Root Cause Analysis of Adverse Events in an Outpatient Anticoagulation Management Consortium

Preventability of serious thromboembolic and bleeding events related to the use of oral anticoagulants: a prospective study

“…We observed poor communication between healthcare providers, or between patients and healthcare providers. A previous root‐cause analysis showed that communication was the second cause of adverse events in patients taking warfarin . Especially, transitions of care are critical periods for the occurrence of medication errors.…”

Causes of hemorrhagic complications in hospitalized patients receiving therapeutic doses of anticoagulants

“…Сходные данные приводят C. Graves и соавт. [16]. Доля тяжелых кровотечений составила 11,5% по классификации GUSTO) в 1 и 9,5% по классификации TIMI.…”

A Network Analysis of Perioperative Communication Patterns

“…The purpose of this study was to characterize the typical OR communication patterns of clinicians at a military outpatient surgery center and determine how their interdependent relationships influence individual behavior. Exploratory research in hospital communication is narrow in scope and noncomprehensive, which inhibits the ability to suggest appropriate interventions . To address these gaps, we conducted research using dissimilar approaches to evaluate two conceptually different forms of communication among OR clinicians.…”

“…Communication errors are a frequent root cause of preventable adverse events and serious injury to patients worldwide . However, the available literature related to interpersonal communication among medical professionals does not address the complexity of patient care .…”