Impact of adverse events on patient outcomes in a Japanese intensive care unit: a retrospective observational study.

The study reviewed records from one 12-bed ICU in one Japanese academic hospital, so its results may not apply to other ICUs or hospitals. Adverse events were found only if they were recorded in medical charts, so unrecorded events were missed. The design was retrospective, so it cannot show that adverse events caused longer ICU stay. Sicker patients or patients staying longer may have had more opportunities for events to occur or be recorded. Only 20 records were sampled each month, not all admitted patients, although random sampling was used. The trigger tool counted physical injury and excluded psychological harm and omissions, so some ICU harms were not captured. Preventability judgments could be subjective because the secondary reviewer did not review records directly and there was no consensus process for preventability.

The authors declared no conflicts of interest.

Do not conclude that adverse events caused higher death rates or longer ICU stay. After accounting for illness severity and ventilation, adverse events were not linked to 28-day mortality or hospital mortality, and the link with ICU stay could reflect sicker or longer-staying patients having more recorded events.