Critical Incident Research Articles

A Qualitative Study of Systems-Level Factors That Affect Rural Obstetric Nurses’ Work During Clinical Emergencies

Maternal morbidity and mortality is rising in the United States. Previous studies focus on patient attributes, and most of the national data are based on research performed at urban tertiary care centers. Although it is well understood that nurses affect patient outcomes, there is scant evidence to understand the nurse work system, and no studies have specifically studied rural nurses. The authors sought to understand the systems-level factors affecting rural obstetric nurses when their patients experience clinical deterioration. The research team used a qualitative descriptive approach, including a modified critical incident technique, in interviews with bedside nurses (n = 7) and physicians (n = 4) to understand what happens when patients experience clinical deterioration. Physicians were included to better understand the systems in which nurses work. Clinicians were interviewed at three rural hospitals in New England, with a mean births per year of 190. Six systems-level factors/themes were identified: (1) shortages of resources; (2) need for teamwork; (3) physicians' multiple conflicting and simultaneous responsibilities, such as seeing patients in the office while women labor on the hospital floor; (4) need for all team members to be at the top of their game; (5) process issues during high-acuity patient transfer, including difficulty finding available beds at tertiary care centers; and (6) insufficient policies that take low-resource contexts into account, such as requiring two registered nurses to remove emergency medications from the medication cabinet. Rural nurses need policies and protocols that are written with their hospital context in mind. Hospitals may need outside support for content expertise, but policies should be co-created with clinicians with rural practice experience.

Point-process modeling of secondary crashes

Secondary crashes or crashes that occur in the wake of a preceding or primary crash are among the most critical incidents occurring on highways, due to the exceptional danger they present to the first responders and victims of the primary crash. In this work, we developed a self-exciting temporal point process to analyze crash events data and classify it into primary and secondary crashes. Our model uses a self-exciting function to describe secondary crashes while primary crashes are modeled using a background rate function. We fit the model to crash incidents data from the Florida Department of Transportation, on Interstate-4 (I-4) highway for the years 2015–2017, to determine the model parameters. These are used to estimate the probability that a given crash is secondary crash and to find queue times. To represent the periodically varying traffic levels and crash incidents, we model the background rate, as a stationary function, a sinusoidal non-stationary function, and a piecewise non-stationary function. We show that the sinusoidal non-stationary background rate fits the traffic data better and replicates the daily and weekly peaks in crash events due to traffic rush hours. Secondary crashes are found to account for up to 15.09% of traffic incidents, depending on the city on the I-4 Highway.

ELT teachers’ agency for wellbeing

Abstract Wellbeing is crucial for teachers, not only for themselves but also for ensuring that they teach to the best of their abilities. Thus, identifying ways of empowering teachers to take action to boost or maintain their wellbeing is vital. In this article, an ecological lens is adopted to understand what determines language teachers’ agency for wellbeing. A thematic analysis of in-depth interviews with 30 EFL teachers based in Austria revealed four key themes which help to explain how teachers exercise their agency for wellbeing. These are: triggers, reflection, affordances, and action. The results show that critical incidents in their personal and professional domains act as triggers drawing teachers’ attention towards their wellbeing and starting a process of deeper reflection. However, a prerequisite for taking action following this reflection appears to be a perceived sense of control about their ability to change things in their personal and professional lives.

Work Social Support and PTSD in Police Officers: The Mediating Role of Organizational Commitment

The military police officers of Rio de Janeiro are often exposed to critical incidents in routine work that may have a potentially traumatic effect on their mental health, such as post-traumatic stress disorder (PTSD). This study aims to explore the protective role of work social support (i.e., emotional, instrumental, and informational) and affective organizational commitment (and its mediation effect) in facing PTSD, considering these variables as essential resources in the work context according to the conservation of resources theory (COR) approach. This is a cross-sectional study, with a sample of 329 military police officers from Rio de Janeiro, Brazil, who were administered a questionnaire of sociodemographic variables, the Critical Incident History Questionnaire (CIHQ), the Post-Traumatic Stress Disorder Checklist 5 (PCL-5), the Perceived Social Support at Work Scale (EPSST), and the Affective Organizational Commitment Scale. It was found that only emotional support showed a significant association with affective commitment and PTSD symptoms. Affective organizational commitment, in turn, partially mediated the relationship between emotional support and PTSD. These findings shed light on the importance of organizations, such as the military police, in promoting the development of psychological resources like emotional support and affective commitment to mitigate PTSD and promote a sustainable work environment.

