A scoping review on the methods used to investigate serious adverse events in healthcare: Comparing approaches and identifying costs

Serious adverse events (SAEs) in healthcare harm patients and families, traumatise the workforce, and place strain on the healthcare system. Investigating the causes of SAEs is crucial for improving patient safety, yet the investigative methods available appear limited and not well synthesised. This scoping review aimed to identify, describe, and compare these methods, to examine their key characteristics, and to explore the resources required and associated costs. A systematic search was conducted in multiple databases. Studies describing methods for investigating single incidents resulting in serious patient harm were included. Data on investigation methods and costs were extracted and synthesised. There were 28 studies that met the inclusion criteria. Root Cause Analysis (RCA) was the dominant method, cited in 25 studies. Other methods were cited in much lower frequency. The included studies lacked sufficient procedural detail, necessitating the use of external protocols to inform the synthesis. All methods were based on accident causation models and followed similar investigation phases. Specific differences included healthcare adaptations, IT software integration and training requirements. No included studies directly reported on the costs to conduct SAE investigations. SAE investigation methods in healthcare remain largely confined to RCA despite its recognised limitations. The lack of investigation methodological diversity presents challenges for healthcare leaders in transitioning to alternative investigation methods. Further research is needed to develop and evaluate alternative methods and to quantify the costs associated with these investigations. Practical Applications: This review highlights the need for scholars and industry to develop methods beyond RCA for the investigation of SAEs. It also emphasises the need for greater transparency of the cost associated with this intervention. Policymakers can use these findings to inform arguments for greater development and implementation of SAE investigation methods, as well as to guide future research in this area.