Classification strategies for non-routine events occurring in high-risk patient care settings: A scoping review

Emily C. Alberto, Childrens National Health System
Swathi Jagannath, Drexel University
Maureen E. McCusker, Virginia Commonwealth University
Susan Keller, Childrens National Health System
Ivan Marsic, Rutgers University–New Brunswick
Aleksandra Sarcevic, Drexel University
Karen J. O'Connell, Childrens National Health System
Randall S. Burd, Childrens National Health System


© 2020 John Wiley & Sons Ltd Introduction: Non-routine events (NREs) are atypical or unusual occurrences in a pre-defined process. Although some NREs in high-risk clinical settings have no adverse effects on patient care, others can potentially cause serious patient harm. A unified strategy for identifying and describing NREs in these domains will facilitate the comparison of results between studies. Methods: We conducted a literature search in PubMed, CINAHL, and EMBASE to identify studies related to NREs in high-risk domains and evaluated the methods used for event observation and description. We applied The Joint Commission on Accreditation of Healthcare Organization (JCAHO) taxonomy (cause, impact, domain, type, prevention, and mitigation) to the descriptions of NREs from the literature. Results: We selected 25 articles that met inclusion criteria for review. Real-time documentation of NREs was more common than a retrospective video review. Thirteen studies used domain experts as observers and seven studies validated observations with interrater reliability. Using the JCAHO taxonomy, “cause” was the most frequently applied classification method, followed by “impact,” “type,” “domain,” and “prevention and mitigation.”. Conclusions: NREs are frequent in high-risk medical settings. Strengths identified in several studies included the use of multiple observers with domain expertise and validation of the event ascertainment approach using interrater reliability. By applying the JCAHO taxonomy to the current literature, we provide an example of a structured approach that can be used for future analyses of NREs.