Critical Incident Monitoring in Emergency Medicine Webbased System CRIMEbase: Current Evidence on In

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Critical Incident Monitoring in Emergency
Medicine Web-based System (CRIME-base) Current
Evidence on Incident Reporting and its Impact to
Quality of Care

• Dr.Theodoros N Arvanitis
• Kodak/Royal Academy of Engineering
• Educational Technology Research Group
• School of Electrical Electronic Engineering
• The University of Birmingham, UK

Dr.John M Ryan Accident Emergency Department
Royal Sussex County Hospital Brighton Health
Care NHS Trust Brighton, UK
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Critical Incident a definition

• A critical incident is any event which is
  inconsistent with routine hospital practice or
  with the quality of patient care and which has or
  could have adverse outcome for a particular
  patient
• J.A. Williamson, (1998),Critical Incident
  Reporting in Anaesthesia. Anaesthetic Intensive
  Care, 16 101-103.

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Incident Monitoring in AE

• Incident Monitoring A form of clinical action
  research
• allows for the elicitation of appropriate
  information towards planning of risk management
  in hospital practice
• Incident Monitoring in Accident Emergency
  Medicine
• Risk management planning
• Best Practice guideline and protocol Design
• Informing intra-departmental educational
  activities

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Current Approaches on Critical Incident
Monitoring in AE Practice

• Traditionally the responsibility of Risk
  Management
• Paper-based reporting systems
• CIM traditionally reactive incident
  investigation after the event
• Disadvantages
• Time consuming exercise
• Lack of Anonymity
• Frequently event rather than patient focussed
• Most often reported by senior staff
• altered perception and outcome bias

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Rational

• Need for patient-centric risk management
• Need for current evidence on guideline and
  protocol design
• Need for improved reporting mechanisms
• Ethical responsibility and shared knowledge
• Financial implications
• Litigation driven risk management

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Objectives of our methodology

• To develop and implement a Web-based reporting
  system to facilitate the electronic submission of
  AE critical incidents.
• Such on-line system should
• provide seamless accessibility options
• offer an easy-to-use interface
• include a relational database for action research

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Methods Web-based system
Client/ html form
parser
Email server
Client/ html form
Client/ html form
database
On-line feedback
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Event-driven Perceived Critical Incidents

• Triage error
• Did Not Wait
• Failure to request an X-ray
• Failure to interpret X-ray appropriately
• Drug error
• Hand over
• Failure to admit

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The CRIME-based Web Site
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Results(I) Reported vs. Involved

Paper Reporting
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Results(I) Reported vs. Involved

Web-based Reporting
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Where the incidents were identified
A Majors B Minors C Paediatrics Area D
Corridor E Emergency Theatre F Triage G Short
Stay Ward
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Type of complaint
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Reasons for Critical Incident
A Inexperienced B Carelessness C Inappropriate
hand over D Lack of Knowledge E Too
Busy F Language Barrier G Other
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Benefits

• Evidence of where Critical Incidents occur
• Participatory Exercise - Shared information
• More appropriate Risk Management
• Allow us to re-direct induction courses
• Allow us to focus teaching to areas of clinical
  need
• Paperless exercise

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Limitations

• Open to abuse
• Incidents cannot be validated
• Parts of the Report form may not be applicable
  internationally!
• Terminology in Emergency Medicine is not
  universal
• Attitudes of emergency personnel

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Future Plans

• Automatic management to preserve anonymity for
  larger studies
• Extended use of agent-based data mining and trend
  analysis
• On-line education programmes based on most
  frequent critical incidents being reported
  (already intranet-based multimedia AE textbook,
  case of the week, BAEM)
• Interactive Emergency Medicine tutorials

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Summary

• Physicians have an ethical and clinical
  responsibility to learn from their mistakes
• An international database of Critical Incidents
  will allow us focus teaching and risk management
  appropriately
• CRIME-base Brighton is a tool which facilitates
  reporting of critical incidents