Patient Safety and Quality

Patients in intensive care units are at significant risk for adverse events and serious errors

Patients face a significant risk for preventable adverse events and serious medical errors in hospital critical care units, according to a study supported in part by the Agency for Healthcare Research and Quality (HS12032 and HS13333). Researchers found that over 20 percent of the patients admitted to two intensive care units at an academic hospital—a medical intensive care unit (MICU), and a coronary critical care unit (CCU)—experienced an adverse event.

Because patients admitted to critical care units are among the sickest, they may be more vulnerable to errors in care and therefore more susceptible to injury. Almost half (45 percent) of adverse events that occurred in the sample were preventable. A significant number of the adverse events involved medications—most commonly, giving patients the wrong dose. Over 90 percent of all incidents occurred during routine care, not on admission or during an emergency intervention.

The researchers conducted direct continuous observations in the MICU and CCU during nine 3-week periods distributed throughout 12 months from July 2002 through June 2003. This was supplemented by confidential incident reporting, a computerized adverse drug event detection monitor, and chart reviews.

According to lead study author Jeffrey M. Rothschild, M.D., M.P.H., critical care units provide an increasingly greater proportion of care, and people can expect to be admitted to an ICU at least once during their lifetimes.

See "The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care," by Dr. Rothschild, Christopher P. Landrigan, M.D., M.P.H., John W. Cronin, M.D., and others, in the August 2005 Critical Care Medicine 33(8), pp. 1694-1700.

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