Чек-лист. Как избежать глупых ошибок, ведущих к фатальным последствиям - страница 79

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(Geneva: WHO, 2004). See annex, table 2.

P. K. Lindenauer et al., «Public Reporting and Pay for Performance in Hospital Quality Improve ment,» New England Journal of Medicine 356 (2007): 486–96.

S. Johnson, The Ghost Map (New York: Riverhead, 2006).

S. P. Luby et al., «Effect of Handwashing on Child Health: A Randomised Controlled Trial,» Lancet 366 (2005): 225–33.

A. A. Gawande and T. G. Weiser, eds., World Health Organization Guidelines for Safe Surgery (Geneva: WHO, 2008).

M. A. Makary et al., «Operating Room Briefings and Wrong-Site Surgery,» Journal of the American College of Surgeons 204 (2007): 236–43.

J. B. Sexton, E. J. Thomas, and R. L. Helmsreich, «Error, Stress, and Teamwork in Medicine and Aviation,» British Medical Journal 320 (2000): 745–49.

Preliminary data reported in «Team Communication in Safety,» OR Manager 19, no. 12 (2003): 3.

Makary et al., «Operating Room Briefings and Wrong-Site Surgery.»

«Preflight Checklist’ Builds Safety Culture, Reduces Nurse Turnover,» OR Manager 19, no. 12 (2003): 1–4.

L. Lingard et al. «Getting Teams to Talk: Development and Prior Implementation of a Checklist to Promote Inter personal Communication in the OR,» Quality and Safety in Health Care 14 (2005): 340–46.

Глава 6. Фабрика чек-листов

D. J. Boorman, «Reducing Flight Crew Errors and Minimizing New Error Modes with Electronic Checklists,» Proceedings of the International Conference on Human-Computer Interaction in Aeronautics (Toulouse: Editions Cepaudes, 2000), pp. 57–63; D. J. Boorman, «Today’s Electronic Checklists Reduce Likelihood of Crew Errors and Help Prevent Mishaps,» ICAO Journal 56 (2001): 17–20.

National Traffic Safety Board, «Aircraft Accident Report: Explosive Decompression – Loss of Cargo Door in Flight, United Airlines Flight 811, Boeing 747–122, N4713U, Honolulu, Hawaii, February 24, 1989,» Washington D.C., March 18, 1992.

S. White, «Twenty-Six Minutes of Terror,» Flight Safety Australia, Nov. – Dec. 1999, pp. 40–42.

A. Degani and E. L.Wiener, «Human Factors of Flight-Deck Checklists: The Normal Checklist,» NASA Contractor Report 177549, Ames Research Center, May 1990.

Aviation Safety Reporting System, «ASRS Database Report Set: Checklist Incidents,» 2009.

Air Accidents Investigation Branch, «AAIB Interim Report,» Department of Transport, London, Sept. 2008.

M. Fricker, «Gordon Brown Just 25 Feet from Death in Heathrow Crash,» Daily Mirror, Jan. 18, 2008.

Air Accidents Investigation Branch, «AAIB Bulletin S1/2008,» Department of Transport, London, Feb. 2008.

Air Accidents Investigation Branch, «AAIB Bulletin S1/2008»; Air Accidents Investigation Branch, «AAIB Bulletin S3/2008,» Department of Transport, London, May 2008.

Air Accidents Investigation Branch, «AAIB Interim Report: Accident to Boeing 777-236ER, G-YMMM, at London Heathrow Airport on 17 January «Department of Transport, London, Sept. 2008.

Federal Aviation Administration, Airworthiness Directive; Boeing Model 777–200 and -300 Series Airplanes Equipped with Rolls-Royce Model RB211-TRENT 800 Series Engines, Washington, D.C., Sept. 12, 2008.

E. A. Balas and S. A. Boren, «Managing Clinical Knowledge for Health Care Improvement,» Yearbook of Medical Informatics (2000): 65–70.

National Library of Medicine, «Key Medline Indicators,» Nov. 12, 2008, accessed at www.nlm.nih.gov/bsd/bsd_key.html.

National Transportation Safety Board, «Safety Recommendations A-09-17-18,» Washington, D.C., March 11, 2009.

Глава 7. Тестирование

Joint Commission, Sentinel Event Alert, June 24, 2003.

R. D. Scott, «The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention,» Centers for Disease Control, March 2009.

The checklist can be accessed at www.who.int/safesurgery.

The videos can be viewed at www.safesurg.org/materials.html.

A. B. Haynes et al., «A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population,» New England Journal of Medicine 360 (2009): 491–99.

Глава 8. Герой эпохи чек-листов

T. Wolfe, The Right Stuff (New York: Farrar, Straus and Giroux, 1979).


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