Objective To apply human performance concepts in an attempt to understand the causes of
and prevent laparoscopic bile duct injury. Summary Background Data Powerful conceptual …

Methods: Our systematic literature review identified 2 groups of studies:(1) those comparing
the effectiveness of IRSs with other methods of error reporting and (2) those examining the …

Objectives: To evaluate how the World Health Organization (WHO) surgical safety checklist
was implemented across hospitals in England; to identify barriers and facilitators toward …

Anaesthesiology, which includes anaesthesia, perioperative care, intensive care medicine,
pain therapy and emergency medicine, has always participated in systematic attempts to …

Background This study describes a nationwide survey that estimates the number and
characteristics of anesthesia-related deaths for the year 1999. Methods Death certificates …

Background To prevent errors made during the prescription of drugs, we need to know why
they arise. Theories of human error used to understand the causes of mistakes made in high …

Objective—To develop a practitioner led definition of a prescribing error for use in
quantitative studies of their incidence. Design—Two stage Delphi technique. Subjects—A …

This article describes a method of investigating and learning from adverse events. Careful
investigation and systems analysis can identify the factors that set the stage for a medical …

Objective: This approach provides the basis of our research program, which aims to expand
operative assessment beyond patient factors and the technical skills of the surgeon; to …

The purpose of the protocol is to ensure a comprehensive and thoughtful investigation and
analysis of an incident, going beyond the more usual identification of fault and blame. A …