Incident Report

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You are currently viewing the Clinician report form. If you are a Consumer, please use the consumer report form to report your incident or compliment by clicking here

Learning from adverse events and near-misses is an important aspect of emergency medicine, particularly due to the challenges inherent in the speciality, including undifferentiated patients, clinical uncertainty, disease evolution/ progression, high risk procedures, overcrowding, and access block. Please refer to Incident Management Guide.

When considering the incident or near-miss, reflect on systemic issues, and how they interface with patient safety in the ED and, where practicable, reflect on opportunities for system improvement.

Your information will be de-identified and analysed in aggregate with other similar incident reports. All reporting will be anonymous and for education purposes/ opportunities for learning only. To assist with this anonymity, please write Dr A or Nurse B instead of using the person’s name and hospital A.

Please enter incident details below - mandatory fields are marked with an asterisk (*).
Please select a country.

Please type in the country.

Identify if the organisation is publicly or privately funded.

Please select a date

Please enter the date time frame.

Please select a value.

Please select a time

Invalid Input

Please enter the patient's triage score on presentation (select one only).

Please enter the age of the subject.

Please enter the gender.

Please type in the gender.

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Please enter a clinical presentation.

Please enter the details of the incident. This includes what happened, who was involved and how the situation was dealt with immediately after it occurred. Please use generic descriptions - Nurse A- Doctor on duty etc.

Please enter details of factors which contributed to the incident occurring. For example, insufficient staff, patient intoxication, failure to read etc

Please enter the factors that reduced the impact of the incident.

Please enter the consequence or outcome details.

Please enter how could the incident have been prevented.

Please enter the immediate action taken.

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Please enter the notifier designation.

Please type in the designation.

Please enter how the incident initiated.

Please enter how the incident was detected.