Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II.
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.
Garrouste-Orgeas
Maité
M
Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France. mgarrouste@outcomerea.org
Timsit
Jean François
JF
Vesin
Aurelien
A
Schwebel
Carole
C
Arnodo
Patrick
P
Lefrant
Jean Yves
JY
Souweine
Bertrand
B
Tabah
Alexis
A
Charpentier
Julien
J
Gontier
Olivier
O
Fieux
Fabienne
F
Mourvillier
Bruno
B
Troché
Gilles
G
Reignier
Jean
J
Dumay
Marie Françoise
MF
Azoulay
Elie
E
Reignier
Bernard
B
Carlet
Jean
J
Soufir
Lilia
L
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
D007328:Insulin