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Iatrogenic adverse events in the coronary care unit
Sherali A Rahim1, Anita Mody, Jennifer Pickering
1Division of Cardiology, Department of Medicine, and the Cardiac and Vascular Program, McMaster University, Hamilton, Ontario, Canada. sherali.rahim@utoronto.ca
Insights
Iatrogenic adverse events (IAEs) are frequent in coronary care units (CCUs), with over half of patients experiencing them. Many of these events, particularly bleeding, are preventable, highlighting a need for improved patient safety protocols in CCUs.
Area of Science:
- Cardiology
- Patient Safety
- Medical Quality Improvement
Background:
- Iatrogenic adverse events (IAEs) are a significant concern in healthcare.
- Little is known about the frequency and preventability of IAEs specifically within coronary care units (CCUs).
Purpose of the Study:
- To determine the incidence of iatrogenic adverse events (IAEs) in a tertiary care coronary care unit (CCU).
- To assess the potential preventability of identified IAEs.
Main Methods:
- Retrospective cohort study of 194 consecutive patients admitted to the CCU.
- Utilized a priori defined criteria to identify IAEs and assess preventability.
Main Results:
- 51% of patients experienced at least one IAE.
- 45% of IAEs were deemed potentially preventable, with bleeding being the most common (27%).
- IAEs were causally related to death in 53% of deceased patients, with 67% of these being preventable.
Conclusions:
- IAEs, particularly bleeding, are common in CCUs and occur more frequently than recurrent ischemic events.
- Findings underscore the need for multicenter studies to further investigate IAEs in CCUs and develop targeted interventions.
Background:
Although our understanding of medical adverse events has increased substantially over the last decade, little is known about iatrogenic adverse events (IAEs) in the coronary care unit (CCU). We sought to determine the frequency and potential preventability of IAEs in the CCU of a tertiary care center.
Methods And Results:
We undertook a retrospective cohort study evaluating the hospital charts of consecutive patients admitted to the CCU at Hamilton General Hospital (Ontario, Canada) from November 1, 2005, to January 1, 2006. We used a priori developed definitions to determine whether patients suffered an IAE and whether it was potentially preventable. We included 194 patients, and 99 (51%; 95% CI, 44% to 58%) patients had at least 1 IAE, of which 45 (45%; 95% CI, 36% to 55%) were judged potentially preventable. Bleeding (14/51, 27%; 95% CI, 17% to 41%) was the most common potentially preventable IAE and was more common than recurrent ischemic events (4/51, 8%; 95% CI, 3% to 19%). Of the patients who died in the hospital, 9 of 17 (53%; 95% CI, 31% to 74%) had an IAE that was causally related to their death, of which 6 (67%; 95% CI, 35% to 88%) were judged potentially preventable.
Conclusions:
The present study suggests that IAEs, especially bleeding, are common in the CCU setting and more frequent than recurrent ischemic events. These results suggest the need for large multicenter studies to evaluate in CCUs the rates of IAEs, their causes, and potential preventability.
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