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Published in: BMC Health Services Research 1/2008

Open Access 01-12-2008 | Research article

The impact of adverse events in the intensive care unit on hospital mortality and length of stay

Authors: Alan J Forster, Kwadwo Kyeremanteng, Jon Hooper, Kaveh G Shojania, Carl van Walraven

Published in: BMC Health Services Research | Issue 1/2008

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Abstract

Background

Adverse events (AEs) are patient injuries caused by medical care. Previous studies have reported increased mortality rates and prolonged hospital length of stay in patients having an AE. However, these studies have not adequately accounted for potential biases which might influence these associations. We performed this study to measure the independent influence of intensive care unit (ICU) based AEs on in-hospital mortality and hospital length of stay.

Methods

Prospective cohort study in an academic tertiary-care ICU. Patients were monitored daily for adverse clinical occurrences. Data about adverse clinical occurrences were reviewed by a multidisciplinary team who rated whether they were AEs and whether they were preventable. We determined the association of AEs in the ICU with time to death and time to hospital discharge using multivariable survival analysis models.

Results

We evaluated 207 critically ill patients (81% required mechanical ventilation, median Glasgow Coma Scale = 8, median predicted mortality = 31%). Observed mortality rate and hospital length of stay were 25% (95% CI 19%–31%) and 15 days (IQR 8–34 days), respectively. ICU-based AEs and preventable AEs occurred in 40 patients (19%, 95% CI 15%–25%) and 21 patients (10%, 95% CI 7%–15%), respectively. ICU-based AEs and preventable AEs were not significantly associated with time to in-hospital death (HR = 0.93, 95% CI 0.44–1.98 and HR = 0.72 95% CI 0.25–2.04, respectively). ICU-based AEs and preventable AEs were independently associated with time to hospital discharge ((HR = 0.50, 95% CI 0.31–0.81 and HR = 0.46 95% CI 0.23–0.91, respectively)). ICU-based AEs were associated with an average increase in hospital length of stay of 31 days.

Conclusion

The impact of AEs on hospital length of stay was clinically relevant. Larger studies are needed to conclusively measure the association between preventable AEs and patient outcomes.
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Metadata
Title
The impact of adverse events in the intensive care unit on hospital mortality and length of stay
Authors
Alan J Forster
Kwadwo Kyeremanteng
Jon Hooper
Kaveh G Shojania
Carl van Walraven
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2008
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-8-259

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