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effectivehealthcare.ahrq.gov/sites/default/files/related_files/lumbar-fusion-protocol.pdf
June 20, 2024 - The utility of IONM in spine tumor and spinal
deformity surgeries is established, however, its utility … Instrumentation: Surgical implants including screws, rods, and cages used to stabilize the
spine during fusion surgeries … electromyography) to assess neural structures and
reduce the risk of neurological injury during spine surgeries … • Neurological injuries due to surgery: Damage to the spinal cord or nerves during
surgeries, possibly
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psnet.ahrq.gov/issue/improving-operating-room-safety
May 17, 2023 - Study
Improving operating room safety.
Citation Text:
Hurlbert SN, Garrett J. Improving operating room safety. Patient Saf Surg. 2009;3(1):25. doi:10.1186/1754-9493-3-25.
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psnet.ahrq.gov/issue/learning-adverse-events-and-near-misses
January 15, 2020 - Commentary
Learning from adverse events and near misses.
Citation Text:
Greenberg CC. Learning from adverse events and near misses. J Gastrointest Surg. 2009;13(1):3-5. doi:10.1007/s11605-008-0693-6.
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psnet.ahrq.gov/issue/expanded-surgical-time-out-key-real-time-data-collection-and-quality-improvement
March 02, 2010 - Study
Expanded surgical time out: a key to real-time data collection and quality improvement.
Citation Text:
Altpeter T, Luckhardt K, Lewis JN, et al. Expanded surgical time out: a key to real-time data collection and quality improvement. J Am Coll Surg. 2007;204(4):527-32.
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psnet.ahrq.gov/issue/handbook-perioperative-and-procedural-patient-safety
December 01, 2021 - Book/Report
Handbook of Perioperative and Procedural Patient Safety.
Citation Text:
Handbook of Perioperative and Procedural Patient Safety. Sanchez JA, Higgins RSD, Kent PS, eds. St Louis, MO: Elsevier; 2024. ISBN: 9780323661799.
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www.ahrq.gov/hai/tools/surgery/tools/applying-cusp/perioperative-asst.html
December 01, 2017 - Perioperative Staff Safety Assessment
AHRQ Safety Program for Surgery
Introduction
Problem Statement
One of the strongest determinants of safety culture is whether local and hospital leadership respond to staff patient safety concerns. Frontline providers understand patient safety risks in the…
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psnet.ahrq.gov/issue/surgeons-non-technical-skills-operating-room-reliability-testing-notss-behavior-rating-system
December 22, 2010 - Study
Surgeons' non-technical skills in the operating room: reliability testing of the NOTSS behavior rating system.
Citation Text:
Yule S, Flin R, Maran N, et al. Surgeons' non-technical skills in the operating room: reliability testing of the NOTSS behavior rating system. World J Sur…
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psnet.ahrq.gov/issue/gossypiboma-tales-lost-sponges-and-lessons-learned
March 24, 2021 - Study
Gossypiboma: tales of lost sponges and lessons learned.
Citation Text:
McIntyre LK. Gossypiboma. Archives of Surgery. 2010;145(8). doi:10.1001/archsurg.2010.152.
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psnet.ahrq.gov/issue/reducing-surgical-complications
January 03, 2018 - Commentary
Reducing surgical complications.
Citation Text:
Griffin F. Reducing surgical complications. Jt Comm J Qual Patient Saf. 2007;33(11):660-5.
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psnet.ahrq.gov/issue/patient-safety-and-office-based-anesthesia
August 13, 2014 - Review
Patient safety and office-based anesthesia.
Citation Text:
Urman RD, Punwani N, Shapiro FE. Patient safety and office-based anesthesia. Curr Opin Anaesthesiol. 2012;25(6):648-53. doi:10.1097/ACO.0b013e3283593094.
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psnet.ahrq.gov/issue/safety-inpatient-pediatric-otolaryngology-service-many-small-errors-few-adverse-events
October 27, 2010 - Study
Safety on an inpatient pediatric otolaryngology service: many small errors, few adverse events.
Citation Text:
Shah RK, Lander L, Forbes P, et al. Safety on an inpatient pediatric otolaryngology service: many small errors, few adverse events. Laryngoscope. 2009;119(5):871-9. doi:…
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psnet.ahrq.gov/issue/prevention-medical-accidents-caused-defective-surgical-instruments
July 31, 2019 - Study
Prevention of medical accidents caused by defective surgical instruments.
Citation Text:
Yasuhara H, Fukatsu K, Komatsu T, et al. Prevention of medical accidents caused by defective surgical instruments. Surgery. 2012;151(2):153-61. doi:10.1016/j.surg.2011.06.029.
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psnet.ahrq.gov/issue/simulation-ward-processes-surgical-care
June 17, 2015 - Commentary
Simulation for ward processes of surgical care.
Citation Text:
Pucher PH, Darzi A, Aggarwal R. Simulation for ward processes of surgical care. Am J Surg. 2013;206(1):96-102. doi:10.1016/j.amjsurg.2012.08.013.
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psnet.ahrq.gov/issue/requirements-design-and-implementation-checklists-surgical-processes
September 25, 2008 - Review
Requirements for the design and implementation of checklists for surgical processes.
Citation Text:
Verdaasdonk EGG, Stassen LPS, Widhiasmara PP, et al. Requirements for the design and implementation of checklists for surgical processes. Surg Endosc. 2009;23(4):715-26. doi:10.10…
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psnet.ahrq.gov/issue/communication-operating-theatre
September 29, 2017 - Review
Communication in the operating theatre.
Citation Text:
Weldon S-M, Korkiakangas T, Bezemer J, et al. Communication in the operating theatre. Br J Surg. 2013;100(13):1677-88. doi:10.1002/bjs.9332.
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psnet.ahrq.gov/web-mm/anticoagulation-held-too-long
April 01, 2008 - Anticoagulation: Held Too Long
Citation Text:
Dunn AS. Anticoagulation: Held Too Long. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2010.
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www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary17/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing-2013
December 15, 2013 - risk-reducing medications in mutation carriers, although false-positive rates, unneeded imaging, and unneeded surgeries … Women receiving tamoxifen had more cataract surgeries than those receiving placebo in the NSABP (National … Higher rates of false-positive test results, unneeded imaging, and unneeded surgeries with screening … Comparisons of salpingo-oophorectomy versus more limited surgeries, such as salpingectomy alone, would … genetic counselors, genetic testing, and use of intensive screening and risk-reducing medications and surgeries
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effectivehealthcare.ahrq.gov/sites/default/files/07_diabetes_potential_high_impact_june_2012.pdf
January 01, 2012 - Bariatric surgeries are classified as purely restrictive, mostly restrictive, or mostly
malabsorptive
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/sustainability/sustainability_learn_from_defects.pptx
December 01, 2017 - PowerPoint Presentation: Learn From Defects for Sustainability
Sustainability: Learning From Defects
AHRQ Safety Program for Surgery
Sustainability
AHRQ Pub. No. 16(18)-0004-15-EF
December 2017
AHRQ Safety Program for Surgery – Sustainability
SAY:
This module will review some concepts from Learning From Defects Th…
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/implementation-guide/app-c.html
May 01, 2017 - Appendix C. Addressing Physician Concerns With the Checklist - Implementation Guide
Common Concern
Response
Explanation
“I'm already safe, and I don't need to use a tool like the checklist.”
“You are safe, but we think that something like this tool can help make the entire center better. I…