Unexpected Failure Events in Surgical Patients: Failure of the System or of the Patient?

Background: Unexpected failure events are undesired harmful effects, which result in prolonged hospital stay, higher mortality and morbidity rates and increased hospital costs. The aim of our study was to identify and thorough investigate patients hospitalized in our university surgical ward, who had to be transferred to the surgical ICU (SICU) due to such an event.

Methods: This was a retrospective observational study performed in the surgical ward of a large, urban, teaching hospital during a 2.5 year period. All failure events, which resulted in the transport of surgical patients from ward to the SICU, were included and reviewed.

Results: There were 56 failure events recorded in 43 patients. Most patients suffering a failure event were admitted through the Emergency Department as acute cases (55,81%) and in most cases the failure event was identified by a nurse on duty (51,8%). Respiratory failure was the most common final diagnosis after SICU admission (60,71%). Of the total 43 patients suffering one or more failure event, 14 died.

Conclusions: Based on our results, it seems that high risk patients admitted through ED should be admitted into ICUs for safety reasons. Moreover, triggering systems and monitoring of postsurgical patients, especially respiratory monitoring, would be helpful in minimizing failure events.