Errors in ICU: How Safe is the Patient? A Prospective Observational Study in a Tertiary Care Hospital

Abstract

Objective: Critically ill patients require high-intensity care and may be at especially high risk of iatrogenic injury because they are severely ill. We sought to study the incidence and nature of adverse events and serious errors in the critical care setting. Design: We conducted a prospective 12 month observational study. Incidents were collected with use of a multifaceted approach including direct continuous observation. The physicians independently assessed incident type, severity, its preventability as well as systems-related failures. Measurements and main results: The primary outcomes of interest were the incidence and rates of adverse events and serious errors per 1000 patient-days. A total of 242 patients were studied during 1190 patient-days. We found 60 adverse, including 33 (55%) non preventable and 27 (45%) preventable adverse events as well as 114 serious errors. The rates per 1000 patient-days for all adverse events, preventable adverse events, and serious errors were 80.5, 36.2, and 149.7, respectively. Among adverse events, 13% (8/60) were life-threatening or fatal; and among serious errors, 10% (12/114) were potentially life-threatening. Among all the errors whether adverse or serious errors, medication errors were the commonest (37.93%; 66/174). Conclusions: Adverse events and serious errors involving critically ill patients were common and often potentially life-threatening. Although many types of errors were identified, failure to carry out intended treatment correctly was the leading category.