Patient Safety

Charles Vincent, Professor of Clinical Safety ResearchImperial College LondonDirector National Institute for Health Research Centre for Patient Safety and ServiceQuality, Imperial College Healthcare Trust

• Preface ixThe nature of the book xiInspiration acknowledgements and thanks xiiiSection One The Evolution of Patient SafetyChapter 1 Medical harm: a brief history 3Chapter 2 The emergence of patient safety 14Chapter 3 Integrating safety and quality 31Section Two The Hazards of HealthcareChapter 4 The nature and scale of error and harm 49Chapter 5 Reporting and learning systems 75Chapter 6 Measuring safety 96Section Three From Accident Analysis to System DesignChapter 7 Human error and systems thinking 119Chapter 8 Understanding how things go wrong 141Section Four The AftermathChapter 9 Caring for patients harmed by treatment 171Chapter 10 Supporting staff after serious incidents 192Section Five Design Technology and StandardizationChapter 11 Clinical interventions and process improvement 211Chapter 12 Design for patient safety 230Chapter 13 Using information technology to reduce error 246Section Six People Create SafetyChapter 14 Creating a culture of safety 269Chapter 15 Patient involvement in patient safety 290Chapter 16 Procedures violations and migrations 307Chapter 17 Safety skills 321Chapter 18 Teams create safety 341Section Seven The Journey to SafetyChapter 19 Safe organizations: bringing it all together 371Chapter 20 High performing healthcare systems 390Index 405

“Therefore I believe that this book should be read by anyone involved in, or responsible for healthcare.”  (Bulletin Royal College of Path, 1 July 2011)“This is a superb book. I can strongly recommend it to all doctors, to medical students, to other clinical staff and to managers who have to try and make sense of the chaotic complexity of healthcare. The author's expertise is demonstrated throughout, and his examples are drawn from UK, American, European healthcare systems, with appropriate comparison across to other industries where they are useful.”  (http://www.amazon.com/gp/pdp/profile/A2ACLHSG57PAL2/ref=cm_cr_pr_pdp"Dr. Nicholas P. G. Davies (Halifax, UK) posted January 1, 2011)"This book is a tremendous asset in advancing the field of patient safety. The book is well-referenced and current and provides a comprehensive yet very readable summary of patient safety. It will serve well anyone who is involved in patient care. In describing this book, the words, "expert", "indispensable", and "worthwhile" come to mind. This is a significant update of the previous edition." (Doody's, 7 October 2011)"The sections on ‘designing out' hospital acquired infection are helpful for infection control staff and architects. Prescribers and pharmacists benefit from seeing how IT can reduce medication errors". (ENT & Audiology News, 1 July 2011)"This book is an outstanding comprehensive overview an summary of the key issues relating to patient safety, as one might hope and expect from one of the leading international experts and researchers in this field." (Casebook, 1 May 2011)"I would recommend this book to all occupational health professionals working in health care, particularly those who sit on clinical risk, infection prevention control or health and safety committees." (Occupational Medicine, 4 June 2011)"This book is highly recommended or anyone in health care with an interest in patient safety. Every practitioner will get something from it." (The Association For Perioperative Practice, 1 March 2011)"This book is directed to those involved in health care and patient safety. It can be used in the classroom setting to illustrate human error and correction methods to provide a safer patient experience. In the institutional setting, this text would be a useful addition to the medical library, as well as personal libraries of physicians, pharmacists, nurses, or other health-care providers interested in patient safety."(The Journal of Pharmacy Technology, 1 March 2011)"This book is essential reading for everyone in health care, but in particular it is a must read for those starting out, training to be the future doctors, nurses, managers and other health-care practitioners." (British Journal of Hospital Medicine, 1 January 2011)