Missed recognition of early signs of clinical deterioration can result in transfer to the intensive care unit (ICU) or death. This study investigated whether critical illness events (transfer to ICU or death) impacted another patient's critical illness event in the subsequent six-hour period. Results suggest one or more critical illness events increase the odds of additional patient transfers into the ICU, but not of death. The authors present several explanations for this phenomenon.

Researchers in this multicenter cohort study found that 19% of patients experienced an adverse event during the transition from the intensive care unit (ICU)  to the hospital ward, with most (62%) occurring within three days of transfer. Compared to patients who did not experience an adverse events, those with adverse events were at increased risk for negative outcomes including ICU readmission, increased length of stay and inpatient morality. Approximately one-third (36%) of these events were deemed preventable by the research team.

Discordance between patient preferences for end-of-life care and documentation of their wishes is a common problem in hospitals. Such events have been described as silent misdiagnoses and may be classified as medical errors. This audit study across 16 hospitals in Canada quantified how often medical orders for life-sustaining treatments do not match patient preferences. Only 2% of patients who reported a preference for cardiopulmonary resuscitation (CPR) had CPR withheld in their medical orders; whereas, 35% of patients who wished to forgo CPR had orders to receive it in the event of an arrest. This mismatch represents a considerable source of potential overtreatment, which may result in numerous adverse downstream effects. A previous WebM&M commentary discussed tools for eliciting end-of-life preferences.

… BMJ quality & safety … BMJ Qual Saf … There is a consensus in the safety field that organizations must use … should consider formal review of RRS activation as a trigger for identifying adverse events. …

… journal of respiratory and critical care medicine … Am J Respir Crit Care Med … This study revealed that … The authors suggest that an independent assessment by a second physician may mitigate cognitive errors . …

A positive safety culture has been linked to improved staff satisfaction as well as a lower incidence of errors. This study, conducted in 23 Canadian intensive care units (ICUs), sought to examine the relationship between safety culture and families' satisfaction with care. The authors found a strong positive correlation between safety culture and family satisfaction with care among a subset of patients who had prolonged and ultimately fatal ICU stays. This finding implies that families of patients who have lengthy hospitalizations are affected by the safety and organizational culture of the units where their loved ones are being cared for and that improving safety culture may also improve patient and family satisfaction with care.

This survey of Canadian intensive care units found that larger units and units directed by full-time intensivists had more positive safety culture scores.

In this study, clinicians were notified in real time about critical lab test abnormalities and provided with immediate decision support. However, this intervention did not prevent adverse events attributable to the critical test results, nor did it seem to result in more timely management.

A multifaceted intervention resulted in increased voluntary reporting of safety incidents in two intensive care units.

This study determined that standardized order sets and dedicated consultation services are associated with less variability in the prescribing of best practices.

Medical emergency teams (also referred to as rapid response teams or critical care outreach teams) are being widely implemented in the US and worldwide. However, their effect on clinical outcomes remains controversial, as a prior commentary found no conclusive evidence of benefits. This systematic review found that most studies of medical emergency teams were of such poor methodologic quality that their results could not be generalized. Only two prospective controlled studies of outreach teams were identified, which demonstrated mixed results on patient outcomes.

… that patients discharged to another unit at night had a higher risk of mortality than those discharged during the day. … Priestap FA, Martin CM. Impact of intensive care unit discharge time on …