title: Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II.
abstract: BACKGROUND
  Although intensive care units (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.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  Fourteen types of MEs were selected as indicators; 1,192 MEs were reported for 1,369 patients, and 367 (26.8%) patients experienced at least 1 ME (2.1/1,000 patient-days). The most common MEs were insulin administration errors (185.9/1,000 d of insulin treatment). Of the 1,192 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 that 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 to develop prevention programs. We have planned a study to assess a program based on our results.
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France. mgarrouste@outcomerea.org
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Jean François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Aurelien
authors.initials: A
authors.lastname: Vesin
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.forename: Patrick
authors.initials: P
authors.lastname: Arnodo
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Lefrant
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Alexis
authors.initials: A
authors.lastname: Tabah
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Olivier
authors.initials: O
authors.lastname: Gontier
authors.forename: Fabienne
authors.initials: F
authors.lastname: Fieux
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Gilles
authors.initials: G
authors.lastname: Troché
authors.forename: Jean
authors.initials: J
authors.lastname: Reignier
authors.forename: Marie Françoise
authors.initials: MF
authors.lastname: Dumay
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Bernard
authors.initials: B
authors.lastname: Reignier
authors.forename: Jean
authors.initials: J
authors.lastname: Carlet
authors.forename: Lilia
authors.initials: L
authors.lastname: Soufir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003697:Delphi Technique; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D019300:Medical Errors / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D017751:Safety Management
chemical_list: D007328:Insulin