Provider Manual

REPORTING ADVERSE CRITICAL INCIDENTS

Critical incidents are clinical events or outcomes that may require further analysis involving HealthChoices eligible consumers seeking or receiving services under Beacon administered plans. They also include incidents that occur during a patient’s transition to home or an alternative level of care. Tracking of critical incidents is a contractual requirement for Beacon with the Counties, DHS, and our providers, so it is important to report an occurrence promptly.

Notification to Beacon that a critical incident has taken place must be done telephonically or by facsimile to a Service Manager or other Beacon staff as soon as reasonably possible, but ideally within 24 hours. Written supplemental notes or a copy of clinical records may be requested. Please use the Critical Incident Log to report all occurrences.

Critical incidents include but are not limited to the following events occurring within any treatment setting:

Code Adverse Critical Incidents Critical “Tracking” Incidents
01 Completed suicide while in any level of care, attempted suicide while inpatient or if needed emergent care and last discharge was within 7 days (VO). Attempted suicide at any other level of care than inpatient with no apparent provider culpability
02 Completed homicide while in any level of treatment Attempted homicide in any level of care with no apparent provider culpability
03 Death by any cause while inpatient for psychiatric /substance abuse treatment or death by an unknown cause while in any other level of care (VO). Death by any cause while in any other level of care
04 Allegations of sexual or physical abuse/neglect/exploitation by a provider or non-consensual sex between consumers while in a facility Allegations of sexual or physical abuse/ neglect/exploitation by non/provider and consensual sex between consumers while in a facility
05 Assaults while in a facility that require serious medical treatment Assaults while in a facility that require minor or no medical treatment
06 Absent without leave and at risk to self or others Absent without leave with no apparent serious risk
07 Undesirable events inconsistent with routine patient care of a serious nature (adverse medical complications, inebriation, etc.) Undesirable events inconsistent with routine patient care of a moderate nature
08 Breach of Confidentiality
09 Parents or guardian taking child AMA from any inpatient setting with child at risk due to AMA (kidnapping, etc.)
10 Serious accidental injuries either in a facility or a providers office Non-serious accidental injuries either in a facility or in a providers office
11 Medication /treatment errors causing severe or potentially severe harm or distress to consumer Medication/treatment errors not resulting in severe or potentially severe harm or distress to consumer
12 Adverse reactions to medication/treatment causing severe or potentially severe harm or distress to consumers (NMS, etc.) Adverse reactions to medication/treatment of a moderate or minor nature
13 Fire setting/Property damage resulting in life threatening risk to self or others, or causing major damage while in a facility or for which fire fighters were summoned to the scene. Fire setting/Property damage without major risk or damage while in a facility and for which fire fighters were not summoned to the scene
14 Any condition that results in temporary closure of a facility
15 Possession of a deadly weapon while in any facility at all levels of care
16 Outbreak of a serious communicable disease
17 Other Other
18 Administrative Discharge
19 ANY real or threatened litigation in a case

If you are in doubt that a critical incident has occurred, please notify the Beacon Risk Management Department so that the information can be reviewed.