Methods of Adverse Event Detection in Intensive Care: A Systematic Review

OBJECTIVE: The objective of this systematic review was to characterize adverse event detection methods in the ICU setting, including neonatal, pediatric, and adult ICUs, to summarize the evidence of their performance characteristics. DATA SOURCES: Ovid MEDLINE, Ovid Embase, CINAHL, the Cochrane Library, and Google Scholar. STUDY SELECTION: Title and abstract screening, as well as full text review, were performed by two reviewers independently using Covidence software. Articles were included if they consisted of original research in a peer-reviewed journal with implementation of an adverse event detection method and reported the total number or category of adverse events, level of harm, or implementation of quality improvement (QI). DATA EXTRACTION: Data were extracted by two reviewers with 20% in duplicate. Extracted data included the study type and period/date, the adverse event detection method, the setting (location and type of ICU), ICU bed base, and the data of interest outlined above in study selection. DATA SYNTHESIS: Fifty-nine studies in neonatal, pediatric, and adult ICUs were included. Every category of adverse event detection was represented, including incident reporting (IR) (38 studies), trigger tool use (14 studies), trained observation (TO; 11 studies), and structured review (10 studies). TO identified the most adverse events per 100 patient days (57.3), and IR the least (6.4). Only 12 studies (20%) described QI initiatives. CONCLUSIONS: Detection methods likely need to be used in combination for comprehensive results. Definitions of adverse events and associated harms need to be standardized to facilitate future comparison and better understanding of the performance of individual methods of detection. In addition, more emphasis needs to be placed on the dissemination of practice change in response to detection. These will be important steps to better characterize high rates of adverse events in the ICU, thereby fueling patient safety initiatives.