Adverse events as key risk factors for in-hospital mortality in intensive care units

Intensive care units (ICUs) represent high-risk environments for adverse events (AEs). Preventing these events requires a solid understanding of their epidemiology based on standardized and validated methodologies. The aim of this study was to quantify AEs using the established Harvard Medical Practice Study (HMPS) methodology, identify associated factors, and analyze their prognostic impact on critically ill patients. A multicenter observational study with a cross-sectional design was conducted in 26 hospitals across the Community of Madrid on a single, specified day in May 2019. Following the HMPS methodology and using its standardized instruments, clinical records were reviewed in two phases: (1) an AE screening phase and (2) a confirmation and characterization phase for cases with positive screenings. A multivariate logistic regression model was developed to identify variables associated with the presence of AEs, and the association between AEs and in-hospital mortality was assessed using an explanatory model adjusted for potential confounders. A total of 458 patients were included, of whom 125 (27.3%; 95% CI: 23.4 to 31.6) had ≥1 AE. The following antecedents were associated with the presence of AEs: pressure ulcer (PU), hypoalbuminemia, mechanical ventilation, central venous catheter, surgical intervention and sensory deficit. Among the AEs found, 44.6% were health care-associated infections (HAIs). In-hospital mortality among patients with AEs was twice that observed in patients without AEs (OR: 2.15; 95% CI: 1.10–4.25). The presence of AEs was associated with a two-fold higher risk of in-hospital mortality. Among the identified AEs, HAIs were the most frequent and had the highest mortality. Designing and implementing bundles of measures adapted to the individual risk of presenting AEs in the ICU emerges as the next step in the development of strategies to reduce the prevalence of AEs.

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Journal
Critical Care
Published
2026-03-07
DOI
https://doi.org/10.1186/s13054-026-05917-x
Primary Topic
Patient Safety and Medication Errors
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article
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article

Adverse events as key risk factors for in-hospital mortality in intensive care units

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Critical Care
Patient Safety and Medication Errors
article

Adverse events as key risk factors for in-hospital mortality in intensive care units

Ana Polo Parada, María Dolores Calles Gato, Marta Soler Vigil, Jesús Minaya Saiz, D. Fernández Redondo, María José Pita López, Guillermo Ordoñez León, Mercedes Vinuesa, Cristina Navarro Royo, Inmaculada Mediavilla Herrera, Rosa Pla Mestre, Carolina del Valle Giráldez García, Beatriz Nieto Pereda, Juan Vega Barea, Carmen de Burgos Lunar, Cornelia Bischofberger Valdés, María Vicenta García Rosado, Belén Martínez Mondéjar, Felisa Jaén Herreros, G de las Casas Cámara, Inmaculada López Carrillo, Angels Figuerola Tejerina, Dolores Martín Ríos, N. Franco Garrobo, Carmen Albéniz Lizárraga, Marta Maroto, Miguel Ruiz Álvarez, Inés Fernández Jiménez, I González-Solana, José Joaquín Mira Solves, Susana Lorenzo Martínez, Juan José Granizo Martínez, ANA HERRANZ ALONSO, Ana Robustillo Rodela, Beatriz Fernández, Alicia Díaz Redondo, JOSE MANUEL CARRASCOSA BERNALDEZ, María Ángel Valcárcel de la Iglesia, Cristina Fernández, María Dolors Montserrat Capella, Ruth González Ferrer, Emely García Carrasco, Carlos Aranda Cosgaya, Nieves López Fresneña, María Teresa Ledo Varela, Laura Moratilla Monzó, Nuria Gálvez Carranza, Rafael Martos Martínez, María de Sebastián Rueda, Libertad Martín Prieto, Laura Rubio Cirilo, Ana Isabel Alguacil Pau, Miguel Miró Murillo, Mercedes Ortiz Otero, José Lorenzo Valencia Martín, P. Moreno-Nunez, Pedro Ruiz Lopez, Alberto Pardo-Hernández, Marta Grande Arnesto, Sonia de Miguel Fernández, Anabel Alguacil Pau, B. Peñalver-Argüeso, Mª José Esteban Niveiro, D. San Jose-Saras, Montserrat Salcero Guijarro, J. Vicente-Guijarro, Margarita Mosquera González, Elena Ramírez García, Rosalía Hernández Holgado, Marco Antonio Espinel Ruíz, Sonia Fraile Gil, Lourdes Sainz de los Terreros oler, María Jesús Labrador Domínguez, María José Durá Jiménez, Asunción Colomer Rosas, Nieves Plana Farrá, Carolina Ruíz Entrecanales, external advisers ESHMAD director group, Beatriz Fidalgo Hermida, C. Díaz-Agero Pérez, Yuri Fabiola Villan Villan, Ana Belén Jiménez Muñoz, J. M. Aranaz-Andres, Elia Mayoral Peccis, María Dolores Martín Ríos, Romina Sánchez Gómez, Carmen Gutiérrez Bezón, Isabel Carrasco Gonzalez, María Pilar González Sánchez, M. Roncal-Redín, Eva Jiménez González de uitrago, Carolina Lucas Molina, Pilar Paloma Blanco Hernández, Carlos Aibar Remón, María Teresa Sayalero Martín, Esteban del Pozo García
article en

Abstract

Intensive care units (ICUs) represent high-risk environments for adverse events (AEs). Preventing these events requires a solid understanding of their epidemiology based on standardized and validated methodologies. The aim of this study was to quantify AEs using the established Harvard Medical Practice Study (HMPS) methodology, identify associated factors, and analyze their prognostic impact on critically ill patients. A multicenter observational study with a cross-sectional design was conducted in 26 hospitals across the Community of Madrid on a single, specified day in May 2019. Following the HMPS methodology and using its standardized instruments, clinical records were reviewed in two phases: (1) an AE screening phase and (2) a confirmation and characterization phase for cases with positive screenings. A multivariate logistic regression model was developed to identify variables associated with the presence of AEs, and the association between AEs and in-hospital mortality was assessed using an explanatory model adjusted for potential confounders. A total of 458 patients were included, of whom 125 (27.3%; 95% CI: 23.4 to 31.6) had ≥1 AE. The following antecedents were associated with the presence of AEs: pressure ulcer (PU), hypoalbuminemia, mechanical ventilation, central venous catheter, surgical intervention and sensory deficit. Among the AEs found, 44.6% were health care-associated infections (HAIs). In-hospital mortality among patients with AEs was twice that observed in patients without AEs (OR: 2.15; 95% CI: 1.10–4.25). The presence of AEs was associated with a two-fold higher risk of in-hospital mortality. Among the identified AEs, HAIs were the most frequent and had the highest mortality. Designing and implementing bundles of measures adapted to the individual risk of presenting AEs in the ICU emerges as the next step in the development of strategies to reduce the prevalence of AEs.

Critical Care
Universidad de La Rioja (ES), Universidad de Alcalá (ES), Instituto Cajal (ES), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
Good health and well-being
Openalex Percentile: Top 38%
Patient Safety and Medication Errors
DOIOpen Access PDFOpenAlex
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