Elsevier

Journal of Critical Care

Volume 19, Issue 3, September 2004, Pages 158-164
Journal of Critical Care

Interventions to reduce mortality among patients treated in Intensive Care Units

https://doi.org/10.1016/j.jcrc.2004.07.003Get rights and content

Abstract

Purpose: Using sensitivity analysis to estimate the impact, in terms of patient lives, of the failure to use proven therapies known to reduce mortality in critically ill intensive care unit patients.

Materials and Methods: We identified high-impact interventions published in the last 5 years in the Journal of the American Medical Association or New England Journal of Medicine, extracted the absolute risk reduction associated with each intervention and gleaned the national incidence of each condition and the percent of the population not receiving the cited therapy from the literature. From this information, we calculated national estimates of the excess deaths from failure to use these therapies.

Results: With consistent and appropriate implementation of the 5 cited evidence-based interventions, we found a total of 167,819 lives could be saved per year, with a range of 137,670 to 197,965 lives saved per year.

Conclusions: Mistakes of omission are common in the critical care setting and lead to significant preventable mortality. There is a significant gap between the discovery of effective interventions and their use in clinical practice. By viewing the delivery of healthcare as a science and increasing funding for health services research, we may be able to increase the use of effective therapies and, as a result, reduce patient mortality.

Section snippets

Study design

To achieve our aims, we conducted a literature review. We identified interventions published in the Journal of the American Medical Association or the New England Journal of Medicine estimated how often people in the United States received these therapies, and calculated national estimates of the excess deaths from failure to use these therapies. Our goal was not to identify every intervention known to improve mortality in critically ill patients but rather to identify significant interventions

Results

Our literature review identified 89 abstracts and we included 5 studies (4 randomized trials and 1 systematic review) in our analysis that met inclusion criteria and are widely accepted.16, 20, 29 We summarize these studies in Table 1.

Table 2 lists the number of patients at risk in the United States, the percentage of patients not receiving a given intervention, the number of patients needed to treat in order to prevent 1 death, and the preventable deaths in the United States annually. Our

Discussion

The Institute of Medicine report “To Err is Human” suggested between 44,000 and 98,000 people die each year in the United States because of medical errors.33 These estimates are based in general on mistakes of commission, things caregivers do to patients, and did not include mistakes of omission– the failure to use therapies we ought to. Our study suggests that mistakes of omission may pose a much greater threat to patient safety. We found that consistent and appropriate implementation of 5

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    P. J. P. is supported by a grant from the VHA Foundation to develop measures of quality sepsis care. S. B. is supported by a grant from VHA Foundation for Sepsis Measures.

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