title: The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care.
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.
  
  
  METHODS
  We conducted a prospective 1-year observational study. Incidents were collected with use of a multifaceted approach including direct continuous observation. Two physicians independently assessed incident type, severity, and preventability as well as systems-related and individual performance failures.
  
  
  METHODS
  Academic, tertiary-care urban hospital.
  
  
  METHODS
  Medical intensive care unit and coronary care unit patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  The primary outcomes of interest were the incidence and rates of adverse events and serious errors per 1000 patient-days. A total of 391 patients with 420 unit admissions were studied during 1490 patient-days. We found 120 adverse events in 79 patients (20.2%), including 66 (55%) nonpreventable and 54 (45%) preventable adverse events as well as 223 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% (16/120) were life-threatening or fatal; and among serious errors, 11% (24/223) were potentially life-threatening. Most serious medical errors occurred during the ordering or execution of treatments, especially medications (61%; 170/277). Performance level failures were most commonly slips and lapses (53%; 148/277), rather than rule-based or knowledge-based mistakes.
  
  
  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.
authors.affiliation: Divisions of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
authors.forename: John W
authors.initials: JW
authors.lastname: Cronin
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: Steven W
authors.initials: SW
authors.lastname: Lockley
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Burdick
authors.forename: Peter H
authors.initials: PH
authors.lastname: Stone
authors.forename: Craig M
authors.initials: CM
authors.lastname: Lilly
authors.forename: Joel T
authors.initials: JT
authors.lastname: Katz
authors.forename: Charles A
authors.initials: CA
authors.lastname: Czeisler
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000368:Aged; D001900:Boston / Q000453:epidemiology; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology* / Q000517:prevention & control; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008875:Middle Aged; D011446:Prospective Studies; D012308:Risk Management; D018709:Statistics, Nonparametric; D013812:Therapeutics / Q000009:adverse effects*