Published ahead of print on October 29, 2009, doi:10.1164/rccm.200812-1820OC A more recent version of this article appeared on November 12, 2009
Submitted on December 4, 2008 Selected Medical Errors in the ICU: Results of the IATROREF Study (Parts I and II)Maité Garrouste Orgeas1*,1 Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France; INSERM U823 "Outcome of cancers and critical illness", Albert Bonniot Institute, La Tronche CEDEX, France, 2 INSERM U823 "Outcome of cancers and critical illness", Albert Bonniot Institute, La Tronche CEDEX, France; Department of Biostatistics, Outcomerea, Grenoble, France; Medical ICU, Albert Michallon Teaching Hospital, Grenoble, France, 3 INSERM U823 "Outcome of cancers and critical illness", Albert Bonniot Institute, La Tronche CEDEX, France; Department of Biostatistics, Outcomerea, Grenoble, France, 4 Medical ICU, Albert Michallon Teaching Hospital, Grenoble, France, 5 Medical-Surgical ICU, Pays d'Aix Hospital, Aix en Provence, France, 6 Surgical ICU, Anesthesiology, Pain and Emergency Department, Caremeau Teaching Hospital Network, Nimes, France, 7 Medical ICU, Montpied Hospital, Clermont Ferrand, France, 8 Medical ICU, Cochin Teaching Hospital, Paris, France, 9 Medical-Surgical ICU, Pasteur Hospital, Chartres, France, 10 Surgical ICU, Saint Louis Teaching Hospital, Paris, France, 11 Medical ICU, Bichat Teaching Hospital, Paris, France, 12 Medical-Surgical ICU, Mignot Hospital, Le Chesnay, France, 13 Medical-Surgical ICU, Les Oudaries Hospital, La Roche Sur Yon, France, 14 Ile de France Regional Hospitalisation Agency, Paris, France, 15 Medical ICU, Saint Louis Teaching Hospital, Paris, France, 16 National Health Authority, Saint Denis, France, 17 Department of Anesthesiology, Saint Joseph Hospital Network, Paris, France * To whom correspondence should be addressed. E-mail: mgarrouste{at}hpsj.fr.
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. Measurements 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. Key words: intensive care unit • adverse event • iatrogenic event • quality indicator • medical error
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