In recent years cognitive error models have provided insights into the unsafe acts that lead
to many accidents in safety-critical environments. Most models of accident causation are …

Objective Quality assurance techniques applied within the healthcare industry have been
widely used and are intended to improve patient outcomes. Two methods that have been …

Inadvertent administration of non-epidural medications into the epidural space has the
potential for serious morbidity and mortality. The aim of this study was to collate reported …

This paper applies the concept of behavioural markers of performance, previously used to
understand the characteristics of the most successful aviation crews (Connelly, EP, 1997. A …

Background. There is increasing emphasis on performance‐based assessment of clinical
competence. The High Fidelity Patient Simulator (HPS) may be useful for assessment of …

Patients are frequently harmed by problems arising from the health care process itself.
Addressing these problems requires understanding the role of errors, violations, and system …

To enhance patient safety, data about actual clinical events must be collected and
scrutinized. This paper has two purposes. First, it provides an overview of some of the …

The new edition of this popular text has been extensively revised and updated throughout. It
will continue to provide the trainee or practising anesthetist with all the information, both …

IMPLICATIONS: A graphic representation of monitored data may provide better support for
detection, diagnosis, and treatment. A user-centered design process led to a novel object …

Human reliability and error have become a very important issue in health care, owing to the
vast number of associated deaths each year. For example, according to the findings of the …