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  1. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Fried.pdf
    January 01, 2003 - The Use of Surgical Simulators to Reduce Errors 165 The Use of Surgical Simulators to Reduce Errors Marvin P. Fried, Richard Satava, Suzanne Weghorst, Anthony Gallagher, Clarence Sasaki, Douglas Ross, Mika Sinanan, Hernando Cuellar, Jose I. Uribe, Michael Zeltsan, Harman Arora Abstract The training of…
  2. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Magid.pdf
    January 01, 2004 - Hunt et al.,22 for example, conducted a systematic review of 15 studies that examined the efficacy of … Similarly, a review of studies addressing the impact of clinical pharmacists in preventing medication … computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review … Computer support for determining drug dose: systematic review and meta-analysis.
  3. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Martin.pdf
    March 01, 2004 - This review resulted in the following summaries: • Aviation Safety Reporting System (ASRS). … designed for reporting all nonaccidents (close calls), it provides an opportunity for more prospective reviewReview of the reporting system was conducted again using standard human-factors methodology for computer
  4. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/McPhillips.pdf
    January 01, 2004 - pediatric service, compared with 4.12 per 1,000 orders on the adult medical service.8 In a pharmacy-based review … and complete prescription information, to accurately describe errors without a formal, costly chart review
  5. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Bonner.pdf
    January 01, 2004 - This review revealed significant gaps and implementation difficulties. … , workgroup members developed or adapted site-specific policies as needed based on the initial CWG review … The “Plan” stage involved development of the workgroup and review of the existing site policies. … “Study” After researching policies at their respective institutions, workgroup members met to review … This policy was reviewed and approved by institutional review boards at participating sites.
  6. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Clair.pdf
    January 01, 2004 - A literature review was completed using online search engines such as MEDLINE®, the Cumulative Index … Tracheostomy care literature review Author Subject Grade Elpern, et al. (1994) Aspiration IV A … After completing a thorough literature review and collecting the staff knowledge data, work commenced … Systematic Review #9. … Tracheostomy care literature review Figure 1.
  7. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Miranda.pdf
    July 01, 2004 - The basis for the fact sheet was a larger set of messages drawn from a review of the health care literature … might help to prevent medical errors, the Agency for Healthcare Research and Quality (AHRQ) launched a review
  8. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Savitz.pdf
    March 01, 2004 - Methods: We conducted a systematic review of literature from the past 6 years, identifying research … We limited our search in an effort to build on the thorough review conducted by Pierce that covered … Step 2: Primary review of abstracts, applying content criteria, n=84. … However, our review of the literature did identify three important lessons. … Arriving at such consensus was beyond the scope of this review.
  9. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Croskerry.pdf
    January 01, 2004 - typically arise in the course of diagnostic test evaluation: verification or work-up bias, diagnostic review … bias, test review bias, and incorporation bias.20 Generally, the action that results from CDRs takes … everything, however trivial • Discuss with others and record their comments and observations • Review … It is important to review and understand the CDRs and ADRs, and to examine and apply them in the context
  10. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Comden.pdf
    January 01, 2003 - reaches the wrong patient) Physician ordering Medication order written in wrong chart Nurse review … of order Pharmacy review of order Verbal discussion of medication with patient Medication administered
  11. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/West.pdf
    September 01, 2005 - The group met regularly to review data, direct additional study, and provide policy oversight. … identified and discussed the epidemiology of errors within the specific medical error domain under review … returned regularly to further observe the changes effected by the interventions and gather data for review … - Assure that providers review results and act in a timely manner. … Identifying adverse drug events: Development of a computer- based monitor and comparison with chart review
  12. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Furmaga.pdf
    January 01, 2005 - First assessment and intervention A utilization review, stratified by individual VA medical center … Advances in Patient Safety: Vol. 3 280 A follow-up utilization review was completed in March 2001 … Third assessment and intervention In February 2004, a third review was completed. … Final assessment and intervention In May 2004, a fourth and final review was completed on the patients … After careful review of the medical record and discussion with the prescribing physician, it was felt
  13. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Savino.pdf
    July 01, 2003 - Review of the continuing medical education (CME) literature revealed that efforts to modify physician … Protocol for Surgical Infection Prophylaxis 269 the videotapes of the sessions and/or review the … In rare cases of noncompliance, departmental peer review was conducted by QCRM staff. … Personnel were trained on how to collect the data, review charts, and analyze data. … The implementation of a concurrent review mechanism is key to early identification of noncompliance.
  14. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Keller.pdf
    January 01, 2004 - An Internet-based tracking interface enables personnel to review their assigned alerts, determine whether
  15. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Nguyen.pdf
    May 01, 2003 - conferences are a way for medicine to self-regulate and for physicians to participate in their own quality review … reported by students should be integrated into discussions in courses that allow students to critically review … reporting often gave a glimpse of the extreme and egregious types of medical errors, but an incomplete review
  16. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Nieva.pdf
    January 07, 2005 - This slow pace is the result of a research supply model that takes research through various cycles of review … No magic bullets: a systematic review of 102 trials of interventions to improve professional practice
  17. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Ramanujam.pdf
    January 01, 2003 - follows is informed by previous research, it is not intended to serve as a comprehensive literature review … members of the guiding coalition in the supporting structures set up to implement change; more frequent review … require new team structures that include physicians, nurses, pharmacists, and dieticians in joint review … rely on committees that are already in place, such as the pharmacy and therapeutic committees, to review
  18. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Shaha.pdf
    May 01, 2004 - industry standards for outcomes, and all impacts were evaluated statistically— not by superficial review
  19. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Harder.pdf
    May 19, 2003 - Outcome As a result of the review, a simplified heparin dosing computer interface that incorporated
  20. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Galt.pdf
    January 01, 2004 - A review of the health and technology literature at the time of this work revealed few reports that

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