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KEY POINTS
The ICU can be a dangerous place for patients.
Many ICU patients experience hospital acquired infections, medication errors, and procedure related complications.
Complications increase morbidity and mortality.
ICU complications may be preventable with structured patient handoffs, use of computerized physician order entry, good hand hygiene, ultrasound guidance for procedures, remote ICU monitoring, use of checklists and standardized treatment protocols.
When an error occurs, physicians should disclose the error, document the error in the record and promptly treat any complications arising from it.
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Hospitals are a dangerous place. Experts estimate that nearly 100,000 people die every year from medical errors that occur in hospitals, more than die from breast cancer, AIDS or car accidents. The ICU is especially challenging. There are multiple medical personnel including the primary ICU team and usually one or more consultants caring for patients. Critically ill patients are treated with multiple medications and often undergo procedures, thereby increasing the risk for adverse events and drug interactions. Recent trends in medical education have reduced the number of hours that house officers can work each week thereby increasing the number of handoffs, creating more opportunities for communication failures.
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In this increasingly complex environment, there will be complications. The stakes are high. Complications increase morbidity and mortality in the critically ill. Furthermore, they erode public trust in physicians and the medical system as a whole. As a result, physicians may experience stress and loss of confidence in an increasingly complex medical system. One study estimated two serious errors per day for a 10-bed critical care unit. Medication errors accounted for 78% of the serious errors in this study.1 Medical error is generally defined as the failure of a planned action to be completed as intended (eg, error of execution) or the use of a wrong plan to achieve an aim (eg, error of planning) and an adverse event as an injury caused by a medical intervention rather than the underlying condition of the patient.2 A recent study reported 1,192 medical errors for 1,369 patients; 27% of patients experienced at least one medical error. Patients experiencing two or more adverse events had a threefold increase in overall mortality.3
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The landmark report “To Err is Human” published by the Institute of Medicine highlighted the magnitude of the problem and the far reaching cost of medical error. The report heralded an era of patient safety and the development of quality initiatives for the care of hospitalized patients, especially patients in the ICU.2 Critically ill patients are subject to intensive therapies that are most often associated with highest risk and therefore untoward events. This chapter describes common ICU complications and risk mitigation strategies.
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HOSPITAL-ACQUIRED INFECTIONS
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Hospital acquired infections (HAIs) are a frequent complication of intensive care accounting for prolonged intensive care unit (ICU) length of stay, morbidity, suffering, ...