[17] used a database of event reports which contained little information on contributing factors. Moreover, they had no opportunity to interview involved healthcare providers. We tried to improve these designs by carrying out a study over a longer period in multiple centres, allowing for generalisation of the results, and by using interviews to complete the event reports. The objectives Inhibitors,research,lifescience,medical of our study are to gain more insight into (1) the nature of unintended events in the ED, (2) the causes of unintended events in the ED and (3) the relationship between the type of event and the causal

factor structure. Methods Study design and setting From October 2006 to December 2007, an observational study was performed to examine the causes of unintended events at the emergency department (ED) of ten hospitals in the Netherlands: one university hospital, three tertiary teaching hospitals and six general hospitals. Unintended events were broadly defined as all events, no matter how seemingly trivial or commonplace, that were unintended and could have harmed Inhibitors,research,lifescience,medical or did harm a patient.[18] The study protocol was granted ethical approval Inhibitors,research,lifescience,medical by the

VU University Medical Centre review board in Amsterdam. The intake of departments was Linsitinib supplier phased, because -for logistical reasons- we did not want all EDs to participate in the study simultaneously. The study period per ED was eight to fourteen weeks depending on the reporting speed. Healthcare providers (i.e. nurses, resident physicians, medical consultants) and clerks at the department were asked to report all unintended events that occurred, both when they were involved in an event and when they witnessed an event. In order to find the causes underlying the reported unintended events, the events Inhibitors,research,lifescience,medical were analysed by an experienced researcher using a Root Cause Analysis (RCA) tool called

PRISMA-medical.[19,20] Inhibitors,research,lifescience,medical In addition, the unintended events were classified into one of the eight classes that we formulated after completion of the study by looking at common themes in the reported events: Materials and equipment, Diagnosis and treatment, Medication, Protocols and regulations, Incorrect GPX6 data and substitutions, Collaboration with resident physicians and consultants, Collaboration with other departments and Other. Data collection Reporting procedure Before the start of the study, ED-staff received an oral and written instruction about the aim and procedure of the study. They had two alternatives for reporting the unintended events: a report card or report form. On the pocketsize report card, the name of the reporter, the moment in time, and a description of the event were requested. The report form was more elaborate and additionally requested the involvement of the reporter, the phase of care, place, some patient characteristics and consequences for the patient. A letter box was placed at the department to drop the report cards and forms.