Amplifying NGO Messages with Critical Incidents: A Comparative Analysis of the Impact of New Media Disruption and Legacy Media in Journalism

Amplifying NGO Messages with Critical Incidents: A Comparative Analysis of the Impact of New Media Disruption and Legacy Media in Journalism

Power profile analysis of criticality accidents involving fissile solution boiling with considering evaporation

ABSTRACT The total fission energy released in a criticality accident involving fissile solution boiling tends to be high because the relatively high fission power continues during boiling. Simulating fission power change correctly during boiling seems essential to estimate the total fission energy. Fission power during boiling changes depending on fissile concentration and volume as the solution evaporates. In this study, we investigated the effect of concentration and volume change on estimated total fission energy for a long time of boiling. We introduced a model calculating the evaporation of fissile solution into the modified quasi-steady-state method to simulate power change during boiling. Three CRAC experiments and the Idaho Chemical Processing Plant (ICPP) criticality accident in 1959 were analyzed. As a result, the calculated energy considering concentration and volume change during boiling reproduced the measured energy well.

Breaking the Condon Approximation for Light Emission from Metal Halide Perovskite Nanocrystals.

The idea that the electronic transition dipole moment does not depend upon nuclear excursions is the Condon approximation and is central to most spectroscopy, especially in the solid state. We show a strong breakdown of the Condon approximation in the time-resolved photoluminescence from CsPbBr3 metal halide perovskite semiconductor nanocrystals. Experiments reveal that the electronic transition dipole moment increases on the 30 ps time scale due to structural dynamics in the lattice. Ab initio molecular dynamics calculations quantitatively reproduce experiments by considering excitation-induced structural dynamics.

UnDerstandIng the cauSes of mediCation errOrs and adVerse drug evEnts for patients with mental illness in community caRe (DISCOVER): a qualitative study.

It is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions. Remote qualitative semi-structured interviews with 26 community-based healthcare professionals in England and Wales were undertaken between June-November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol. A total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management. These findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group.

Safety standards in anesthesiology and during regional anesthesia: implementation in Ukraine

Patient safety in surgical settings is an integral part of the further sustainable development of medicine in Ukraine. This is key in times of the war and post-war state when the budget deficit at all levels of public administration and health care is significant and may grow significantly in the future. Medical errors during anesthetic management and surgery are particularly costly and significantly burden the health care system. Even the wealthiest economies cannot afford such mistakes. The price is particularly high for Ukrainian realities, and these mistakes are fatal for our health care. For this review, the authors used the electronic databases MEDLINE and Embase. 15 studies were included in the review. A part of the data was also included from the department research. Demonstration of own results is limited, as the data have already been published in other publications or materials are in the reviewing process. Basic monitoring according to the WHO standards / World Federation of Societies of Anesthesiologists (WFSA) is mainly used in hospitals of European Union countries. Results are close to 100 % for pulseoximetry and blood pressure, 98 % for electrocardiography, and 96 % for capnography. In Ukraine, monitoring methods do not have critical differences, except for a slightly lower (73.7 %) spread of capnography and ECG monitoring (83.4 %). The situation is less encouraging in the context of regional anesthesia. In Ukraine, the situation is much worse. According to the survey conducted by our department, ultrasound navigation is available in only 67 % of hospitals. There is also a low level of taking safety measures, which include checklists, training, and clinical analyzes of errors. Conclusions. According to the data of this literature review, the components of the Declaration of Helsinki on safety in anesthesiology are gradually being implemented in Ukraine, the use of the WHO checklist “Safe surgery” and safety standards of regional anesthesia is spreading. The main directions for further development are the education of physicians and other staff on patient safety, the approval of national standards and monitoring of their implementation in practice, the creation of a notification and audit system for complications and critical incidents during anesthesia.

