A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units

Abstract

Objective To investigate associations among care errors, staffing, and workload in small animal ICUs. Design Multicenter observational cohort study conducted between January 2017 and September 2018. Setting Three small animal teaching hospital ICUs. Animals None. Interventions None. Measurements and main results Data on patient numbers, illness severity (assesed via the acute patient physiologic and laboratory evaluation [APPLE] score), care burden, staffing levels, technician experience/education level, and care errors were collected at each study site. Care errors were categorized as major (unanticipated arrest or death; patient endangerment through IV line, arterial catheter, chest tube or other invasive device mismanagement, or errors in drug calculation/administration) or minor. Median patient:technician ratio was 4.3 (range: 1–18). Median patient illness severity was 15.1 (4.7–27.1) APPLE score units. A total of 221 major and 3,317 minor errors were observed over the study period. The odds of a major error increased by an average of 11% (odds ratio [OR] = 1.11; 95% confidence interval [CI], 1.02–1.20; P = 0.012) for each 1 patient increase in the patient:technician ratio after averaging by ICU location. The major error incident rate ratio was 2.53 (95% CI, 1.84–3.54; P < 0.001) for patient:technician ratios of >4.0 compared with ≤4.0. The odds of a major error increased by 0.5% per total unit APPLE score increase (OR = 1.005; 95% CI, 1.002–1.007; P < 0.001). The major error incident rate ratio was 1.71 (95% CI, 1.30–2.25; P < 0.001) for APPLEfast:technician ratios of >73 compared with ≤73. The odds of a major error decreased by 2% (OR = 0.98; 95% CI, 0.97–0.99; P = 0.01) for each year increase in total technician years of ICU work experience. Conclusions Substantial reductions in major care errors may be achieved by maintaining ICU patient:technician ratios at ≤4. Technician experience and total unit burden of patient illness severity are also associated with error incidence, and should be taken into consideration when scheduling staff.

Veterinary healthcare needs to talk more about error: For the wellbeing of our patients and medical teams

“…A study recently described the complexity of working in the ICU and the importance of staffing levels in relation to major care errors. 11 A recent look into clinician wellbeing in human healthcare demonstrated clinician burnout is associated with an increased risk of errors and malpractice claims. 12 After Banks was discharged, a multidisciplinary team including veterinarians, nurses and leadership discussed potential root causes that led to the error.…”

“…These and other factors, such as fatigue and lengthy shifts, become additive and make individuals more prone to error. A study recently described the complexity of working in the ICU and the importance of staffing levels in relation to major care errors 11 . A recent look into clinician wellbeing in human healthcare demonstrated clinician burnout is associated with an increased risk of errors and malpractice claims 12 …”

Survival of formalin intoxication in a 13‐year‐old Thoroughbred gelding

“…The magnitude of such adverse events can be extreme, with medical errors reported to be the third leading cause of death in the United States in 2016 56 . In veterinary medicine less has been published on animal safety and medical error, although it is gaining more attention of late 57–60 . A study using an incident reporting system in three veterinary hospitals (university large animal, university small animal, private emergency small animal) investigated the type and severity of errors and found drug errors were most frequent (55%–69% of all errors) 59 .…”

Medical errors: Experiences, attitudes and perspectives of incoming and outgoing final‐year veterinary students in the USA

“…Inadequate staffing is an issue in veterinary practices across the nation, 34 and increases in new patient volume and higher wait times are a consequence of the COVID‐19 pandemic 35 . A study investigating the association between medical errors and staffing in small animal intensive care units noted that reductions in medical errors may be accomplished by preserving adequate patient–technician ratios 36 . The lower median survey opinion may be a result of OFY students, who worked in the VTH during their clinical year, witnessing provider shortages or patient safety events that occurred during times of insufficient staffing.…”

“…35 A study investigating the association between medical errors and staffing in small animal intensive care units noted that reductions in medical errors may be accomplished by preserving adequate patienttechnician ratios. 36 The lower median survey opinion may be a result of OFY students, who worked in the VTH during their clinical year, witnessing provider shortages or patient safety events that occurred during times of insufficient staffing. In-person experience may have also influenced the significant difference between the groups regarding the opinion of frequency of medical errors in veterinary medicine.…”