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Iatrogenic illness in a department of general internal medicine: a prospective study
Abstract:
The incidence and causes of iatrogenic illness in a department of internal medicine were studied prospectively in 1,176 patients admitted from 1 January 1986 to 31 December 1986. A total of 295 patients (25.1%) developed 367 episodes of iatrogenic illness. Phlebitis occurred most frequently (75.2% of all iatrogenic events), followed by drug reactions (10.7%), contusion (4.6%), and urinary tract infections (1.4%). Nineteen patients developed life-threatening events (in 2 it was the cause of death). Etiologic agents included intravenous catheter (79% of all adverse reactions), drugs (9.5%), falls from bed (5.4%), diagnostic procedures (3.3%), and urinary catheterization (1.6%). Risk factors associated with iatrogenic illness were hospital stay longer than 12 days, female sex, poor general medical status on admission, intravenous catheterization, and intravenously administered antibiotics and anticoagulants. We conclude that in our hospital (a) 25% of the inpatient admissions to the general medicine service resulted in iatrogenic illness, (b) most iatrogenic illnesses were not severe (phlebitis), but 2 of 19 patients with life-threatening events died, and (c) the probability of developing iatrogenic illness generally depended on long hospital stay, poor general status at admission, and the use of both intravenous catheters and medication. In our patients, a reduction of hospital stay and a rational limitation of these procedures may diminish the rate of complications.
Insights
Approximately 25% of internal medicine patients experienced iatrogenic illness, primarily phlebitis from intravenous catheters. Reducing hospital stays and limiting invasive procedures can decrease these preventable complications.
Area of Science:
- Internal Medicine
- Patient Safety
- Hospital-Acquired Conditions
Background:
- Iatrogenic illnesses are a significant concern in healthcare settings.
- Understanding the incidence and causes of these events is crucial for improving patient outcomes.
Purpose of the Study:
- To prospectively investigate the incidence, causes, and risk factors of iatrogenic illness in internal medicine patients.
- To identify specific interventions that could reduce the rate of iatrogenic complications.
Main Methods:
- Prospective study of 1,176 internal medicine admissions over one year.
- Detailed recording of all iatrogenic events, their causes, and patient outcomes.
- Analysis of risk factors associated with developing iatrogenic illness.
Main Results:
- 25.1% of patients (295/1,176) developed 367 episodes of iatrogenic illness.
- Phlebitis (75.2%) and drug reactions (10.7%) were the most common events.
- Intravenous catheters (79%) were the leading cause; prolonged hospital stay, poor admission status, and invasive devices/medications were key risk factors.
Conclusions:
- Iatrogenic illness affects a substantial portion of internal medicine inpatients.
- While many events are minor (e.g., phlebitis), some can be life-threatening.
- Strategies focusing on reducing hospital stay and judicious use of invasive procedures and medications are recommended to mitigate risks.