Enhancing Traffic Management in Lahore: A Comprehensive Analysis of Drivers' Perspectives on Interactions with City Traffic Police

The purpose of this study is to investigate the challenges faced by drivers while interacting with City Traffic Police (CTP) in Lahore, Pakistan. CTP plays a vital role in maintaining traffic flow and improving road safety. The study used a mixed methods approach, combining qualitative interviews using Critical Incident Techniques (CIT) to explore issues, affinity diagrams for thematic analysis, and frequency analysis to quantitatively identify the most important transportation issues based on their occurrence. The study identified 32 different traffic problems and classified them into four categories of drivers. Thematic analysis reveals eight overarching themes, including road conditions, behavioral issues of traffic police, license issuance hurdles, traffic tickets and challans, grievance redressal procedures, signal malfunctions, discriminatory conduct, and corruption within the CTP domain. Quantitative analysis highlights road conditions, behavioral issues, and license-related problems as the most frequently reported concerns. Theoretical implications draw on Social Exchange Theory (SET) to analyze drivers' interactions, emphasizing the pivotal role of trust in shaping satisfaction and compliance. Practical implications urge policymakers to prioritize road maintenance, enhance communication skills of traffic wardens, and address corruption and discrimination for improved traffic management. Limitations include potential bias from convenience sampling, reliance on subjective recollections in CIT, and the study's exclusive focus on drivers. Recommendations for future research advocate rigorous sampling methods, broader geographical scope, diverse stakeholder involvement, and the incorporation of quantitative surveys.

Enhancing Traffic Management in Lahore: A Comprehensive Analysis of Drivers' Perspectives on Interactions with City Traffic Police

The purpose of this study is to investigate the challenges faced by drivers while interacting with City Traffic Police (CTP) in Lahore, Pakistan. CTP plays a vital role in maintaining traffic flow and improving road safety. The study used a mixed methods approach, combining qualitative interviews using Critical Incident Techniques (CIT) to explore issues, affinity diagrams for thematic analysis, and frequency analysis to quantitatively identify the most important transportation issues based on their occurrence. The study identified 32 different traffic problems and classified them into four categories of drivers. Thematic analysis reveals eight overarching themes, including road conditions, behavioral issues of traffic police, license issuance hurdles, traffic tickets and challans, grievance redressal procedures, signal malfunctions, discriminatory conduct, and corruption within the CTP domain. Quantitative analysis highlights road conditions, behavioral issues, and license-related problems as the most frequently reported concerns. Theoretical implications draw on Social Exchange Theory (SET) to analyze drivers' interactions, emphasizing the pivotal role of trust in shaping satisfaction and compliance. Practical implications urge policymakers to prioritize road maintenance, enhance communication skills of traffic wardens, and address corruption and discrimination for improved traffic management. Limitations include potential bias from convenience sampling, reliance on subjective recollections in CIT, and the study's exclusive focus on drivers. Recommendations for future research advocate rigorous sampling methods, broader geographical scope, diverse stakeholder involvement, and the incorporation of quantitative surveys.

Bereavement and Critical Incidents Involving Healthcare Professionals in Italy During COVID-19: The Importance of the Spiritual Dimension

This exploratory research investigated the work of healthcare professionals during the COVID-19 pandemic, highlighting the major critical aspects, including healthcare providers’ needs as well as personal, professional, and social changes brought about by the pandemic upon both living and dying. In general, for many healthcare providers, the changes imposed by COVID-19 together with their inadequate training led to an excessive emotional load that caused high levels of stress and, consequently, the risk of burnout. In the present study, we wanted to investigate the impact of the COVID-19 pandemic on healthcare professionals and to explore if and how spirituality influenced their experience. We adopted a qualitative methodological design based on interpretative phenomenological analysis. The respondents were 15 healthcare professionals (12 general practitioners, 1 physician, and 2 nurses). This research was carried out in Italy during the first lockdown, that is, between March and September 2020. Following the analysis of participants’ experiences, four main themes were created: (1) critical issues in healthcare, critical incidents, and changes in the attitudes and habits of general practitioners during the pandemic; (2) emotional experiences and primary needs during the emergency; (3) dying during the pandemic and new psychological symptoms in noninfected patients; and (4) resilience and the role of spirituality. Since healthcare professionals, and general practitioners more specifically, were extensively exposed to the dying process and to changes in the end-of-life scenario, the support offered by palliative care is desirable, in terms of both the special skills that palliative physicians can provide and the presence of psychologists as well as through death education.

