Zeggwagh Amine Ali, Mouad Houda, Dendane Tarek, Abidi Khalid, Belayachi Jihane, Madani Naoufel, Abouqal Redouane
Medical Intensive Care Unit, Hospital Ibn Sina of Rabat, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Souissi, Rabat, Morocco.
Indian J Crit Care Med. 2014 Feb;18(2):88-94. doi: 10.4103/0972-5229.126078.
To determine the incidence and characteristics of preventable in-ICU deaths.
A one-year observational study was conducted in a medical ICU of a teaching hospital. All patients who died in medical ICU beyond 24 h were analyzed and reviewed during daily medical meeting. A death was considered preventable when it would not have occurred if the patient had received ordinary standards of care appropriate for the time of study. Preventability of death was classified by using a 1-6 point preventability scale. The types of medical errors causing preventable in-ICU deaths and the contributory factors to deaths were identified.
120 deaths (47 ± 19 years, 57 months-63 weeks) were analyzed (mortality: 23%; 95% confidence interval (CI):15-31%). At admission, Acute Physiology and Chronic Health Evaluation (APACHE) II score was 18 ± 7.6 and Charlson comorbidity index was 1.3 ± 1.6. The main diagnosis was infectious disease (57%) and respiratory disease (23%). The median period between the ICU admission and death was 5 days. The rate of preventable in-ICU deaths was 14.1% (17/120). The most common medical errors related to occurrence of preventable in-ICU deaths were therapeutic error (52.9%) and inappropriate technical procedure (23.5%). The preventable in-ICU deaths were associated with inadequate training or supervision of clinical staff (58.8%), no protocol (47.1%), inadequate functioning of hospital departments (29.4%), unavailable equipment (23.5%), and inadequate communication (17.6%).
According to our study, one to two in-ICU deaths would be preventable per month. Our results suggest that the implementation of supervision and protocols could improve outcomes for critically ill patients.
确定重症监护病房（ICU）可预防死亡的发生率及特征。
在一家教学医院的内科ICU进行了为期一年的观察性研究。对所有入住内科ICU超过24小时后死亡的患者在每日医疗会议期间进行分析和回顾。如果患者接受了符合研究当时普通标准的护理就不会发生死亡，则该死亡被视为可预防的。使用1 - 6分的可预防性量表对死亡的可预防性进行分类。确定导致ICU内可预防死亡的医疗差错类型及死亡的促成因素。
分析了120例死亡病例（年龄47±19岁，57个月至63周）（死亡率：23%；95%置信区间（CI）：15 - 31%）。入院时，急性生理与慢性健康状况评估（APACHE）II评分为18±7.6，查尔森合并症指数为1.3±1.6。主要诊断为传染病（57%）和呼吸系统疾病（23%）。入住ICU至死亡的中位时间为5天。ICU内可预防死亡的发生率为14.1%（17/120）。与ICU内可预防死亡发生相关的最常见医疗差错为治疗差错（52.9%）和不适当的技术操作（23.5%）。ICU内可预防死亡与临床工作人员培训或监督不足（58.8%）、无方案（47.1%）、医院科室运作不充分（29.4%）、设备不可用（23.5%）以及沟通不足（17.6%）有关。
根据我们的研究，每月有1至2例ICU内死亡是可预防的。我们的结果表明，实施监督和方案可改善危重症患者的预后。
