Health Services ResearchIntensive care unit safety incidents for medical versus surgical patients: A prospective multicenter study☆
Introduction
Patient safety incidents and medical errors occur frequently [1], [2], [3], [4], [5]. A prospective examination of surgical patients [6] discovered that complication rates may be 2 to 4 times higher than previously described [3], and suggested that almost half of incidents were preventable. Many reports also demonstrate that medical patients are subject to injury from preventable errors [7], [8], [9]. Although previous patient safety studies have focused on specific types of incidents (eg, adverse drug events [10], [11], [12]) or care settings (eg, intensive care units [ICUs]) [13], [14], little research has directly compared incidents involving medical versus surgical patients. Given differences in admitting diagnoses, hospital treatment, and organizational culture within hospital units [15], safety incidents may systematically differ for medical versus surgical patients. A comparison of incidents between these 2 patient groups may help clinicians design safety evaluations and interventions that are most appropriate for these different patient populations.
The ICU is a highly complex environment [16] that cares for both medical and surgical patients. This setting provides an important opportunity to evaluate patient safety [1], [14], [17]. Contemporary patient safety research focuses on the role that systems, rather than specific individuals, play in contributing to, limiting, and preventing safety incidents [17], [18], [19], [20]. The objective of this study was to compare these contributing, limiting, and preventive system factors associated with safety incidents for medical versus surgical patients in ICUs, and to compare the characteristics and type of patient harm associated with these incidents. We hypothesize that there are significant differences between medical and surgical ICU patients in the type of safety incidents, and the associated harm and system factors.
Section snippets
Methods
This research was conducted using prospective patient safety reports from a voluntary, anonymous, Web-based ICU Safety Reporting System (ICUSRS). This study focused on incidents reported to the ICUSRS from July 1, 2002, to June 30, 2004. During this time, 20 adult ICUs (3 medical, 10 surgical, 7 medical-surgical) located primarily in the northeastern, midatlantic, and southern United States reported patient safety incident data to the ICUSRS. Of the 20 participating ICUs, 19 were at teaching
Results
A total of 1582 incidents involving adult patients were reported to the ICUSRS. We excluded 195 (12.3%) reports for which patient surgical status was unavailable, and 34 (2.1%) potentially duplicate reports. There were no significant differences in the excluded versus included group of incidents with respect to patient or incident characteristics, patient harm, type of incident, or associated system factors. The final data set included 646 (48%) and 707 (52%) events involving adult medical and
Discussion
This multicenter prospective study comparing 1353 patient safety incidents in critically ill medical versus surgical patients demonstrated great similarity in patient and incident characteristics, harm, and associated system factors between these 2 distinct patient groups.
Our findings were contrary to the hypothesis that such factors would differ for medical versus surgical ICU patients. Because little prior research had been done to address this specific question, we based our hypothesis on
Acknowledgments
We thank Maureen Fahey and Fern Dickman for their assistance with database issues.
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Cited by (0)
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This study was funded by the Agency for Healthcare Research and Quality (grant no. U18HS11902). Analyses were performed at The Johns Hopkins University School of Medicine and Bloomberg School of Public Health.
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Supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research.