Incident Report | EMER - Emergency Medicine Events Register

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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 (*).

Country*

Please select a country.

Please specify...*

Please type in the country.

Organisation type?*

Identify if the organisation is publicly or privately funded.

On what date did the incident occur? (Please use date picker on right hand side.)*

Please select a date

Date is

Please enter the date time frame.

WeekendPublic Holiday Please select a value.

Timeband

Please select a time

Whose safety was primarily at risk? (Select all that apply)

Patient

Staff

Visitor

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What happened? (Include details on what happened, who was involved and how the situation was dealt with immediately after it occurred)*

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.

What were the contributing factors for the adverse event or near miss?

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

What were the factors that reduced the impact of the incident?

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

What were the consequences or outcomes of the incident?

Please enter the consequence or outcome details.

How could the incident have been prevented?

Please enter how could the incident have been prevented.

What was the immediate action(s) taken to manage the incident?

Please enter the immediate action taken.

Which of the following events did the incident involve? (Select all that apply)

What is your designation?*

Please enter the notifier designation.

Please specify...*

Please type in the designation.

At what stage of the patient's journey was the incident first initiated?*

Please enter how the incident initiated.

At what stage of the patient's journey was the incident detected?*

Please enter how the incident was detected.

When you click 'Submit' it may take a second or two to load this incident into the database

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