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Sentinel events are adverse patient safety events that result in serious harm, or death of a patient while in the care of a health service.

Sentinel events happen independently of a patient’s condition and often reflect deficiencies in hospital (or agency) systems and processes.

Serious harm occurs when an adverse event results in a patient:

  • needing life-saving surgical or medical intervention
  • receiving a shortened life expectancy
  • experiencing permanent or long-term physical harm or experienced permanent or long-term loss of function.

Visit the Australian Commission on Safety and Quality in Health Care for more on sentinel events and serious harm

When determining whether or not serious harm has occurred, health service staff should adopt a consumer-focused approach.

Safer Care Victoria oversees the sentinel event program in Victoria.

In Victoria, public and private health services and all services under their governance structure are required to report sentinel events. Examples include:

  • Ambulance Victoria
  • bush nursing centres
  • Forensicare (Thomas Embling Hospital)
  • public sector residential aged care facilities
  • hospital in the home services
  • private day surgery facilities.

Find out what and how to report

Check what is covered under the national sentinel event reporting requirements
Find out what steps you need to take to report and review a sentinel event
Find out what to do after you've reported a sentinel event
Find out how health services and consumer representatives can work together to review serious adverse events.
Find out what documents you should collect and keep when conducting an incident review

Page last updated: 28 Jun 2019