Identifying and comparing risks in emergency medicine.

OBJECTIVES To identify common risk types occurring in emergency departments (EDs). To compare the risks occurring between different emergency departments. DESIGN Application of a typology of risks to a database of critical incidents. Comparison of results of applying typology to group of critical incidents collected in a uniform manner in four different EDs. SETTING EDs in two teaching hospitals and two district general hospitals in the north west of England. INTERVENTIONS Observational study. MAIN OUTCOME MEASURES Types of critical incidents identified. Statistical comparisons between EDs. RESULTS 816 critical incidents were classified. Patient assessment omission failures were the commonest type of failure, accounting for 291 (35.6%) of the critical incidents. Level 1 and level 2 failures accounted for 254 (31.1%) of critical incidents. Significant differences (p = 0.009) were shown between EDs when the categories of critical incidents occurring were compared. No significant differences (p = 0.336) were shown between EDs when the levels of severity of critical incidents occurring were compared. CONCLUSIONS Large numbers of critical incidents with potentially fatal consequences occur. The types of risks differ significantly between different EDs.