Critical Care Negligence

Introduction

Critical care is a relatively new subspecialty and its precise role has been gradually defined.  Recently, national attention has focused on quality assessment and medical error avoidance in intensive care units. These concerns were prompted by the realization that medical errors result in patient suffering, mortality, and are costly.

Patient outcomes may be influenced by several variables, among which are: severity of illness, surgical experience, hospital organization, and  ICU physician and nurse staffing. 

“An intensive care unit (ICU) is a hospital facility for provision of intensive nursing and medical care of critically ill patients, characterized by high quality and quantity of continuous nursing and medical supervision and by use of sophisticated monitoring and resuscitative equipment.”

Using this definition, three areas of patient care and expectations come into focus. 

• The reason the patient was admitted to the ICU.
• The monitoring, testing, procedures, and use of the data in caring for the patient.
• The staff providing care for the patient

 

The more ill a patient is the more complications he/she may have when admitted to the ICU.  This correlation has been proven to be true in the medical literature.  When a patient is admitted to the ICU a set of data called the APACHE score is recorded to provide an estimate of ICU mortality. This is calculated on a number of laboratory values and vital signs as well an acute and chronic disease states. Despite what is intuitive, there can still be a disparity between patient’s expectations and what can realistically be done for the patient when admitted to the ICU. 
Once the patient is admitted to an ICU he/she should expect that there will be skilled doctors and nurses available to care for him/her at all times.  The unfortunate reality is that in order to keep costs down, many ICUs today are grossly under-staffed.  A high patient to nurse ratio has been shown to be associated with high incidence of patient complications. 
New technological interventions, and therapies are constantly emerging for the treatment of previously untreatable diseases.  These new modalities, however, can also lead to new and different complications.  Iatrogenic (doctor induced) complications must be distinguished from 'medical negligence'; the latter denotes a deviation from the standard of care by the treating physician.  Just because a patient has an iatrogenic complication does not necessarily mean that it was the result of medical negligence.

The following are categories of conditions and circumstances that may result in malpractice.