Memorable interactive experiences between hosts and guests in B&Bs and their generation process: The host perspective

Experiences of bed and breakfast (B&B) hosts during guest interactions profoundly affect both guest experiences and the hosts' business passion. However, research on hosts' memorable interaction experiences (MIEs) is still limited. This study, using the critical incident technique and thematic analysis, examines MIEs among B&B hosts in Yangshuo, China, within the framework of interaction ritual chains theory. It identifies that MIEs of B&B practitioners vary from negative to positive, underpinned by two primary experiences: social interaction and novelty. Preventing negative MIEs hinges on service outcomes, decent work, and emotional experience. MIEs, emerging from both successful and broken interaction rituals around positively distinctive daily interactions and problematic crisis events, impact practitioners' well-being and professional passion through the accumulation of emotional energy and sacred symbols. This research contributes to the theoretical understanding of tourism host-guest relations and supports the sustainable growth of the B&B industry.

P171: Identifying pre-agitation biometric signature in dementia patients: A feasibility study

Objectives:Agitation and aggression (AA) occur frequently in patients with dementia (PwD), are challenging to manage, and are distressing for PwD, families, caregivers, and healthcare systems. Physiological parameters, such as Actigraphy, Heart Rate Variability, and Electrodermal Activity, measured via wearable sensors are correlated with AA in PwD. It is unclear whether these parameters could be compiled into an operational algorithm to create a pre-agitation biometric marker (i.e. parameters of Autonomous Nervous System’s arousal: elevated EDA, more frequent HR, lower heart rate variability (HRV), as well as higher motor activity) capable of predicting episodes of AA. This study will assess the feasibility and clinical utility of collecting physiological parameters via wearable multi-sensor Empatica E4 device in relation to clinically recorded episodes of AA in PwD.Methods:This study is leveraging a clinical trial (ClinicalTrials.gov/NCT04516057) taking place at Ontario Shores Centre for Mental Health Sciences. Participants are inpatients, males and females, 55-years old or older, with clinically significant AA, and a diagnosis of a Major Neurocognitive Disorder due to Alzheimer’s disease or multiple aetiologies. Participants wear the E4 device for 48 to 72 hours on three occasions during the 8-week study period. Participant demographics, and clinical measures used to assess behavior are collected at specific time intervals during the study period.Results:The study is ongoing and currently to-date we have been able to acquire approximately 240 hours of recordings from patients. We will be presenting feasibility data (proportion of participants successfully completing a minimum 48-hours of recordings), correlation analysis between physiological measures and clinical measures to identify pre-agitation triggers. Further, we will use generalized linear models to test whether physiological measures can predict pre-agitation triggers. This study will allow estimation of sample size needed to detect a meaningful effect size, which will be determined from the prediction model. Deep learning using Python will be used to create a predictive algorithm using the physiological data to profile participants’ behaviors and detect pre-agitation triggers.Conclusion:Early detection of AA in PwD will allow caregivers to offer timely, ndividualized, non-medical or medical interventions which will help avoid crises and critical incidents and improve quality of life of the PwD and their caregivers.

