10 most common sentinel events of 2021: Joint Commission

The number of serious patient safety incidents reported to The Joint Commission jumped in 2021, reaching the highest annual level seen since the accrediting body started publicly reporting them in 2007, according to a report shared with Becker's Feb. 22. 

The accrediting body received 1,197 reports of sentinel events last year, 89 percent of which healthcare organizations voluntarily reported. In 2020, 809 total events were reported. This total had previously peaked in 2012, when 946 sentinel events were reported. 

The organization defines a sentinel event as a patient safety event that results in death, permanent harm, severe temporary harm or intervention required to sustain life. 

Only a small portion of all sentinel events are reported to The Joint Commission, meaning conclusions about the events' frequency and long-term trends should not be drawn from the dataset, the organization said.

The 10 most frequently reported sentinel events for 2021:

  1. Fall — 485 reported events
  2. Delay in treatment  — 97
  3. Unintended retention of a foreign object — 97
  4. Wrong surgical site — 85
  5. Patient suicide  — 79
  6. Assault/rape/sexual assault of a patient — 55
  7. Patient self-harm — 45
  8. Fire — 38
  9. Medication management — 35
  10. Clinical alarm response — 22

Learn more here.

Editor's note: This article was updated Feb. 23 at 6:35 p.m. CT.

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