Critical incident monitoring is a useful quality improvement tool for the emergency department.

Abstract

Objectives To describe and evaluate the critical incident methodology as a quality improvement tool in the emergency department. Method An audit of Emergency Department Incident Reports over a five-month period. The main outcome measures used were aetiology, factors which may have minimised the incident, the outcome and any suggested corrective strategies. The result was a 230 point questionnaire. This tool was called the Emergency Department Incident Monitoring System. Despite the number of questions, the circling of responses allowed the form to be completed in under five minutes. Results In the 112 incidents analysed, there were 46 patient factors, 92 human factors and 33 diagnostic factors identified. Skilled assistance and supervision minimised the incidents in 44% of cases. In 86% of incidents, patients suffered minor or no physiological change. In 8% of incidents, patients suffered major morbidity. There was one death in the series. Improved communication was identified as the most important corrective strategy in 21% of incidents. Further training and education were felt to be important in 20% of incidents and improved supervision in 16% of incidents. Conclusion The critical incident technique provides a practical and effective framework for analysing incidents. It is an inexpensive, easily implemented adjunct to traditional quality improvement programs and provides useful clinical and administrative information. Sampling error does limit the value of the technique.