In 2004, Saskatchewan was the very first province to mandate in law the reporting of critical incidents in the health system. The current regulations require health care organizations, including the Saskatchewan Health Authority and the Saskatchewan Cancer Agency, to report and investigate critical incidents in a timely manner, and implement and monitor corrective actions. This results in health system improvements for future patients.
The Saskatchewan Critical Incident Reporting Guideline, 2023 provides the definition of critical incident and contains a specific list of events that are to be reported to the Ministry of Health.
1. What is a critical incident?
A "critical incident" is defined in the Saskatchewan Critical Incident Reporting Guideline, 2023 as "a serious adverse health event that:
a) occurred while receiving a health service provided by, or a program operated by, the Saskatchewan Health Authority (SHA), a health services provider or the Saskatchewan Cancer Agency (SCA), hereinafter collectively referred to as "health services entity”, and
b) was not expected or intended to occur, and
c) is serious and undesired, such as
i. death, disability, injury or harm, or
ii. unplanned admission to a health facility or an unusual extension of a stay in a health facility, or
iii. a significant risk of substantial or serious harm to the safety, well-being or health of the patient, and
d) does not result primarily from the individual’s underlying health condition or from a known risk inherent in providing the health services.
2. Critical incident classification
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 and invasive procedure 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.
3. Critical incident reporting
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.
4. Patient Safety Alerts
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.
5. Role of Provincial Quality of Care Coordinator
Provincial Quality of Care Coordinators compile, analyze and report on critical incidents, and are involved in identifying and communicating system improvement opportunities.
The Provincial Quality of Care Coordinators (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.
6. Annual statistics
Aggregate data on critical incidents reported to the Ministry of Health is published annually. 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 more information, including a breakdown of the nature of the incidents by category, see "Appendix II - Critical Incidents Summary" in the Ministry of Health Annual Report.