Adverse outcomes: why bad things happen to good people.
Sonnenberg A. Clin Gastroenterol Hepatol. 2015;13:820-823.
This commentary provides a statistical discussion of adverse events in gastroenterology to conclude that some events are unavoidable, even with quality improvement strategies. A related commentary offers counterpoints and suggests that although some adverse events are unavoidable, many are preventable and efforts to improve safety in health care should focus on accountability, systems factors, and preventability of errors.
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Causes of errors in the electrocardiographic diagnosis of atrial fibrillation by physicians.
Davidenko JM, Snyder LS. J Electrocardiol. 2007;40:450-457.
Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis.
Lipitz-Snyderman A, Steinwachs D, Needham DM, Colantuoni E, Morlock LL, Pronovost PJ. BMJ. 2011;342:d219.
Association between Leapfrog safe practices score and hospital mortality in major surgery.
Qian F, Lustik SJ, Diachun CA, Wissler RN, Zollo RA, Glance LG. Med Care. 2011;49:1082-1088.
BOOK/REPORTView all related resources...
Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2012.
Oakbrook Terrace, IL: The Joint Commission; September 2012.
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