Peter Dodek, MD, MHSc
Do medical errors in the intensive care unit (ICU) increase risk for death?
Prospective cohort study.
70 ICUs in France, 50% in university hospitals.
1369 patients (mean age 61 y, 65% men) who were treated in ICUs during a 1-week period.
14 medical errors selected by a panel of experts.
During the 1-week study period, 1192 medical errors were reported in 367 patients (27% of patients, 2.1 errors/1000 patient-d), the most frequent being errors administering insulin (Table). Patient factors that increased risk for medical errors were mechanical ventilation, central venous catheter, insulin prescription, and not having scheduled surgery. Although medical error rates varied by unit, no ICU characteristic was identified to explain the variability. Clinical or therapeutic consequences (adverse events) resulted from 183 medical errors (15% of all errors) in 128 patients (9.3% of all patients); 40 of these errors (3.4% of all errors) were scored > 3 on a severity scale of 1 to 6. Of 285 ICU deaths (21% of patients), 4 deaths (1.4% of ICU deaths and 0.3% of patients) were attributable to adverse events following medical errors (1 after self-extubation and 3 after delay in surgical treatment). Medical errors alone, up to 5 or more in the same patient, did not increase risk for ICU death (P = 0.65). For medical errors resulting in adverse events, ICU death was not increased after 1 occurrence (6.8% of patients; adjusted odds ratio 1.1, 95% CI 0.64 to 1.9) but was increased after ≥ 2 occurrences in the same patient (2.6% of patients; adjusted odds ratio 3.1, CI 1.3 to 7.4).
Medical errors of varying severity were common in intensive care units but did not increase risk for death except among the 2.6% of patients who had ≥ 2 errors resulting in adverse events.
Occurrence of 14 selected medical errors during 1 week in 70 intensive care units
Dodek P. 2 or more medical errors with adverse consequences, affecting 2.6% of patients, increased mortality in intensive care units. Ann Intern Med. ;152:JC5–12. doi: 10.7326/0003-4819-152-10-201005180-02012
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Published: Ann Intern Med. 2010;152(10):JC5-12.
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