Physiotherapists must ensure plans are in place to manage any critical or unexpected events including adverse events associated with restricted activities. When developing these plans, physiotherapists must consider safety literature and resources describing adverse events and their management strategies.

This Guideline is intended to help physiotherapists create a Critical Event Management Plan.

Adverse event: An unexpected and undesired incident directly associated with the care or services provided to the patient; an incident that occurs during the process of providing health care and results in patient injury or death; or an adverse outcome for a patient, including an injury or complication.

Restricted activities include dry needling, spinal manipulation and ordering diagnostic imaging.

Click here to view the Critical Event Management Plan Practice Guideline as a PDF.

The Health Quality Council of Alberta’s Patient Safety Framework for Albertan’s (page 8-9) outlines four distinct elements which provide the foundation for managing critical events:

  • Proactive identification of risks to patient safety.
  • Effective response to adverse events and close calls when they do occur.
  • Implementation of strategies based on the learnings from a review of adverse events and their causes.
  • Evaluation of implemented recommendations.

A critical event management plan will identify how an organization will:

  • Monitor risks to patient care and utilize appropriate reporting and response systems.
  • Provide education for all employees and others working in the organization on patient safety and adverse event response processes.
  • Provide all employees and others working in the organization with a critical path for managing and reporting events when patients are seriously harmed by the health system or experience a close call.
  • Outline a process to investigate an adverse event or close call to understand underlying factors and implement changes to reduce the chances of recurrence.
  • Engage in other safety improvement processes (as required) to deliver safe patient care. 

Physiotherapists must consider the people, equipment, processes and data available in their practice setting and decide who is doing what and when to address a critical event if it occurs.

When constructing management plans for critical (including adverse) events, physiotherapists must give consideration to:

  • Management strategies for when the patient is in the clinic.
  • Management strategies for when the patient leaves the clinic, including whether it is safe for the patient to function in the community.
  • Procedures for timely communication with the treating therapist informing them that their patient has contacted the clinic for guidance on how to manage a symptom after leaving the clinic, and for the treating therapist to provide a timely response to the patient’s inquiries.
  • Regular review of safety protocols with staff.

Examples of a completed planning template are found in the Appendix of the Dry Needling Critical Event Management Guideline.

Critical Event Man​agement Planning Template
Adverse Event Protocol or
Unique Identifier
Description of Adverse Outcome
  • Define purpose of the plan, application and limitations.
Management Procedure
  • List preventative steps and protocols for management should the event arise.
Equipment (type and location)
  • List the equipment required for managing the event.
Roles and Responsibilities
  • Outline the roles and responsibilities of personnel involved in managing the event when it occurs and period of time following the event.
Personnel Involved
  • List the persons who are involved in the event.
  • Indicate their roles and responsibilities.
  • Include the patient, list the instructions provided to them and any protocols that the patient is expected to undertake to assist with management of the event.
Follow-up Including Communication, Post-event Analysis and Staff Support
  • Communicate plan with patient following departure from clinic (i.e., learning the outcomes when referral to other health-care providers is recommended, disclosure or apologies).
  • Communicate plan for ensuring treating physiotherapist is informed of and responds in a timely manner when a patient calls the clinic back to express concerns.
  • Complete critical incident forms as required.
  • Analyze event or close call to understand underlying factors and reduce chance of recurrence.
  • Support staff/contractee.
  1. Canadian Physiotherapy Association. “Position Statement: Patient Safety Author (2007) Retrieved 2014/09/02 Safety_en.pdf.aspx
  2. Ginsburg, Liane R., et al. “Categorizing Errors and Adverse Events for Learning: A Provider Perspective Healthcare Quarterly.12 Special Issue (2009):154-160. Retrieved 2014/09/02
  3. Health Quality Council of Alberta. Patient Safety Framework for Albertans (Author) 2010. Retrieved 2014/11/26
  4. Health Quality Council of Alberta. The safe practice of dry needling in Alberta. Author (2014) Retrieved 2014/11/16
  5. Health Quality Council of Alberta. Systematic systems analysis: A practical approach to patient safety reviews. (Author) 2012. Retrieved 2014/11/26
  6. Physiotherapy Alberta College + Association (2013) “Practice Standard - Performance of Restricted Activities” Author (2012) Retrieved 2014/09/02
  7. Tardif, G., et al. “Implementation of a safety framework in a rehabilitation hospital.” Healthcare quarterly (Toronto, Ont.) 11.3 Spec No. (2007): 21-25 Retrieved 2014/9/02.