Elsevier

Journal of Critical Care

Volume 22, Issue 3, September 2007, Pages 177-183
Journal of Critical Care

Health Services Research
Intensive care unit safety incidents for medical versus surgical patients: A prospective multicenter study

https://doi.org/10.1016/j.jcrc.2006.11.002Get rights and content

Abstract

Purpose

The aim of this study is to determine if patient safety incidents and the system-related factors contributing to them systematically differ for medical versus surgical patients in intensive care units.

Materials and Methods

We conducted a multicenter prospective study of 646 incidents involving adult medical patients and 707 incidents involving adult surgical patients that were reported to an anonymous patient safety registry over a 2-year period. We compared incident characteristics, patient harm, and associated system factors for medical versus surgical patients.

Results

The proportion of safety incidents reported for medical versus surgical patients differed for only 3 of 11 categories: equipment/devices (14% vs 19%; P = .02), “line, tube, or drain” events (8% vs 13%; P = .001), and computerized physician order entry (13% vs 6%; P ≤ .001). The type of patient harm associated with incidents also did not differ. System factors were similar for medical versus surgical patients, with training and teamwork being the most important factors in both groups.

Conclusions

Medical and surgical patients in the intensive care unit experience very similar types of safety incidents with similar associated patient harm and system factors. Common initiatives to improve patient safety for medical and surgical patients should be undertaken with a specific focus on improving training and teamwork among the intensive care team.

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)

    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.

    1

    Supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research.

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