Iatrogenic Illness on a General Medical Service at a University Hospital

Abstract

We found that 36% of 815 consecutive patients on a general medical service of a university hospital had an iatrogenic illness. In 9% of all persons admitted, the incident was considered major in that it threatened life or produced considerable disability. In 2% of the 815 patients, the iatrogenic illness was believed to contribute to the death of the patient. Exposure to drugs was a particularly important factor in determining which patients had complications. Given the increasing number and complexity of diagnostic procedures and therapeutic agents, monitoring of untoward events is essential, and attention should be paid to educational efforts to reduce the risks of iatrogenic illness.

The diseases we cause: Iatrogenic illness in a department of internal medicine

“…Iatrogenic disease is a serious problem with a great social impact. It occurs very frequently, is expensive [3][4][5][6][7][8][12][13][14][15][16], and is potentially responsible for high morbidity and mortality [5,6,8,[12][13][14]17,18]. In the U.S., it is estimated that iatrogenic causes are responsible for 225,000 deaths each year, thus being the third leading cause of death after heart disease and cancer [5].…”

“…In the U.S., it is estimated that iatrogenic causes are responsible for 225,000 deaths each year, thus being the third leading cause of death after heart disease and cancer [5]. Iatrogenic events have a high incidence [10][11][12]19]; some studies show that 3.7% [8,9] to 17% [4,20] of all patients admitted to the hospital experience some kind of iatrogenic event. In three major prospective studies carried out in 1980, 1986, and 1993 in different departments of internal medicine with 815, 1176, and 1549 patients each, the incidence found was 36% [12], 25.1% [19], and 14.7% [10], respectively.…”

“…Iatrogenic events have a high incidence [10][11][12]19]; some studies show that 3.7% [8,9] to 17% [4,20] of all patients admitted to the hospital experience some kind of iatrogenic event. In three major prospective studies carried out in 1980, 1986, and 1993 in different departments of internal medicine with 815, 1176, and 1549 patients each, the incidence found was 36% [12], 25.1% [19], and 14.7% [10], respectively. More recent studies show that iatrogenic events occur in 14-25% [10,19] of hospitalized patients in internal medicine departments and in 33% of patients over 65 years of age [18].…”

“…However, the few studies that are available have shown that there are some important predictors for the occurrence of iatrogenic events, namely, older age [10,11,14,[18][19][20][21], longer hospital stay [5,10,15,[18][19][20][21], number of drugs taken daily [11,15,18,21,32], associated pathologies [21], poor general medical status on admission [19], associated renal function impairment or failure [18], and IV catheterization [19]. Amongst the many types of iatrogenic diseases, the most common seem to be drugrelated [6,9,10,12,16,21,23,[30][31][32][33] or adverse drug reactions (ADRs). ADRs are frequent, costly and, in some cases, responsible for severe complications [6].…”

“…In the published studies, some 16-50% of all ADRs are serious [12,14,[18][19][20]30] and 22-80% avoidable/preventable [6,9,10,16,[20][21][22]. Some authors suggest strategies to fight this "pandemic", including enhanced educational programs from the pre-graduate to post-graduate level, aimed at prescribing physicians, patients, the general public, the pharmaceutical industry, health authorities, epidemiologists, and medical educators; measures of risk reduction (e.g., decreasing hospital stay, number of drugs, and technical procedures); the setting up of databases or electronic systems to diminish errors and ADRs; and determined efforts to improve ambulatory care [6,[12][13][14]16,17,19,20,23,34].…”