Identifying pre-agitation biometric signature in patients with dementia: A feasibility study

Background:Agitation and aggression (AA) occur frequently in patients with dementia (PwD), and cause distress to PwD and caregivers. This study will investigate whether physiological parameters, such as actigraphy, heart rate variability, temperature, and electrodermal activity, measured via wearable sensors, correlate with AA in PwD. It will also explore whether these parameters could be compiled to create a pre-agitation biometric marker capable of predicting episodes of AA in PwD.Methods:This study will take place at Ontario Shores Centre for Mental Health Sciences. Thirty inpatient participants who are inpatients, males, and females, aged 60 or older, with clinically significant AA, and diagnosis of Major Neurocognitive Disorder will be recruited. Participants will wear the device for 48 to 72 hours on three occasions during an 8-week study period. Participant demographics and clinical measures used to assess behavior will be collected at specific time intervals during the study period.Ceiling mounted cameras and clinical data are collected to annotate episodes of AA, which will allow identification of peripheral physiological markers “signature” unique to the patientResults:the algorithm connecting wearable devices, cloud and cameras was tested on healthy volunteers and demonstrated feasibility and reliability. The feasibility of implementation in PwD has been demonstrated in our sample of PwD previously in a sample of 6 participants. Feasibility in this larger sample will be assessed. Correlation analysis between physiological measures, camera capture of agitation onset and clinical measures will be calculated to identify agitation events and pre-agitation triggers. Various machine learning and features extraction/exploration techniques will be used to test whether physiological measures can detect exact time of agitation and predict pre-agitation triggers. This study will provide a reasonable estimation of sample size needed to detect a meaningful effect size, which will be determined from the prediction model.Conclusion:Early detection of AA in PwD will allow caregivers to offer timely and personalized interventions which will help avoid crises and critical incidents and improve quality of life in PwD and their caregivers.

Croissance post-traumatique et stratégies de coping chez les sapeurs-pompiers civils français

IntroductionOften faced with potentially traumatic critical incidents, firefighters may experience both negative and positive changes. These include full or partial post-traumatic stress disorder, specific coping strategies and possibly post-traumatic growth. For firefighters, these factors might be related, and their experiences may be possibly different depending on the status of the participants (professional vs volunteer firefighters). ObjectiveThe aim of this study is to explore and predict post-traumatic growth, post-traumatic stress disorder and coping strategies in a sample of French professional and volunteer firefighters. MethodA mixed research methodology was used. The Post-traumatic Stress Disorder Checklist, the Post-traumatic Growth Inventory, the Brief-Cope Inventory, and a semi-structured research interview were used with sixteen participants, divided into two equal groups: a group of eight professional firefighters and a group of eight volunteer firefighters. ResultsPost-traumatic growth was predicted at 63.4 % by traumatic symptomatology (altered arousal and reactivity) and by coping strategies (avoidance and positive thoughts). Spiritual changes predicted post-traumatic distress at 24.9 %. Firefighters who were not parents had more post-traumatic growth and positive thoughts than those who had children. There were no statistical difference between the volunteer and professional firefighter groups. Volunteer firefighters felt more vulnerable to critical incidents than professional firefighters because they have access to fewer effective resources. ConclusionPost-traumatic growth among firefighters could be explained by post-traumatic distress and coping strategies. Other factors influencing post-traumatic growth would need to be investigated (coping flexibility, parenting, a sense of self-efficacy).

CE: Suicide Prevention: Protecting the Future of Nurses.

Nurse suicide is an alarming issue that remains largely underexplored and underaddressed. Moreover, rates of suicide among nurses, which are higher than those in the general population, may increase due to additional stressors caused by the COVID-19 pandemic. There is a decided lack of data regarding nurse suicide or the efficacy of evidence-based prevention programs. This article examines the state of nurse suicide and explores the latest statistics on nurse suicide rates; contributing factors to nurse suicide; and current suicide prevention programs, such as the Critical Incident Stress Management and Healer Education Assessment and Referral programs.

