Hospital-acquired complications in critically ill patients

Graeme J Duke; Frank Shann; Cameron I Knott; Felix Oberender; David V Pilcher; Owen Roodenburg; John D Santamaria

doi:10.51893/2021.3.OA5

Hospital-acquired complications in critically ill patients

Crit Care Resusc. 2023 Oct 18;23(3):285-291. doi: 10.51893/2021.3.OA5. eCollection 2021 Sep 6.

Authors

Graeme J Duke^{1

2

3}, Frank Shann^{3

4}, Cameron I Knott^{3

5

6}, Felix Oberender^{3

7}, David V Pilcher^{3

8

9}, Owen Roodenburg^{1

2}, John D Santamaria^{3

10}

Affiliations

¹ Intensive Care Service, Eastern Health, Melbourne, VIC, Australia.
² Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
³ INSIGHT Committee, Critical Care Clinical Network, Safer Care Victoria, Melbourne, VIC, Australia.
⁴ Intensive Care Department, Royal Children's Hospital, Melbourne, VIC, Australia.
⁵ Intensive Care Department, Bendigo Health, Bendigo, VIC, Australia.
⁶ Intensive Care Department, Austin Health, Melbourne, VIC, Australia.
⁷ Paediatric Intensive Care Department, Monash Children's Hospital, Melbourne, VIC, Australia.
⁸ Intensive Care Department, Alfred Health, Melbourne, VIC, Australia.
⁹ Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia.
¹⁰ Critical Care Department, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.

Abstract

Background: The national hospital-acquired complications (HAC) system has been promoted as a method to identify health care errors that may be mitigated by clinical interventions. Objectives: To quantify the rate of HAC in multiday stay adults admitted to major hospitals. Design: Retrospective observational analysis of 5-year (July 2014 - June 2019) administrative dataset abstracted from medical records. Setting: All 47 hospitals with on-site intensive care units (ICUs) in the State of Victoria. Participants: All adults (aged ≥ 18 years) stratified into planned or unplanned, surgical or medical, ICU or other ward, and by hospital peer group (tertiary referral, metropolitan, regional). Main outcome measures: HAC rates in ICU compared with ward, and mixed-effects regression estimates of the association between HAC and i) risk of clinical deterioration, and ii) admission hospital site (intraclass correlation coefficient [ICC] > 0.3). Results: 211 120 adult ICU separations with mean hospital mortality of 7.3% (95% CI, 7.2-7.4%) reported 110 132 (42.6%) HAC events (commonly, delirium, infection, arrhythmia and respiratory failure) in 62 945 records (29.8%). Higher HAC rates were reported in elective (cardiac [50.3%] and non-cardiac [40.6%]) surgical subgroups compared with emergency medical subgroup (23.9%), and in tertiary (35.4%) compared with non-tertiary (22.7%) hospitals. HAC was strongly associated with on-admission patient characteristics (P < 0.001), but was weakly associated with hospital site (ICC, 0.08; 95% CI, 0.05-0.11). Conclusions: Critically ill patients have a high burden of HAC events, which appear to be associated with patient admission characteristics. HAC may an indicator of hospital admission complexity rather than hospital-acquired complications.