Patient Safety Incidents in an Intensive Care Unit during the COVID‑19 Pandemic: A Retrospective Cohort Study

Background: The COVID-19 pandemic has placed an unprecedented burden on intensive care units (ICU), increasing patient vulnerability to adverse events (AEs). This study aimed to analyze the occurrence of AEs, their characteristics, and associations with clinical outcomes and resource utilization among ICU patients. Methods: A retrospective observational cohort study was conducted in a private tertiary hospital in São Paulo, Brazil. Data from ICU admissions between March 2020 and July 2021 were analyzed. The study included patients ≥17 years old with a confirmed COVID-19 diagnosis. Data on demographics, clinical scores, AE occurrence, ICU outcomes, and device usage were collected and analyzed using descriptive statistics and appropriate inferential tests. Results: Among the 1,226 patients admitted to the ICU, 25.2% experienced at least one AE. Most patients were male (68.8%) with a mean age of 64.1 years. The ICU mortality rate was 19.1%, and the hospital mortality rate was 24.2%. Patients with AEs had a significantly longer ICU length of stay (mean 23.8 ± 22.3 vs. 9.8 ± 9.9 days), higher Charlson Comorbidity Index, Simplified Acute Physiology Score III and Sequential Organ Failure Assessment scores, and standardized mortality ratios (p < 0.001 for all comparisons). Most AEs involved harm (60.96%), primarily mild (86.5%), with skin/soft tissue injuries and device-related incidents being the most common categories. AE occurrence was significantly associated with increased use of invasive interventions, including mechanical ventilation (OR 6.71), vasopressors (OR 2.88), and central venous catheters (OR 4.25) . Conclusions: AE occurrence was frequent among ICU patients with COVID-19 and was significantly associated with longer ICU stays, higher mortality, and greater use of critical care resources. These findings underscore the importance of targeted strategies to reduce AEs in high-acuity settings. Trial registration: Not applicable.