Regular discussion of serious complications during admission to an internal medicine department

Three patients, two women aged 54 and 84 years, and a man aged 76 years, had serious complications during a stay in an internal medicine ward. The complications were discussed at monthly multidisciplinary complication meetings, which we organise from 2007 and which are aimed at improving care processes. The first patient developed urinary tract infection, fever and delirium and an arm fracture as a result of a fall after she had been given a routine urinary catheter in order to monitor her fluid balance. The complication discussion indicated that a urinary catheter should not be routinely installed. The second patient developed phlebitis and endocarditis after a venous infusion had been present for several days. As a result of the complication discussion it was decided that venous access was to be renewed after 96 h. The third patient, who was treated for atrial fibrillation, had fatal intracerebral bleeding due to INR > 5. A result of the complication discussion was that active antagonism of anticoagulants is warranted in these cases, not just discontinuation of the anticoagulants. The monthly multidisciplinary complication discussions in our department have led to a change in culture, facilitating the expression of doubts and criticisms, and a readiness to change policies.