss (21)

Approach to Improving Safety

•Quality Improvement Strategies (278)

•Legal and Policy Approaches (121)

•Error Reporting and Analysis (241)

•Communication Improvement (269)

•Human Factors Engineering (155)

•Teamwork (113)

•Specialization of Care (81)

•Logistical Approaches (70)

•Culture of Safety (160)

•Technologic Approaches (169)

•Education and Training (215)

Clinical Areas

•Allied Health Services (1)

Target Audience

•Health Care Providers (785)

•Health Care Executives and Administrators (734)

•Non-Health Care Professionals (343)

•Patients (25)

Setting of Care

•Hospitals (659)

•Psychiatric Facilities (3)

•Residential Facilities (8)

•Ambulatory Care (74)

•Outpatient Surgery (8)

•Patient Transport (2)

1 - 20 of 967

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COMMENTARY

Improving heparin safety: a multidisciplinary invited conference.

Peterson C, Ham CW, Vanderveen T. Hosp Pharm. 2008;43:491-497.

COMMENTARY

The Team Checkup Tool: evaluating QI team activities and giving feedback to senior leaders.

Lubomski LH, Marsteller JA, Hsu YJ, et al. Jt Comm J Qual Patient Saf. 2008;34:619-623.

COMMENTARY

Learning accountability for patient outcomes.

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

COMMENTARY

Medication errors in family practice, in hospitals and after discharge from the hospital: an ethical analysis.

Clark PA. J Law Med Ethics. 2004;32:349-357.

COMMENTARY

The power of collaboration with patient safety programs: building safe passage for patients, nurses, and clinical staff.

Kerfoot KM, Rapala K, Ebright P, Rogers SM. J Nurs Adm. 2006;36:582-588.

COMMENTARY

Operating room briefings: working on the same page.

Makary MA, Holzmueller CG, Thompson D, et al. Jt Comm J Qual Patient Saf. 2006;32:351-355.

COMMENTARY

A new frontier in patient safety.

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

COMMENTARY

I-CaRe: a case review tool focused on improving inpatient care.

Huang Lee J, Vidyarthi AR, Sehgal NL, Auerbach AD, Wachter RM. Jt Comm J Qual Patient Saf. 2009;35:115-119.

COMMENTARY

Integrating CUSP and TRIP to improve patient safety.

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

COMMENTARY

View the world through a different lens: shadowing another provider.

Thompson DA, Holzmueller CG, Lubomski L, Pronovost PJ. Jt Comm J Qual Patient Saf. 2008;34:614-618.

COMMENTARY

Debriefing medical teams: 12 evidence-based best practices and tips.

Salas E, Klein C, King H, et al. Jt Comm J Qual Patient Saf. 2008;34:518-527.

COMMENTARY

Medicare nonpayment, hospital falls, and unintended consequences.

Inouye SK, Brown CJ, Tinetti ME. N Engl J Med. 2009;360:2390-2393.

COMMENTARY

Anatomy of an incident disclosure: the importance of dialogue.

Iedema R, Allen S. Jt Comm J Qual Patient Saf. 2012;38:435-442.

COMMENTARY

Medication reconciliation in the hospital: what, why, where, when, who and how?

Fernandes O, Shojania KG. Healthc Q. 2012;15:42-49.

COMMENTARY

The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care.

Wohlauer MV, Arora VM, Horwitz LI, Bass EJ, Mahar SE, Philibert I. Acad Med. 2012;87:411-418.

COMMENTARY

Development and evaluation of the Institute for Healthcare Improvement global trigger tool.

Classen DC, Lloyd RC, Provost L, Griffin FA, Resar R. J Patient Saf. 2008;4:169-177.

COMMENTARY

Application of electronic health records to The Joint Commission's 2011 National Patient Safety Goals.

Radecki RP, Sittig DF. JAMA. 2011;306:92-93.

COMMENTARY

Implementing a perioperative handoff tool to improve postprocedural patient transfers.

Petrovic MA, Martinez EA, Aboumatar H. Jt Comm J Qual Patient Saf. 2012;38:135-142.

COMMENTARY

Smart pumps: advanced capabilities and continuous quality improvement.

Vanderveen T. Patient Saf Quality Healthc. January/February 2007.

COMMENTARY

Attending physician work hours: ethical considerations and the last doctor standing.

Mercurio MR, Peterec SM. Pediatrics. 2009;124:758-762.

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