U.S. Department of Health & Human Services
PATIENT SAFETY PRIMERS
2014 ANNUAL PERSPECTIVES
Device-related Complications (17)
Diagnostic Errors (65)
Identification Errors (7)
Discontinuities, Gaps, and Hand-Off Problems (21)
Medication Safety (7)
Medical Complications (8)
Nonsurgical Procedural Complications (42)
Surgical Complications (9)
Psychological and Social Complications (3)
Australia and New Zealand (5)
Central and South America (1)
North America (132)
Clinical Guideline (1)
Journal Article (128)
Newspaper/Magazine Article (16)
Press Release/Announcement (5)
Special or Theme Issue (3)
Web Resource (2)
Epidemiology of Errors and Adverse Events (39)
Active Errors (62)
Latent Errors (19)
Near Miss (8)
Approach to Improving Safety
Quality Improvement Strategies (48)
Legal and Policy Approaches (17)
Error Reporting and Analysis (58)
Communication Improvement (31)
Human Factors Engineering (28)
Specialization of Care (6)
Logistical Approaches (12)
Culture of Safety (15)
Technologic Approaches (20)
Education and Training (27)
Health Care Providers (141)
Health Care Executives and Administrators (112)
Non-Health Care Professionals (39)
Setting of Care
Ambulatory Care (17)
Outpatient Surgery (2)
Patient Transport (2)
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Do telephone call interruptions have an impact on radiology resident diagnostic accuracy?
Balint BJ, Steenburg SD, Lin H, Shen C, Steele JL, Gunderman RB. Acad Radiol. 2014;21:1623-1628.
Errare humanum est: frequency of laterality errors in radiology reports.
Sangwaiya MJ, Saini S, Blake MA, Dreyer KJ, Kalra MK. AJR Am J Roentgenol. 2009;192:W239-W244.
Diagnostic errors in pediatric radiology.
Taylor GA, Voss SD, Melvin PR, Graham DA. Pediatr Radiol. 2011;41:327-334.
Radiation protection and dose monitoring in medical imaging: a journey from awareness, through accountability, ability and action … but where will we arrive?
Frush D, Denham CR, Goske MJ, et al. J Patient Saf. 2013;9:232-238.
Diagnostic errors with inserted tubes, lines and catheters in children.
Fuentealba I, Taylor GA. Pediatr Radiol. 2012;42:1305-1315.
To disclose or not to disclose radiologic errors: should "patient-first" supersede radiologist self-interest?
Berlin L. Radiology. 2013;268:4-7.
Increasing rate of detection of wrong-patient radiographs: use of photographs obtained at time of radiography.
Tridandapani S, Ramamurthy S, Galgano SJ, Provenzale JM. AJR Am J Roentgenol. 2013;200:W345-W352.
Eight CT lessons that we learned the hard way: an analysis of current patterns of radiological error and discrepancy with particular emphasis on CT.
McCreadie G, Oliver TB. Clin Radiol. 2009;64:491-499; discussion 500-501.
Disclosing harmful mammography errors to patients.
Gallagher TH, Cook AJ, Brenner RJ, et al. Radiology. 2009;253:443-452.
Accuracy of radiographic readings in the emergency department.
Petinaux B, Bhat R, Boniface K, Aristizabal J. Am J Emerg Med. 2011;29:18-25.
Clinically missed cancer: how effectively can radiologists use computer-aided detection?
Nishikawa RM, Schmidt RA, Linver MN, Edwards AV, Papaioannou J, Stull MA. AJR Am J Roentgenol. 2012;198:708-716.
Overdiagnosis in low-dose computed tomography screening for lung cancer.
Patz EF Jr, Pinsky P, Gatsonis C, et al; NLST Overdiagnosis Manuscript Writing Team. JAMA Intern Med. 2014;174:269-274.
Application of failure mode and effect analysis in a radiology department.
Thornton E, Brook OR, Mendiratta-Lala M, Hallett DT, Kruskal JB. Radiographics. 2011;31:281-293.
Spike in MR imaging accidents underscores need for regulation.
Radiological Society of North America. RSNA News; October 2010.
The frequency of diagnostic errors in radiologic reports depends on the patient's age.
Diaz S, Ekberg O. Acta Radiol. 2010;51:934-938.
Patient safety event reporting in a large radiology department.
Schultz SR, Watson RE Jr, Prescott SL, et al. AJR Am J Roentgenol. 2011;197:684-688.
Emergency department image interpretation accuracy: the influence of immediate reporting by radiology.
Snaith B, Hardy M. Int Emerg Nurs. 2014;22:63-68.
ISMP medication error report analysis.
Smetzer JL, Cohen MR. Hosp Pharm. 2008;43:869-872.
New technologies in radiation therapy: ensuring patient safety, radiation safety and regulatory issues in radiation oncology.
Amols HI. Health Phys. 2008;95:658-665.
Analysis and prioritization of near-miss adverse events in a radiology department.
Thornton RH, Miransky J, Killen AR, Solomon SB, Brody LA. AJR Am J Roentgenol. 2011;196:1120-1124.
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