Am J Respir Crit Care Med.

Selected Medical Errors in the ICU: Results of the IATROREF Study (Parts I and II).

Garrouste Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B,Tabah A, Charpentier J, Gontier O, Fieux F, Mourvillier B, Troché G, Reignier J, Dumay MF, Azoulay E, Reignier B, Carlet J, Soufir L.

RATIONALE: Although 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.

MEASUREMENT AND MAIN RESULTS. Fourteen types of MEs were selected as indicators; 1192 MEs were reported in 1369 patients, and 367 (26.8%) patients experienced at least one ME (2.1/1000 patient-days). The most common MEs were insulin administration errors (185.9/1000 days of insulin treatment). Of the 1192 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 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 for developing prevention programs. We have planned a study to assess a program based on our results.

PMID: 19875690 [PubMed - as supplied by publisher]