Research article Critical incidents rates and types in Italian Intensive Care Units: A five- year analysis Matteo Danielis a,⇑ , Fabrizio Bellomo b , Federico Farneti b , Alvisa Palese a a School of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy b Accreditation, Clinical Risk Management and Performance Assessment Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy article info Article history: Received 3 February 2020 Revised 2 August 2020 Accepted 7 August 2020 Available online xxxx Keywords: Critical incident Hospital incident reporting Intensive Care Unit Italy Patient safety abstract Objective: To describe rates and types of critical incidents in Intensive Care Units. Research methodology: A retrospective study in four intensive care units of an Academic Hospital located in the North-East of Italy. All critical incidents recorded in an incident reporting system database from 2013 to 2017 were collected. Results: 160 critical incidents emerged. The rate was 1.7/100 intensive care-patient admissions, and 2.86/1000 in intensive care-patient days. Nurses reported most of the critical incidents (n = 113, 70.6%). In 2013 there were 19 (11.9%) critical incidents which significantly increased by 2017 (n = 38, 23.7%; p = 0.034). The most frequent critical incidents were medication/intravenous fluids issues (n = 35, 21.9%) and resources and organisational management (n = 35, 21.9%). Less frequently occurring incidents concerned medical devices/equipment (n = 29, 18.1%), clinical processes/procedures (n = 18, 11.3%), documentation (n = 14, 8.8%) and patient accidents (n = 13, 8.1%). Rare incidents included beha- viour, clinical administration, nutrition, blood products and healthcare associated infection. Conclusion: Over a five-year period, documented incidents were steadily increasing in four Italian inten- sive care units. A voluntary incident reporting system might provide precious information on safety issues occurring in units. at both policy and professional levels. Ó 2020 Elsevier Ltd. All rights reserved. Implications for Clinical Practice  Intensive Care Unit nurses are more likely to report critical incidents, especially those regarding medication/intravenous fluids, resources, and organisational management.  A clear definition of what should be considered a critical incident is needed to address uncertainty regarding what should be reported.  Timely feedback should be given to health care professionals, promoting a learning environment where safety issues can be openly discussed and analysed. Introduction Critical incidents (CIs) are defined as unintended circumstances or complications related to the process of care that may result in unfavourable patients’ outcomes (Runciman, 2006; Vries et al., 2008). CIs have been discussed in Intensive Care Units (ICUs) since the 1980s when the pioneering work of Abramson and colleagues (1980) outlined the need for a well-structured incident reporting system to detect and prevent health care professionals’ errors. In 2016, a systematic review aimed at comparing different incident reporting systems in ICUs (Brunsveld-Reinders et al., 2016) was published summarising the results of 36 studies conducted in dif- ferent individual countries ([Canada], Ilan et al., 2011; [Italy], Capuzzo et al., 2005), as well as on a multinational level https://doi.org/10.1016/j.iccn.2020.102950 0964-3397/Ó 2020 Elsevier Ltd. All rights reserved. ⇑ Corresponding author at: Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy. E-mail address: matteo.danielis@uniud.it (M. Danielis). Intensive & Critical Care Nursing xxx (xxxx) xxx Contents lists available at ScienceDirect Intensive & Critical Care Nursing journal homepage: www.elsevier.com/iccn Please cite this article as: M. Danielis, F. Bellomo, F. Farneti et al., Critical incidents rates and types in Italian Intensive Care Units: A five-year analysis, Intensive & Critical Care Nursing, https://doi.org/10.1016/j.iccn.2020.102950