Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 18 , ISSUE 2 ( February, 2014 ) > List of Articles


Preventability of death in a medical intensive care unit at a university hospital in a developing country

Houda Mouad, Jihane Belayachi, Naoufel Madani, Redouane Abouqal

Keywords : Adverse events, intensive care unit, medical errors, patient safety, preventable mortality

Citation Information : Mouad H, Belayachi J, Madani N, Abouqal R. Preventability of death in a medical intensive care unit at a university hospital in a developing country. Indian J Crit Care Med 2014; 18 (2):88-94.

DOI: 10.4103/0972-5229.126078

License: CC BY-ND 3.0

Published Online: 01-02-2014

Copyright Statement:  Copyright © 2014; The Author(s).


Objective: To determine the incidence and characteristics of preventable in-ICU deaths. Materials and Methods: 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. Results: 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%). Conclusion: 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.

PDF Share
  1. Gore DC. National survey of surgical morbidity and mortality conferences. Am J Surg 2006;191:708-14.
  2. Wilson RM, Michel P, Olsen S, Gibberd RW, Vincent C, El-Assady R, et al. WHO Patient Safety EMRO/AFRO Working Group. Patient safety in developing countries: Retrospective estimation of scale and nature of harm to patients in hospital. BMJ 2012;344:e832.
  3. Croskerry P, Sinclair D. Emergency medicine: A practice prone to error. CJEM 2001;3:271-6.
  4. Hevia A, Hobgood C. Medical error during residency: To tell or not to tell. Ann Emerg Med 2003;42:565-70.
  5. Ksouri H, Balanant PY, Tadié JM, Heraud G, Abboud I, Lerolle N, et al. Impact of morbidity and mortality conferences on analysis of mortality and critical events in intensive care practice. Am J Crit Care 2010;19:135-45.
  6. Dijkema LM, Dieperink W, van Meurs M, Zijlstra JG. Preventable mortality evaluation in the ICU. Crit Care 2012;16:309.
  7. Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust 1995;163:458-71.
  8. Beckmann U, Bohringer C, Carless R, Gillies DM, Runciman WB, Wu AW. Evaluation of two methods for quality improvement in intensive care: Facilitated incident monitoring and retrospective medical chart review. Crit Care Med 2003;31:1006-11.
  9. Dubois RW, Brook RH. Preventable deaths: Who, how often, and why? Ann Intern Med 1988;109:582-9.
  10. Coimbra R, Razuk A, Pinto MC, Aguida HC, Saad R Jr, Rasslan S. Severely injured patients in the intensive care unit: A critical analysis of outcome and unexpected deaths identified by TRISS methodology. Int Surg 1996;81:102-6.
  11. Lu TC, Tsai CL, Lee CC, Ko PC, Yen ZS, Yuan A, et al. Preventable deaths in patients admitted from emergency department. Emerg Med J 2006;23:452-5.
  12. Davis JW, Hoyt DB, McArdle MS, Mackersie RC, Eastman AB, Virgilio RW, et al. An analysis of errors causing morbidity and mortality in a trauma center system: A guide for quality improvement. J Trauma 1992;32:660-5.
  13. Teixeira PG, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma 2007;63:1338-46.
  14. Michel P, Quenon JL, de Sarasqueta AM, Scemama O. Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals. BMJ 2004;328:199.
  15. Brennan TA, Gawande A, Thomas E, Studdert D. Accidental deaths, saved lives and improved quality. N Engl J Med 2005;353:1405-9.
  16. Kopp BJ, Erstad BL, Allen ME, Theodorou AA, Priestley G. Medication errors and adverse drug events in an intensive care unit: Direct observation approach for detection. Crit Care Med 2006;34:415-25.
  17. Rowell KS, Turrentine FE, Hutter MM, Khuri SF, Henderson WG. Use of national surgical quality improvement program data as a catalyst for quality improvement. J Am Coll Surg 2007;204:1293-300.
  18. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events: Implications for prevention. JAMA 1995;274:29-34.
  19. Andrews LB, Stocking C, Krizek T, Gottlieb L, Krizek C, Vargish T, et al. An alternative strategy for studying adverse events in medical care. Lancet 1997;349:309-13.
  20. Leape LL. Institute of Medicine medical error figures are not exaggerated. JAMA 2000;284:95-7.
  21. Meurer LN, Yang H, Guse CE, Russo C, Brasel KJ, Layde PM. Excess mortality caused by medical injury. Ann Fam Med 2006;4:410-6.
  22. Walshe K. Adverse events in health care: Issues in measurement. Qual Health Care 2000;9:47-52.
  23. Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000;38:261-71.
  24. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. CMAJ 2004;170:1678-86.
  25. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard medical practice study I. Qual Saf Health Care 2004;13:145-52.
  26. Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: Preventability is in the eye of the reviewer. JAMA 2001;286:415-20.
  27. Rothschild JM, Landrigan CP, Cronin JW, Kaushal R, Lockley SW, Burdick E, et al. The critical care safety study: The incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med 2005;33:1694-700.
  28. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101-14.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.