PUSHing forward with healthcare emergency classification: Introducing the predictability-urgency-scale-harm model

Healthcare emergencies are common and heterogenous, but conceptually poorly defined in health professions education. This gap was highlighted while developing educational materials for medical students and newly qualified doctors learning to manage healthcare emergencies. We found no existing comprehensive framework to describe the nature of emergencies for educational and other purposes.

We propose the Predictability-Urgency-Scale-Harm (PUSH) model, a multidimensional taxonomy that characterises healthcare emergencies by predictability (fully to unpredictable), urgency (pressing to immediate), scale (individual to population) and harm (none to severe). This adapts the WHO definition of emergencies to clinical practice and goes beyond existing one-dimensional acuity or triage scales.

The PUSH model can be used by educators and clinicians to design and debrief simulation scenarios, map learners' real-life emergency exposure, and support shared mental models of emergencies in healthcare teams. It can enhance research design and comparability of studies. Other benefits include being low-cost, requiring no technology and applicability in both high- and low-resource settings.

Future work will refine the PUSH model through expert consensus and evaluate reliability, usability and educational impact when applied to clinical incidents and simulation-based education.