Estimating risk when zero events have been observed

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Assessing the risk of complications or adverse events following an intervention presents challenges when they have not yet occurred. Suppose, for instance, a chronic shortage of cardiac telemetry beds has prompted a hospital to implement a new policy that places low-risk patients admitted to ‘rule out myocardial infarction’ in regular ward beds (ie, with no telemetry). After 6 months and the admission of 100 such patients, no cardiac arrests or other untoward events have occurred. This absence of harm (ie, zero adverse events) indicates a low risk, but clearly we cannot infer a risk of zero on the basis of only 100 patients. But, what can we say about the true underlying risk?
Original languageEnglish
Pages (from-to)1042-1043
Number of pages2
JournalBMJ Quality and Safety
Issue number12
Early online date19 Aug 2013
Publication statusPublished - 2013


  • risk management
  • cardiac telemetry beds
  • hospitals


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