Exploring unplanned ICU admissions: a systematic review.

Area of Science:

• Healthcare quality and safety research
• Patient safety and risk management
• Critical care medicine and epidemiology

Background:

• Adverse events (AEs) are unintended patient injuries from healthcare, potentially causing death, disability, or prolonged hospitalization.
• AEs requiring critical care represent a significant financial burden on healthcare systems.
• Medical record review is a recognized method for identifying AEs.

Purpose of the Study:

• To synthesize evidence on the incidence and preventability of AEs necessitating intensive care unit (ICU) admission.
• To determine the types of AEs, patient harm, mortality, ICU length of stay, and direct medical costs associated with these events.

Main Methods:

• A systematic literature search of MEDLINE, EMBASE, and CENTRAL databases was conducted.
• Additional studies were sourced from grey literature, conference proceedings, and reference lists.
• Quantitative studies using chart review to detect AEs leading to ICU admission were included.

Main Results:

• 27 studies were reviewed, with meta-analysis deemed inappropriate due to heterogeneity.
• The incidence of AEs leading to ICU admission ranged from 1.1% to 37.2%.
• Preventability rates varied widely (17%–76.5%), with consequences including prolonged ICU stays (1.5–10.4 days) and significant mortality (0%–58%).

Conclusions:

• AEs are a significant cause of ICU admissions, but robust estimates of incidence and preventability are lacking.
• Methodological variability and poor reporting contribute to study heterogeneity.
• Further research with standardized measures is needed to improve understanding and prevention of AEs in critical care settings.