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A "critical incident" is defined in the Saskatchewan Critical Incident Reporting Guideline, 2004 as "a serious adverse health event including, but not limited to, the actual or potential loss of life, limb or function related to a health service provided by, or a program operated by, a health care organization."
The reporting of critical incidents is also mandatory for the Saskatchewan Cancer Agency.
In addition to the definition of critical incident, the Saskatchewan Critical Incident Reporting Guideline, 2004 contains a specific list of events that are to be reported to the Ministry of Health.
A "critical incident" is defined in the Saskatchewan Critical Incident Reporting Guideline, 2004 as "a serious adverse health event including, but not limited to, the actual or potential loss of life, limb or function related to a health service provided by, or a program operated by, a health care organization (HCO)."
Critical incidents are classified according to the following six categories (as described in the Saskatchewan Critical Incident Reporting Guideline, 2004). Note: for the purpose of these definitions, the word "patient" is used to represent a client, resident or patient.
I. Surgical events include critical incidents that occur during a surgical, endoscopic or other invasive procedure. For example, surgery performed on a wrong body part or the retention of a foreign object would be included in this category.
II. Product or device events are those critical incidents where a patient is harmed or has the potential to be harmed by the function or malfunction of the equipment that is used during the provision of care. For example, use of an unsterilized device or the failure of a piece of equipment in patient care would be included in this category.
III. Patient protection events include critical incidents where the provider fails to provide for the safety of the patient receiving care. For example, an infant is discharged to the wrong person or a patient disappears while being cared for would be included in this category.
IV. Care management events are those critical incidents that result during the provision of patient care. This category encompasses the most diffuse and frequently reported types of critical incidents and can include such things as medication errors or an error in diagnosis.
V. Environmental events are those critical incidents where patients are harmed as a direct result of their immediate physical environment. For example, patient death associated with a fall or a patient burn or unintentional electric shock.
VI. Criminal events are those critical incidents where a patient is harmed as the result of illegal activity by another person and for which a criminal charge could result. For example, a physical or sexual assault of a patient.
When a patient is harmed or where there is a potential for harm, professionals in the health system report information (excluding the identity of the patient) to Provincial Quality of Care Coordinators in the Ministry of Health.
An investigation is conducted on each critical incident. Following the investigation, health organizations generate recommendations for improvement that they are then responsible for implementing.
Patient Safety Alerts (previously known as Issue Alerts) are issued when recommendations that result from the review of a critical incident may benefit the province more broadly. Sharing information about an event, along with recommendations to prevent the event from recurring, promotes learning and helps improve health system quality and safety.
Recent Patient Safety Alerts are available on the eHealth Saskatchewan website. The alerts are also distributed broadly to the Saskatchewan Health Authority, the Saskatchewan Cancer Agency and other health care organizations and partners.
Provincial Client Concern Specialists compile, analyze and report on critical incidents, and are involved in identifying and communicating system improvement opportunities.
The Provincial Client Concern Specialist (phone 306-787-2718) also provide advice and support to the Saskatchewan Health Authority and the Saskatchewan Cancer Agency in their investigation and review of critical incidents.
Find more information about their role resolving concerns raised by patients and caregivers.
During 2015-16, a total of 249 critical incidents were reported to the Ministry of Health. A growth in the number of reported critical incidents may be due to increased awareness of, and compliance with, the legislation and regulations. It does not necessarily indicate a growth in the number of critical incidents occurring in the health system.
For a breakdown of the nature of the incidents by category, see "Appendix II - Critical Incidents Summary" in the Ministry of Health Annual Report.
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