Iatrogenic events resulting in intensive care admission: Frequency, cause, and disclosure to patients and institutions

doi:10.1016/j.amjmed.2005.01.012

The American Journal of Medicine

Volume 118, Issue 4, April 2005, Pages 409-413

https://doi.org/10.1016/j.amjmed.2005.01.012 Get rights and content

Abstract

Purpose

To identify the frequency and type of iatrogenic medical events requiring admission to an intensive care unit. To assess the consequences of iatrogenic medical events for patients and institutions. To assess the prevalence of disclosure of iatrogenic medical events to patients, surrogates, and institutions.

Methods

The project on Care Improvement for the Critically Ill enrolled 5727 patients to 8 intensive care units at 4 Boston teaching hospitals. To determine the nature, consequences, and disclosure of iatrogenic medical events, we did a retrospective chart review on all patients whose admission to an intensive care unit was precipitated by an iatrogenic event.

Results

Sixty-six patients (1.2 %) were identified by an intensive care unit’s clinical team as having an iatrogenic medical event as the primary reason for admission to the unit. The majority (29, or 45%) of iatrogenic medical events were secondary to technical error, but a high percentage (21, or 33%) was due to iatrogenic drug events. Twenty-two (34%) cases were assessed by the investigators to have been preventable. In 60 (94%) cases there was no documentation in the patient’s chart of communication to the patient regarding the reason for admission to the intensive care unit. In 11 (17%) cases there was documentation of a discussion with the surrogate about the reason for admission to the unit. In only 3 (5%) cases was there documentation that the patient or surrogate was informed that an iatrogenic medical event was the reason for admission to the intensive care unit. Incident reports or malpractice claims were filed in only 4 (6 %) cases.

Conclusion

The frequency of iatrogenic medical events resulting in admission to intensive care units is lower than previous studies have reported. Iatrogenic drug events continue to be an important source of error. A considerable percentage of iatrogenic events may be preventable. Health care professionals rarely document disclosure of iatrogenic events to patients and surrogates.

Section snippets

Background

This study was conducted as part of the project on Care Improvement for the Critically Ill, organized in 1997 by a consortium from the intensive care units at Harvard teaching hospitals in response to emerging controversies in critical care medicine. The complete methods for this project have been published elsewhere.⁸

Settings

The project on Care Improvement for the Critically Ill was a prospective observational study that examined decision making and satisfaction with care provided in 8 intensive care

Characteristics of patients

A total of 5727 patients were admitted to the intensive care units during the period of November 1998 to March 1999. Among these, 873 (15%) patients were enrolled in the project on Care Improvement for the Critically Ill based on a positive response to 1 of 4 screening questions. Sixty-six patients (1.2%) were identified as having an iatrogenic medical event that was the primary reason for admission to the intensive care unit. A retrospective review of patient charts was performed for 64 (97%)

Discussion

Over 20 years ago, Trunet et al found that 41 (12.6%) intensive care unit admissions during a 1-year period were linked to iatrogenic medical events and, of those, 19 (46%) were preventable.¹³ In 1999 Darchy et al. did a retrospective review of admissions during a 1-year period to a French general hospital and found a similar percentage of admissions (68 or 10.9%) to the intensive care unit resulted from iatrogenic medical events.¹⁴ Because many errors may not be documented in the medical record

Acknowledgements

We would like to thank Eric Poon, MD, for his assistance with chart review and Jeffrey P. Burns, MD, MPH, for his comments on a draft of this manuscript.

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Iatrogenic events: A significant cause of admission in intensive care units
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Colliger et analyser les événements indésirables conduisant à une hospitalisation en réanimation.
Étude prospective, observationnelle, monocentrique.
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La provenance, les caractéristiques démographiques, le motif d’admission, le terrain sous-jacent, la gravité, les diagnostics, les caractéristiques du séjour en réanimation et les thérapeutiques entreprises ont été relevées pour chaque patient. Deux médecins ont déterminé par consensus les admissions imputables à des événements indésirables et leur caractère évitable éventuel. Une analyse statistique univariée a été effectuée.
En un an, 603 patients ont été admis dont 71 (12 %) suite à un événement indésirable. Comparés à la population admise pour un autre motif, ces patients étaient plus âgés (66 ans vs 60, p 0,009) et plus fréquemment issus du secteur hospitalier (82 % vs 54 %, p < 0,0001). Ils justifiaient d’un recours accru aux transfusions (39 % vs 26 %, p 0,02) avec une tendance à un moindre recours à la ventilation (67 % vs 77 %, p 0,07). Leur mortalité en réanimation était superposable (20 % vs 19 %). Vingt-sept événements indésirables (38 %) ont été jugés évitables.
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: This study was funded by a grant from the Harvard Risk Management Foundation.

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Clinical research studyIatrogenic events resulting in intensive care admission: Frequency, cause, and disclosure to patients and institutions

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Background

Settings

Characteristics of patients

Discussion

Acknowledgements

Surgery

Lancet

JAMA

Incidence of iatrogenic drug events and potential iatrogenic drug eventsimplications for prevention

JAMA

Incidence of iatrogenic events and negligence in hospitalized patientsresults of the Harvard medical practice study

N Engl J Med

Deaths due to medical errors are exaggerated in Institute of Medicine report

JAMA

Estimating hospital deaths due to medical errorspreventability is in the eye of the reviewer

JAMA

Results of a clinical trial on care improvement for the critically ill

Critical Care Medicine

A new simplified acute physiology score (SAPS II) based on European/north American multicenter study

JAMA

The nature of iatrogenic events in hospitalized patients. Results of the Harvard medical practice study II

N Engl J Med

Hospital ownership and preventable iatrogenic events

J Gen Intern Med

Iatrogenic drug reactionsa critical review

JAMA

The role of iatrogenic medical disease in admission to intensive care

JAMA

Iatrogenic diseases as a reason for admission to the intensive care unitIncidence, causes, and consequences

Arch Intern Med

Finding common ground in the measurement of iatrogenic events

International Journal for Quality Health Care

Incidence and types of iatrogenic events and negligent care in Utah and Colorado in 1992

Med Care

Clinical research study
Iatrogenic events resulting in intensive care admission: Frequency, cause, and disclosure to patients and institutions