1 Instructional Design Based on Interaction for the Development of Communicative Competence

This paper describes a research project aimed at analyzing students’ Communicative Competence in a virtual English course which was modified according to principles of the RASE (Resources, Activities, Support and Evaluation) techno pedagogical model and the communicative approach to language teaching (CLT). The study is based on a convergent mixed methods design, with control and experimental groups. From the quantitative perspective, it employed a repeated measures design in three moments, demonstrating that the experimental group showed improvements due to the modifications to the instructional design. From the qualitative perspective, the communicative acts in four critical incidents were observed during synchronous sessions, showing that the modifications to the instructional design benefited the students’ formal assessments of their communicative competence, as well as their performance in other interactions in which different micro and macro lang uage skills became more complex

Understanding the causes of preventable medication incidents for patients with mental illness in primary care

Abstract Introduction A recent scoping review has highlighted that whilst patients with mental illness are commonly affected by medication errors and preventable adverse drug events in primary care, there were limited data regarding their causes1. By understanding why these preventable events occur, targeted interventions can be developed. Aim To understand the nature and contributory factors that lead to medication errors and preventable adverse drug events amongst patients with mental illness in primary care. Methods This study used a qualitative design. A researcher remotely interviewed 26 healthcare professionals (14 pharmacists, 5 GPs, 5 nurses, 2 psychiatrists) working in primary care between June-November 2022, guided by the critical incident technique. Professionals were recruited via social media, research team networks, and snowballing. Data were analysed using the framework method and any data that involved speculation as to the causes of errors was not included. The data were organised into themes based on the London protocol error framework, which describes the contributory factors leading to care delivery problems2. Themes generated were validated by other members of the research team and a patient advisory group. This study was approved by the University of Manchester Ethics Committee 1 (reference 2022-13735-23555). Results Forty-three medication errors and twelve preventable adverse drug events were discussed during interview. Prescribing errors were discussed most commonly (n=24) and administration errors least commonly (n=4). Six contributory factors were identified which were: the individual (staff) (n=37); the work environment (n=31); the teams/interfaces (n=28); the organisation and management (n=24); the patient (n=23); and the task and technology (n=15). Primary care clinicians reported a lack of knowledge regarding psychotropics and mental illness which accompanied diffusion of responsibility. The responsibilities of staff were also confused by limited clinical information communicated between teams and across care interfaces. Service demand was reported to exceed capacity, creating stress for the staff, as well as limiting the time available for staff to undergo training. Complicated patient lifestyles and behavioural challenges were reported as unique contributory factors. Discussion/Conclusion Lack of knowledge amongst primary care clinicians regarding psychotropics and mental illness was a key issue. This was exacerbated by a mental health service structure placing considerable pressure on primary care leaving clinicians to support patients with needs perceived to be outside their areas of confidence and competence. There is a need to support this workforce by upskilling them to effectively manage patients by addressing the educational needs regarding neuropharmacology and communication skills. These changes may have a positive effect in reducing error rates for this patient group in primary care. Study limitations include recall bias, social desirability bias, as well as the majority errors discussed were made by another clinician within a chain therefore critical details may be missing in the series of events. This is the first study to identify the nature and contributory factors of preventable medication incidents for patients with mental illness in primary care. Future research should focus on exploring this topic from the perspective of patients to better understand the causes of preventable medication incidents.

Blackbox error management: how do practices deal with critical incidents in everyday practice? A qualitative interview study

BackgroundError management plays a key role in patient safety. It is a systematic approach aimed at identifying and learning from critical incidents by reporting, documenting and analyzing them. Almost nothing is known about the incidents physicians in outpatient care consider to be critical and how they deal with them. We carried out an interview study to explore outpatient physicians’ views on error management, discover what they regard as critical incidents, and find out how error management is put into practice in ambulatory care.MethodsWe conducted 72 semi-structured interviews with physicians from ambulatory practices. We asked participants what they considered to be a critical incident, how they reacted following an incident, how they discussed incidents with their coworkers, and whether they used critical incident reporting systems. The interviews were transcribed verbatim and analyzed using qualitative content analysis.ResultsInterviewed physicians defined the term “critical incident” differently. Most participants reported that they recorded information on incidents and discussed them in their teams. Several physicians reported taking a ‘pay better attention next time-approach’ to the analysis of incidents. Systematic error management involving incident documentation, analysis, preventive measure development, and follow-up, was the exception.ConclusionsTo promote error management, medical training should include teaching on the topic, so that medical professionals can learn about critical incidents and how to deal with them in an open and structured manner. This would help establish the culture of safety that has long been called for internationally.