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78 PART 1: An Overview of the Approach to and Organization of Critical Care

TABLE 12-1 Summary of Studies Reporting Adverse Events in Hospitalized Patients
Reference(s) and Year of Inception Study Population Definition of Adverse Events Major Findings
Schimmel 1960-1961 1014 patients admitted over 8 months to a Every noxious response to medical care occurring 20% suffered iatrogenic injury
2
university-affiliated hospital among patients…resulting from acceptable diagnos- 6.7% of adverse events resulted in death
tic and therapeutic measures deliberately instituted
at the hospital LOS in those with noxious events was 28.7 days
compared with 11.4 days in other patients
3
Leape et al, 1984 30,195 patients in 51 hospitals in New York Unintended injury that was caused by medical man- 3.7% incidence of adverse events
agement that resulted in measurable disability 47.7% associated with operation
Drug error, wound infection, and technical
complication responsible for 45.9% of events
4
Thomas et al, 1992 14,700 patients in 28 hospitals in Utah and Injury caused by medical management rather than by 2.9% incidence of adverse events
Colorado the disease process and resulted in prolonged LOS or 6.6% of adverse events resulted in death
disability at discharge
44.9% were due to operative events
5
Andrews et al, 1989-1990 1047 patients from 3 units of a university Situations in which an inappropriate decision was 17.7% suffered at least one adverse event
teaching hospital in the United States made when, at the time, an appropriate alternative Increased events in those with long stays
could have been chosen
37.8% due to an individual
9.8% due to administrative decisions
Wilson et al, 1992 14,179 patients in 28 hospitals in New Unintended injury or complication that resulted in 16.6% incidence of adverse events
6
South Wales and South Australia disability, death, or prolonged hospital stay and was 51% had high preventability
caused by the health care management rather than
by the underlying disease process 13.7% resulted in permanent disability
4.9% resulted in death
Resulted in 7.1 day increased LOS
7
Davis et al, 1998 6579 patients in 13 New Zealand hospitals Same as the study by Wilson et al 12.9% incidence of adverse events
with more than 100 beds 37% preventable to a significant degree
15% associated with permanent disability or death
Resulted in 9-day increased LOS
57.5% associated with surgery
8
Vincent et al, 1999-2000 1014 patients in 2 London hospitals Unintended injury that was caused by medical man- 10.8% incidence of adverse events
agement rather than the disease process 48% preventable
Baker et al, 2000 3745 patients in 20 Canadian hospitals Same as the study by Wilson et al 7.5% incidence of adverse events
9
36.9% preventable
10
Bellomo et al, 1998-1999 1125 patients undergoing major surgery in Specific criteria for 11 predefined adverse events 16.9% incidence of serious adverse events
a university teaching hospital 20% mortality in patients over 75 undergoing
unscheduled surgery
LOS, length of stay.
Data from Baker GR, Norton PG, Flintoft V, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients with Canada. CMAJ. May 25, 2004;170(11):1678-1686.

TABLE 12-2 Summary of Studies Reporting Antecedents to Serious Adverse Events and In-Hospital Cardiopulmonary Arrests
Reference and Year of Inception Study Population and Setting Method of Assessment Major Findings
Bedell et al, 1981 203 cardiac arrests Iatrogenic arrest defined as an arrest that 14% followed an iatrogenic complication
11
(Most arrests were in medical patients) resulted from a therapy or procedure or Iatrogenic arrests less likely to have cardiogenic shock or
Boston Beth Israel Hospital from a clearly identified error of omission myocardial infarction before arrest
Review by three independent internists 64% of iatrogenic arrests associated with inadequate
clinical assessment, medication errors, and suboptimal
response to symptoms (dyspnea and tachypnea)
15
Schein et al, Jul-Oct 1987 64 consecutive cardiopulmonary arrests Only included arrests in ward patients Arrest occurred 161 ± 26 h postadmission
(age 51 ± 2 years) Assessment of charts for vital signs, medi- 84% had documented deterioration or new complaint
Jackson Memorial hospital (1200-bed cal and nursing notes during the 8 hours within 8 hours of the arrest
university teaching hospital) before the arrest Frequency of alteration were respiratory > multiple >
The patients’ underlying condition was cardiac > neurologic
classified as rapidly fatal, ultimately fatal, Prognosis of underlying disease nonfatal in 36%
or nonfatal
(Continued)

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