Identifying and analyzing cases with negative impact on the quality of intensive care in the neonatal ICU

Abstract

Adverse events (AEs) during the provision of medical care, especially in such intensive and high-tech departments as the neonatal intensive care unit (NICU), inevitably occur. However, identifying these cases and critically analyzing the results obtained can significantly improve the quality of medical care and prevent or lower their further occurrence. The purpose of this research was to identify and conduct an analysis of negative cases/adverse events (hereinafter referred to as ‘cases’) by surveying employees in order to improve the quality of medical care in the NICU. Materials and methods used: a single-center cohort study was conducted at the Newborns’ Resuscitation and Intensive Care Unit with the Yekaterinburg Clinical Perinatal Center (Yekaterinburg, Sverdlovsk Oblast, Russia) during six months in 2022. 15 physicians and 27 nurses took part in the study filling out a formalized questionnaire. During this period, 411 patients were admitted at the NICU. Results: 200 cases were registered that had a negative impact on the quality of medical care, of which, according to possible harm to the patient, they were distributed as follows: no harm to the patient - 40 (20.0%), 95% CI (14.4-25.5), could cause harm, but did not reach the patient - 29 (14.5%), 95% CI (9.7-19.2), reached the patient, but did not harm - 74 (37.0%), 95% CI (29 ,4-44.5), probably caused harm to the patient - 57 (28.5%), 95% CI (21.8-35.1). Among the root causes of cases, the following were identified: physician (in-/lack of) competence - 115 (57.5%), 95% CI (48.1-66.8), nurse competence - 34 (17.0%), 95% CI (11.8-22.1 ), updating and maintenance of equipment - 33 (16.5%), 95% CI (11.4-21.5), competencies of physician and nurse combined - 10 (5.0%), 95% CI (2.2-7 ,7), organizational issues - 5 (2.5%), 95% CI (0.5-4.4), psychologist’s part of work - 3 (1.5%), 95% CI (0-3.0). 186 (93%), 95% CI (81.0-100) cases were considered preventable and 14 (7%) 95% CI (3.7-10.2) cases were recognized as probably preventable; no unpreventable cases were identified during the study. Conclusion: the study results revealed that ca. 50% of NICU patients experience AEs during admission process. The competencies of medical personnel are in first place in terms of the root causes of cases, and no unpreventable cases were identified during the study. Based on the findings of the study, a set of organizational measures to prevent AEs in the NICUs was developed by the Authors.