Contemporary clinical incident analysis methods used within acute care settings: a scoping review

The objective of this review was to explore and synthesize the research on the use of contemporary incident analysis methods in acute care settings, and to report on characteristics of these methods and how they are being used to minimize, prevent, or learn from errors to improve patient safety.

A clinical incident is defined as an unexpected event that has arisen from providing care, resulting in harm or having the potential to cause unintended harm. Approaches to incident analysis in hospitals are moving from the concept of the error being attributed to a single causal factor to a more holistic approach incorporating family, patient, and staff perspectives, as well as system or process reviews. Exploring processes and perspectives of how clinical incidents in hospital settings are analyzed and managed can help health care organizations to improve patient safety.

The review considered studies reporting on clinical incident analysis methods used to investigate clinical incidents in acute care settings, involving any person engaging with the organization. The concepts of interest were the type of clinical incident investigated, any reported methods for consumer involvement or engagement with the reported clinical incident analysis process or system; as well as ways in which data were used to make improvements in clinical practice. Primary research studies and research syntheses from any country, published from 2013 to January 2025, were included.

The review followed JBI scoping review methodology and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Databases searched included PubMed, CINAHL (EBSCOhost), Embase, Scopus, the Cochrane Library, and Web of Science Core Collection. ProQuest Dissertations and Theses was also searched for unpublished research studies. No language restrictions were applied.

A total of 108 studies were included, from 29 countries and regions, reporting a variety of incident analysis methods, including root cause analysis, human factors and systems approaches, and artificial intelligence (AI) methods, such as natural language processing and text mining. The number of publications from 2013 to 2023 ranged from 4 to 10 per year, with a notable spike of 28 publications in 2024. An increase in the reports on AI approaches was observed from 2021. Less than half of the included studies reported on the inclusion of consumer, family, patient, or staff engagement in the incident analysis process. Of these, only 6 primary research studies and 1 qualitative synthesis specifically reported on the inclusion of families, patients, or consumers in their processes. Strategies to close the loop on incident analysis were discussed in varying depth in these papers. Where reported, organizational changes included updating policies or protocols, additional training, and repeated audits to check progress of corrective actions.

This scoping review highlights the diversity of clinical incident analysis methods used in acute care settings and underscores the importance of considering both human and organizational factors in understanding the causes of health care incidents. While traditional methods like root cause analysis are still being used and remain valuable tools, more advanced methodologies that consider system complexity are being used more frequently and offer a broader perspective toward improving organizational and patient safety outcomes.

OSF https://osf.io/t9wgq/.

A Chinese-language version of the abstract of this review is available at: http://links.lww.com/SRX/A159 .