Error investigation and management: DipIMC practice questions

PHEM curriculum unit B.8 · Cross-cutting theme B: Team Resource Management

The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit B.8, Understand and apply principles of error investigation and management.

Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 8 questions on this unit.

Question 1 · Law, Ethics & Human Factors · Moderate

Thirty minutes after a helicopter emergency medical service (HEMS) mission, the crew realise that the patient received ten times the intended dose of intravenous fentanyl; naloxone was needed and the patient is now stable in hospital. The whole crew is still on the base, recollections are fresh, and the base lead wants to capture what happened and start learning today, before the crew disperses to different rotas. Under the Patient Safety Incident Response Framework (PSIRF), which learning response best fits this situation?

AA patient safety incident investigation, completed within six months
BA multidisciplinary team review, held one to three months from now
CA thematic review of all drug errors across the service in the past year
DA root cause analysis identifying the single root cause of the error
EA swarm huddle with the staff involved, started as soon as possible

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Answer: E

A swarm huddle with the staff involved, started as soon as possible

PSIRF asks organisations to choose learning responses proportionately. NHS England's guide to responding proportionately describes the swarm huddle as designed to be initiated as soon as possible after an event, as a multidisciplinary discussion in which staff gather information about what happened and why as quickly as possible, which is exactly what the base lead wants while the crew and their recollections are together. A multidisciplinary team review supports teams to learn from incidents that occurred in the significant past or where it is more difficult to collect staff recollections, which is the opposite of this situation. A patient safety incident investigation (PSII) is the in-depth review of a single incident or cluster; PSIIs should take no longer than six months, but that must not become a new default target. A thematic review looks for common links or themes across a cluster of incidents rather than responding to one event. The guide states that root cause analysis has consistently failed to deliver benefits of the scale and quality needed, and PSIRF methods explore multiple contributory factors instead of a single cause. The incident must still be reported, and the guide reminds organisations that where such incidents involve moderate or greater harm they must fulfil their Duty of Candour obligations.

Where this comes from

NHS England — A guide to responding proportionately to patient safety incidentsNHS England, PSIRF supporting guidance, version 1.3 (September 2025)·Learning response methods: swarm huddle“designed to be initiated as soon as possible after an event”Open PDF at page 14
NHS England — A guide to responding proportionately to patient safety incidentsNHS England, PSIRF supporting guidance, version 1.3 (September 2025)·Learning response methods: MDT review“patient safety incidents that occurred in the significant past”Open PDF at page 14
NHS England — A guide to responding proportionately to patient safety incidentsNHS England, PSIRF supporting guidance, version 1.3 (September 2025)·Timeframes for learning response methods“no longer than six months, but this must not become a new default target”Open PDF at page 19
NHS England — A guide to responding proportionately to patient safety incidentsNHS England, PSIRF supporting guidance, version 1.3 (September 2025)·Tools to respond to broad patient safety issues: thematic review“A thematic review may be useful for understanding common links, themes or issues”Open PDF at page 17
NHS England — A guide to responding proportionately to patient safety incidentsNHS England, PSIRF supporting guidance, version 1.3 (September 2025)·Is root cause analysis 'system-based'?“has consistently failed to deliver benefits of the scale and quality needed”Open PDF at page 4
NHS England — A guide to responding proportionately to patient safety incidentsNHS England, PSIRF supporting guidance, version 1.3 (September 2025)·Duty of candour“organisations must fulfil their Duty of Candour obligations”Open PDF at page 17

law-081 · Law, Ethics & Human Factors · Human Factors · Moderate · v3

Question 2 · Law, Ethics & Human Factors · Moderate

An air ambulance charity reviews five years of incident data and finds that only the most serious events were ever reported, and that the usual response to an error was to discipline the individual involved. The new clinical governance lead wants to build a safety culture of the kind described in the ABC of Prehospital Emergency Medicine, which rests on three underpinning cultures. Which option lists them?

AA blame culture, a learning culture and a compliance culture
BA reporting culture, a learning culture and a just culture
CA no-blame culture, an audit culture and a training culture
DA reporting culture, an investigation culture and a punitive culture
EA safety culture, a risk culture and an accountability culture

Show answer

Answer: B

A reporting culture, a learning culture and a just culture

The ABC says a safety culture results when accountability and learning are balanced, and that it relies on an underpinning reporting culture, a learning culture and a just culture (Figure 36.2). Personnel need to feel confident about reporting actual and potential adverse events, no matter how trivial, and the organisation should be actively seeking to learn from mistakes. The book observes that in many healthcare systems such a culture is conspicuously absent: only the most serious incidents are reported and investigated, and subsequent actions tend to be punitive and person focused rather than system focused, which is precisely this charity's history. The same thinking runs through the Patient Safety Incident Response Framework (PSIRF), whose four aims include the application of a range of system-based approaches to learning from patient safety incidents, and whose supporting guidance states that root cause analysis has consistently failed to deliver benefits of the scale and quality needed.

Where this comes from

ABC of Prehospital Emergency Medicine
- Ch. 36 Clinical Governance · Risk management: components of a safety culture (Fig. 36.2) · p. 199“A safety culture results when accountability and learning are balanced”
- Ch. 36 Clinical Governance · Risk management: components of a safety culture (Fig. 36.2) · p. 199“a learning culture and a just culture”
- Ch. 36 Clinical Governance · Risk management: components of a safety culture · p. 199“only the most serious incidents are reported”
- Ch. 36 Clinical Governance · Risk management: components of a safety culture · p. 199“person focused rather than system focused”
NHS England — A guide to responding proportionately to patient safety incidentsNHS England, PSIRF supporting guidance, version 1.3 (September 2025)·Purpose: the four aims of PSIRF“application of a range of system-based approaches to learning”Open PDF at page 3
NHS England — A guide to responding proportionately to patient safety incidentsNHS England, PSIRF supporting guidance, version 1.3 (September 2025)·Is root cause analysis 'system-based'?“has consistently failed to deliver benefits of the scale and quality needed”Open PDF at page 4

law-082 · Law, Ethics & Human Factors · Human Factors · Moderate · v3

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Error investigation and management: DipIMC practice questions

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