In 2024, healthcare facilities voluntarily reported 1,575 serious harmful events to The Joint Commission, which has been tracking sentinel events since 1996.
The Joint Commission defines a sentinel event as a patient safety event that results in severe temporary harm, permanent harm or death. Because the reports are voluntary, the organization says its dataset represents a small portion of actual sentinel events and that “no conclusions should be drawn about the actual relative frequency of events or trends in events over time.”
Of the 1,575 events, 21% were associated with patient death, 49% with severe harm, 21% with moderate harm, 5% with mild harm, 2% with psychological harm and 2% with no harm, according to the commission’s report.
With 776 voluntarily reported events, patient falls were the most frequently reported sentinel event in 2024. Falls led The Joint Commission’s annual lists in 2021, 2022 and 2023. In 2024, 51 of the reported falls resulted in patient death, 503 in severe harm and 199 in moderate harm.
Similar to 2022 and 2023, the leading mechanisms for falls were walking (31% of falls), falling from bed (30%) and falling from the toilet (18%).
The 11 most frequently reported sentinel events in 2024:
1. Falls — 49%
2. Wrong surgery — 8%
3. Delay in treatment — 8%
4. Suicide — 8%
5. Unintended retention of foreign object — 8%
6. Assault/rape/sexual assault/homicide — 4%
7. Fire/burns — 3%
8. Severe maternal morbidity — 2%
9. Medication management — 2%
10. Self-harm — 1%
11. Perinatal event — 1%
View the full report here.
