Eventos adversos como motivo de ingreso en la Unidad de Medicina Intensiva. Plan de calidad en la Unidad de Medicina Intensiva del Hospital San Pedro de Logroño

Résumé

To know the incidence of adverse events (AE) as a cause of admission to a Second Level Intensive Care Unit (ICU), analyzing the cause that originated it and the place of origin. Know the incidence of preventable events, and analyze the prevention mode. Know the survival upon discharge from the ICU, upon discharge from the hospital, at six months and a year. Calculate the overall cost per patient. Material and Methods. Observational, descriptive study, with retrospective information collection, at the ICU of San Pedro Hospital (SPH) of Logroño. We reviewed 4,855 medical records from July 15, 2010 to July 15, 2015, selecting 455 in which it was described that the reason for admission was an AE. Results. The incidence of AE as a reason for admission to the ICU was 9.4%. It happened more often in men in the 70s. The most frequent place of origin of these patients was the SPH, and the service most involved was the General Surgery Service, both in the hospital ward and in the operating room. In the outpatient setting, it was the cardiological AEs that most frequently motivated the care in the Emergency Department. The most frequent major AEs were those classified as "complications related to surgery", highlighting among them the "hemorrhage associated with the procedure". The most involved surgical intervention was cholecystectomy. The second main AE was the "AE related to medication". Of these, adverse reactions were the most frequent AE, highlighting cerebral hemorrhages. Acenocoumarol was involved in a large part of this AE causing 23.9% of the deaths of this study, in ICU. AEs secondary to treatments with antiarrhythmics and / or beta-blockers occurred more frequently in patients ≥ 80 years of age. AEs due to metformin are very rare but carry a high mortality. The AEs related to a "diagnostic error" and with category I severity were the most frequent among the no doubt preventable AEs. The total DRG estimate of the cost of the AE was 4,112,233.4 €. Diseases and disorders of the digestive system were the DRG with the highest cost, representing 37% of the total. 9.7% of the AEs collected in this study, would have underestimated the cost per DRG. Conclusions. The carrying out of epidemiological studies aimed at assessing the incidence of AE in services and intensive care units can contribute to the sensitization of professionals and improve their involvement in actions aimed at their prevention. Key words. intensive care; mortality; surgery; drugs action.