Completed typology for critical incidents in emergency medicine
| Critical incident type | Level of severity | ||||
|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | |
| Patient assessment—omission | Failure to make diagnosis with life threatening consequences | Failure to make diagnosis with potentially life threatening, limb threatening, or sight threatening consequences | Failure to make diagnosis of condition usually associated with severe pain or prolonged pain, disability or illness | Failure to make diagnosis of condition usually associated with short term disability or unnecessary short term pain | Failure or delay in patient assessment resulting in, or likely to result in, no harm |
| Failure to make diagnosis that significantly changes treatment | |||||
| Failure to adequately exclude significant condition where indicated | Delay in patient assessment resulting in, or likely to result in, unnecessary short term pain, disability, or illness | ||||
| Delay in patient assessment with life threatening consequences | Delay in patient assessment with potentially life threatening, limb threatening, or sight threatening consequences | Delay in patient assessment resulting in, or likely to result in, continuation of severe pain or unnecessarily prolonged pain, disability, or illness | |||
| Patient assessment—commission | Inappropriate investigations in life threatening situation | Inappropriate investigations in potentially life threatening, limb threatening, or sight threatening situation | Inappropriate investigations resulting in, or likely to result in, unnecessary prolonged pain, disability. or illness | Inappropriate investigations resulting in, or likely to result in, unnecessary short term pain, disability, or illness | Inappropriate investigations resulting in, or likely to result in, delay but no further harm |
| Treatment—omission | Failure to give or delay in giving adequate treatment with life threatening consequences | Failure to give or delay in giving treatment with potential life threatening, limb threatening, or sight threatening consequences | Failure to give or delay in giving adequate treatment for condition usually associated with severe pain or long term pain, disability, or illness | Failure to give or delay in giving adequate treatment for condition usually associated with short term pain, disability, or illness | Failure to give treatment resulting in, or likely to result in, no harm, except short delay |
| Treatment—commission | Inappropriate treatment given to patient with life threatening consequences | Inappropriate or unnecessary treatment given to patient with potential life threatening, limb threatening, or sight threatening consequences | Inappropriate or unnecessary treatment given to patient resulting in, or likely to result in, long term pain, disability, illness. or severe side effects | Inappropriate or unnecessary treatment given to patient resulting in, or likely to result in, unnecessary short term pain, disability, illness, or side effects | Inappropriate or unnecessary treatment given to patient resulting in, or likely to result in, no harm, except delay |
| Treatment prescribed to which patient is known to be allergic or intolerant | |||||
| External disposal—omission | Failure to admit patient with life threatening condition | Failure to admit, or failure to arrange appropriate follow up, with potentially life threatening, limb threatening, or sight threatening consequences | Failure to admit, or failure to arrange appropriate follow up, in patient with condition usually associated with prolonged pain, disability, or illness | Failure to admit, or failure to arrange appropriate follow up, in patient with condition usually associated with short term pain, disability, or illness | Disposal omission failure resulting in, or likely to result in, no harm |
| Failure to discharge patient with appropriate advice, or information to GP, resulting in, or likely to result in, prolonged pain, disability, or illness | Failure to discharge patient with appropriate advice, or information to GP, regarding condition resulting in, or likely to result in, short term pain, disability, or illness | ||||
| Failure or inability to admit patient with life threatening condition to ward/unit of appropriately high level of dependency | Failure or inability to admit patient with potentially life shortening, limb threatening, or sight threatening condition to ward/unit of appropriately high level of dependency | Inability to admit patient to ward, leading to them having to remain in ED or be transferred elsewhere | |||
| External disposal—commission | N/A | Patient admitted to ward/unit of inappropriately high level of dependency | Patient admitted to ward unnecessarily | Unnecessary follow up arranged | Disposal commission failure resulting in, or likely to result in, no harm |
| Internal disposal | Resuscitation area full, unable to put in any more patients who need to be there, leading to life threatening situation | All trolleys, cubicles, and available space in department fully occupied, with the exception of the resuscitation area | Trolleys occupied throughout department, so that emergency measures have to be taken, such as placing patients in corridors, or inappropriately in waiting room | Area of department intended for “Majors” full, so that such patients then occupy some of ambulatory care areas | Trolley shortage resulting in, or likely to result in, no significant effect |
| Capacity of resuscitation area exceeded | Patient with condition associated with severe pain or prolonged pain, disability or illness has to be, or is, placed in area of insufficiently high dependency | ||||
| Patient with life threatening condition not placed in resuscitation area | Patient with potentially life threatening, limb threatening, or sight threatening condition has to be, or is, placed in area of insufficiently high dependency | ||||
| Equipment | Equipment or service failure that affects functioning of whole department | Equipment or service failure resulting in inability of, or delay in, diagnosis or treatment of potentially life threatening, limb threatening, or sight threatening condition | Equipment or service failure leading to inability to diagnose or treat patient, resulting in, or likely to result in, continuation of severe pain or unnecessarily prolonged pain, disability or illness | Equipment or service failure leading to inability to diagnose or treat patient, resulting in, or likely to result in, unnecessary short term pain, disability, or illness | Equipment or service failure resulting in, or likely to result in, no significant effect on patient diagnosis or treatment, other than delay |
| Equipment or service failure resulting in, or likely to result in, inability to perform part of assessment of patient, but unlikely to influence overall management of patient | |||||
| Equipment or service failure resulting in life threatening situation to patients or staff | Faulty equipment resulting in potentially life threatening, limb threatening, or sight threatening situation to patients or staff | Faulty equipment resulting in, or likely to result in, prolonged pain, disability or illness, to patients, or staff | Faulty equipment resulting, or likely to result in, in short term pain, disability or illness, to patients or staff | ||
| Documentation | Inadequate, illegible, inaccurate or missing documentation with effect of causing delayed or inadequate patient management with life threatening consequences | Inadequate, illegible, inaccurate or missing documentation with effect of causing delayed or inadequate patient management resulting in, or likely to result in, potentially life threatening, limb threatening, or sight threatening consequences | Inadequate, illegible, inaccurate or missing documentation with effect of causing delayed or inadequate patient management resulting in, or likely to result in, unnecessary prolonged pain, disability, or illness | Inadequate, illegible, inaccurate or missing documentation with effect of causing delayed or inadequate patient management resulting in, or likely to result in, in unnecessary short term pain, disability, or illness | Inadequate, illegible, inaccurate or missing documentation resulting, or likely to result in, no harm to patient, other than delay |
| Patient action | Action by patient, with consequences to themselves or to others that are life threatening | Action by patient, with consequences to themselves or to others that are potentially life threatening, limb threatening, or sight threatening | Action by patient, with consequences to themselves or to others resulting in, or likely to result in, unnecessary prolonged pain, disability, or illness | Action by patient, with consequences to themselves or to others, resulting in, or likely to result in, unnecessary short term pain, disability, or illness | Action by patient resulting in, or likely to result in, no adverse consequences to themselves or to others |
| General | Failure resulting in, or likely to result in, life threatening situation | Failure resulting, or likely to result in, in potentially life threatening, limb threatening, or sight threatening situation | Failure resulting, or likely to result in, in unnecessary prolonged pain, disability, or illness | Failure resulting in, or likely to result in, unnecessary short term pain, disability, or illness | Failure resulting in, or likely to result in, no harm except delay |