This report summarises the 2014-15 implementation of the Emergency Medicine Events Register (EMER), an emergency medicine-specific incident reporting system, across Australia and New Zealand. The aim of the implementation was to enable the provision of EMER to all Australasian College for Emergency Medicine (ACEM) members, through developing the database and website, wide recruiting of site champions, ‘burst reporting’ (targeting specific incident types), classification of incidents and feed back to the profession.
What are the benefits?
EMER has been modelled on the successful implementation of other specialty-specific incident reporting systems in anaesthesia and radiology. Collecting and analysing data about specialty-specific adverse events has led to a better understanding of contributing factors and how the risk of harm to patients can be minimised or prevented. Through promotion of findings through publications and conferences, assessment of clinical practice can be reviewed to ensure best patient outcomes and a safety culture.
The classification and analysis of incidents in EMER allows a systematic means for the following purposes:
- to identify the aetiology of specific incident types in emergency medicine;
- to identify common failure modes in the emergency medicine environements;
- to differentiate organisational and technical failures in emergency medicine from human factor issues.
Additionally, the above learnings can be translated back to the emergency medicine profession, thereby promoting a safety culture and an enhanced understanding of intiatives to enhance patient safety.
Information collected on the notification page includes:
- “generic” information about the incident, (e.g. the date, time, medical specialty, notifier designation, what happened, what was the outcome), and
- specific information related to emergency medicine, (e.g. the phase of care where the incident occurred, the ED role delineation and whether or not the incident involved known ED patient safety problems, such as readmission, absconding, communication failures).
Once collected, incidents are classified into the Advanced Incident Management System (AIMS) using a pre-defined patient safety classification.
Patient safety incidents (involving a near miss or adverse event) can be reported into EMER. The following definitions, from the World Health Organization’s International Classification for Patient Safety will be used during the project. (Source: Runciman W, Hibbert P, Thomson R, Van Der Schaaf T, Sherman H, Lewalle P: Towards an International Classification for Patient Safety: key concepts and terms. Int J Qual Health Care 2009, 21:18-26).
A patient safety incident (an ‘incident’) is an event or circumstance that could have resulted, or did result, in unnecessary harm to a patient. The use of the term ‘unnecessary’ in this definition recognises that errors, violations, patient abuse and deliberately unsafe acts occur in healthcare and are unnecessary incidents, whereas certain forms of harm, such as an incision for a laparotomy, are necessary. The former are incidents, whereas the latter is not.
Further definitions are available from the Patient Safety Terminology page.
The results of the pilot implementation of EMER across a small number of hospitals have been recently published in Emergency Medicine Australasia. The open-access article is available from http://onlinelibrary.wiley.com/enhanced/doi/10.1111/1742-6723.12271/