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Selected Medical Errors in the Intensive Care Unit

Results of the IATROREF Study: Parts I and II

¹ Medical–Surgical Intensive Care Unit, Saint Joseph Hospital Network, Paris; ² INSERM U823 (Outcome of Cancers and Critical Illness), Albert Bonniot Institute, La Tronche; ³ Department of Biostatistics, OUTCOMEREA, La Tronche; ⁴ Medical Intensive Care Unit, Albert Michallon Teaching Hospital, Grenoble; ⁵ Medical–Surgical Intensive Care Unit, Pays d'Aix Hospital, Aix en Provence; ⁶ Surgical Intensive Care Unit, Anesthesiology, Pain, and Emergency Department, Caremeau Teaching Hospital Network, Nîmes; ⁷ Medical Intensive Care Unit, Montpied Hospital, Clermont Ferrand; ⁸ Medical Intensive Care Unit, Cochin Teaching Hospital, Paris; ⁹ Medical–Surgical Intensive Care Unit, Pasteur Hospital, Chartres; ¹⁰ Surgical Intensive Care Unit, Saint Louis Teaching Hospital, Paris; ¹¹ Medical Intensive Care Unit, Bichat Teaching Hospital, Paris; ¹² Medical–Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay; ¹³ Medical Surgical Intensive Care Unit, Les Oudaries Hospital, La Roche Sur Yon; ¹⁴ Ile de France Regional Hospitalization Agency, Paris; ¹⁵ Medical Intensive Care Unit, Saint Louis Teaching Hospital, Paris; ¹⁶ Saint Joseph Hospital Network, Paris; and ¹⁷ Department of Anesthesiology, Saint Joseph Hospital Network, Paris, France

Correspondence and requests for reprints should be addressed to Maité Garrouste-Orgeas, M.D., Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France. E-mail: mgarrouste{at}outcomerea.org, mgarrouste{at}hpsj.fr

Rationale: Although intensive care units (ICUs) were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention.

Objectives: We describe the selection of indicator MEs, the incidence of such MEs, and their relationship with mortality.

Methods: We selected indicator MEs using Delphi techniques. An observational prospective multicenter cohort study of these MEs was conducted from March 27 to April 3, 2006, in 70 ICUs; 16 (23%) centers were audited. Harm from MEs was collected using specific scales.

Measurements and Main Results: Fourteen types of MEs were selected as indicators; 1,192 MEs were reported for 1,369 patients, and 367 (26.8%) patients experienced at least 1 ME (2.1/1,000 patient-days). The most common MEs were insulin administration errors (185.9/1,000 d of insulin treatment). Of the 1,192 medical errors, 183 (15.4%) in 128 (9.3%) patients were adverse events that were followed by one or more clinical consequences (n = 163) or that required one or more procedures or treatments (n = 58). By multivariable analysis, having two or more adverse events was an independent risk factor for ICU mortality (odds ratio, 3.09; 95% confidence interval, 1.30–7.36; P = 0.039).

Conclusions: The impact of medical errors on mortality indicates an urgent need to develop prevention programs. We have planned a study to assess a program based on our results.

Key Words: adverse event • IATROREF • intensive care unit • medical error • quality indicator

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject In intensive care units (ICUs), the complexity of care and severity of illnesses result in a high risk for iatrogenic events. Medical errors are common and cause morbidity and mortality in critically ill patients. What This Study Adds to the Field After careful adjustment for severity of illness, experiencing more than two adverse events was associated with a threefold increase in the risk of ICU death.