Description of categories of the Eindhoven Classification Model: PRISMA medical version
Main category | Subcategory | Code | Description | Examples (if available) | Discharged home frequencies n (%)* | Admitted frequencies n (%)* |
Technical | External | T-ex | Technical failures beyond the control of the organisation. | Not available. | 0 (0) | 0 (0) |
Design | TD | Failures due to poor design of equipment, etc. | Not available. | 0 (0) | 0 (0) | |
Construction | TC | Correct design inappropriately constructed or placed. | Not available. | 0 (0) | 0 (0) | |
Materials | TM | Material defects not classified under TD or TC. | Not available. | 0 (0) | 0 (0) | |
Organisational | External | O-ex | Failures at an organisational level beyond the control and responsibility of the investigating team. | Patient presented to the ED due to delay in time to operate due to delay in receiving patient information from an external hospital. | 0 (0) | 1 (1.4) |
Transfer of knowledge | OK | Failure resulting from inadequate measures to train or supervise new or inexperienced staff. | Not available. | 0 (0) | 0 (0) | |
Protocols | OP | Failures relating to the quality or availability of appropriate protocols. | Oncological patient who is instructed by the specialist to present to the ED when he has fever. | 1 (1.2%) | 2 (2.7) | |
Management priorities | OM | Internal management decisions which reduce focus on patient safety when faced with conflicting priorities. | Patient presented to the ED because there is no short-term outpatient department appointment available. Presentation due to long waiting time until operation. | 7 (8.2) | 5 (6.7) | |
Culture | OC | Failure due to attitude and approach of the treating organisation. | Patient is sent from the outpatient department to the ED by a specialist instead of to the GP. | 1 (1.2) | 1 (1.4) | |
Human | External | H-ex | Human failures beyond the control of the organisation/department. | Patient arrived at the ED with an ambulance, which was called by bystanders after a fall on the street. | 1 (1.2) | 0 (0) |
Knowledge-based behaviour | HKK | Failure of an individual to apply their knowledge to a new clinical situation. | GP thought the fever was due to influenza instead of rheumatism. Therefore inadequate treatment and presentation to ED. | 1 (1.2) | 2 (2.7) | |
Qualifications | HRQ | An inappropriately trained individual performing the clinical task. | Not available. | 0 (0) | 0 (0) | |
Coordination | HRC | A lack of task coordination within the healthcare team. | Not available. | 0 (0) | 0 (0) | |
Verification | HRV | Failure to correctly check and assess the situation before performing interventions | GP refers the patient to the ED directly without examining the patient adequately due to lack of time. | 3 (1.9) | 0 (0) | |
Intervention | HRI | Failure resulting from faulty task planning or performance. | Inadequate medication schedule, therefore progression of complaints. Inadequate explanation to the patient when to present to the ED. | 4 (4.7) | 3 (4.0) | |
Monitoring | HRM | Failure to monitor the patient’s progress or condition. | Patient was admitted to the hospital, no adequate analysis of complaints and discharged home. Presents to the ED with same complaints. Insufficient monitoring done by GP. | 1 (1.2) | 1 (1.4) | |
Skills-based | HSS | Failure in performance of highly developed skills. | Not available. | 0 (0) | 0 (0) | |
Patient | Patient-related | PRF | Failures related to patient characteristics or conditions, which are beyond the control of staff and influence clinical progress. | Patient falls due to refusal to walk with walking aid. Patient postponed GP appointment due to anxiety and presents to ED with heavy complaints. | 18 (21.2) | 10 (13.5) |
Disease-related | DRF | Failures related to the natural progress of disease which are beyond the control of the patient, its carers and staff. | Patient with COPD presents with acute progression of dyspnoea. Shoulder luxation after fall. | 46 (54.1) | 47 (63.5) | |
X | Unclassifiable | X | Trauma capitis due to fall of suitcase during flight. Patient is still living independently despite frailty. Uncertainty of GP resulting in referral to ED. Patient presents to ED with postoperative infection. | 2 (2.3) | 2 (2.7) | |
Total | 85 (100) | 74 (100) |
Distribution of 159 root causes based on 100 patient cases.
*Number of root causes.
COPD, chronic obstructive pulmonary disease; ED, emergency department; GP, general practitioner; PRISMA, Prevention and Recovery Information System for Monitoring and Analysis.