Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II

Am J Respir Crit Care Med. 2010 Jan 15;181(2):134-42. doi: 10.1164/rccm.200812-1820OC. Epub 2009 Oct 29.


Rationale: Although intensive care units (ICUs) were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention.

Objectives: We describe the selection of indicator MEs, the incidence of such MEs, and their relationship with mortality.

Methods: We selected indicator MEs using Delphi techniques. An observational prospective multicenter cohort study of these MEs was conducted from March 27 to April 3, 2006, in 70 ICUs; 16 (23%) centers were audited. Harm from MEs was collected using specific scales.

Measurements and main results: Fourteen types of MEs were selected as indicators; 1,192 MEs were reported for 1,369 patients, and 367 (26.8%) patients experienced at least 1 ME (2.1/1,000 patient-days). The most common MEs were insulin administration errors (185.9/1,000 d of insulin treatment). Of the 1,192 medical errors, 183 (15.4%) in 128 (9.3%) patients were adverse events that were followed by one or more clinical consequences (n = 163) or that required one or more procedures or treatments (n = 58). By multivariable analysis, having two or more adverse events was an independent risk factor for ICU mortality (odds ratio, 3.09; 95% confidence interval, 1.30-7.36; P = 0.039).

Conclusions: The impact of medical errors on mortality indicates an urgent need to develop prevention programs. We have planned a study to assess a program based on our results.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Cross-Sectional Studies
  • Delphi Technique
  • Female
  • France
  • Hospital Mortality
  • Humans
  • Incidence
  • Insulin / administration & dosage
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Medical Audit
  • Medical Errors / adverse effects*
  • Medical Errors / mortality
  • Medical Errors / statistics & numerical data*
  • Medication Errors / adverse effects
  • Medication Errors / mortality
  • Medication Errors / statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Prospective Studies
  • Quality Indicators, Health Care
  • Safety Management


  • Insulin