Trigger tools and incident reporting are widely utilized methods for detecting harm in health care. The most useful method for capturing safety events in the emergency department remains unknown. In this prospective observational study, researchers assessed a monitoring system designed to detect adverse events in the emergency department of an academic medical center over a 1-year period. The system included two event reporting methods and five trigger tools. Of the 285 adverse events identified during the study period, 77.2% were captured by reporting systems, 26% by trigger tools, and 3.2% by both approaches. In keeping with prior research, the authors conclude that the use of a combination of methods for capturing harm is more effective than the use of a singular approach. A past PSNet perspective highlighted the importance of feedback with regard to incident reporting.