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Patient Safety and Quality

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Medical and surgical intensive care unit patients suffer from similar types of safety problems and related harm

When it comes to safety problems in the intensive care unit (ICU), the similarity in medical issues faced by critically ill surgical or medical ICU patients may be more important than their differences, suggests the largest ICU safety report project to date. Researchers found that both medical and surgical ICU patients suffered from similar types of safety incidents and related harm. Also, most of these incidents were due to lack of training and teamwork.

The researchers analyzed 646 incidents involving adult medical patients and 707 incidents involving adult surgical patients at 20 ICUs. The incidents were reported to the voluntary and anonymous Web-based ICU Safety Reporting System from 2002 to 2004.

About 15 percent of incidents resulted in physical injury, 10 percent resulted in longer hospital stays (either expected or actual), 2 percent or fewer in death. Nurses reported more than 70 percent of incidents. About 80 percent of incidents were considered preventable and more than 40 percent caused harm. The incidents were reported to patients' family or friends in 18 percent of cases.

Problems related to communication, clinical management, and ICU management were factors in half of the safety incidents affecting both ICU groups. There were significant differences in only 3 of the 11 types of incidents between the 2 groups (Figure 1).

Incidents involving problems with equipment/devices and a line, tube, or drain were less common in medical versus surgical patients, whereas incidents related to computerized physician order entry were more common in medical patients. The study was supported by the Agency for Healthcare Research and Quality (HS11902).

More details are in "Intensive care unit safety incidents for medical versus surgical patients: A prospective multicenter study," by David Sinopoli, M.P.H., M.B.A., Dale M. Needham, M.D., Ph.D., David A. Thompson, D.N.Sc., M.S., and others, in the September 2007 Journal of Critical Care 22, pp. 177-183.

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