A critical incident may be defined as an event that is inconsistent with routine hospital practice and with the high quality level of patient care. To date, critical incident occurrence in hospital emergency departments has traditionally been reported on paper documents as to improve guidelines and intensify protocol design. The problem with a paper-based system however is its lack of anonymity, leaving junior officers to the impression that they are being policed, and the time-consuming exercise it demands from the hospital personnel. As a result, the Royal Sussex Hospital staff began to feel the need to install an improved reporting mechanism to obtain a more patient-centric risk management instead of one that was focusing on the critical event itself.
The University of Birmingham research team came up with the solution of a simple Web-based reporting system to facilitate the electronic submission of critical incident reports in the Accident and Emergency Department. An on-line HTML form offers a user-friendly interface to submit and store the report in a Microsoft Access Database Management System. In turn, the reported data is stored in relational records, integrating all elements that identify the type and experience of personnel involved in the incident, evidence of where the incident occurred, as well as patient details and complaints. The person reporting is also invited to submit suggestions on the factors contributing to the incident, possible corrective actions which have been undertaken, and recommendations on future prevention of similar events.
During the two-year pilot phase, incidents at the Royal Sussex Hospital have dropped from 108 to 26. The scientific study showed that 41% of incidents happened due to lack of sufficient experience with the clinical problem from the part of the hospital worker. In this regard, the CRIME-base system has helped to focus the areas where additional training programmes are needed. Another 27% of incidents were due to carelessness in patient handling; 9% occurred because of inappropriate hand-over; and 8% because of inadequate patient history or examination. The remaining 15% were attributed to work-overload, communication difficulties, or other unidentified reasons. Thanks to the electronic critical incident reporting system, the team thus was able to re-address induction courses for junior personnel.
The CRIME-base system has offered the Accident & Emergency Department staff at Brighton an excellent opportunity to learn from their mistakes in this participatory exercise. Nevertheless, this electronic reporting tool has a few important limitations, which reside in the fact that the critical incidents can not be validated and that the system will always remain open to abuse. One of the major drawbacks for international use may be that parts of the report are inherent to the local medical habits and health legislation of the country which make them inapplicable on a cross-boundary level. Still, the research team of the Birmingham University is convinced that CRIME-base is able to contribute to a better risk management planning in hospital emergency care departments.