When an event sparks behavior change: an introduction to the sentinel event method of dynamic model building and its application to emergency medicine

UMMS Affiliation

Department of Emergency Medicine

Publication Date


Document Type



Emergency Service, Hospital; Patients; Health Behavior


Behavior and Behavior Mechanisms | Emergency Medicine


Experiencing a negative consequence related to one's health behavior, like a medical problem leading to an emergency department (ED) visit, can promote behavior change, giving rise to the popular concept of the "teachable moment." However, the mechanisms of action underlying this process of change have received scant attention. In particular, most existing health behavior theories are limited in explaining why such events can inspire short-term change in some and long-term change in others. Expanding on recommendations published in the 2009 Academic Emergency Medicine consensus conference on public health in emergency medicine (EM), we propose a new method for developing conceptual models that explain how negative events, like medical emergencies, influence behavior change, called the Sentinel Event Method. The method itself is atheoretical; instead, it defines steps to guide investigations that seek to relate specific consequences or events to specific health behaviors. This method can be used to adapt existing health behavior theories to study the event-behavior change relationship or to guide formulation of completely new conceptual models. This paper presents the tenets underlying the Sentinel Event Method, describes the steps comprising the process, and illustrates its application to EM through an example of a cardiac-related ED visit and tobacco use.

DOI of Published Version



Acad Emerg Med. 2012 Mar;19(3):329-35. doi: 10.1111/j.1553-2712.2012.01291.x. Link to article on publisher's site

Journal/Book/Conference Title

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Related Resources

Link to Article in PubMed

PubMed ID