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KEY POINTS

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  • Fundamental to improving patient safety is the ability to design systems of care that reliably deliver evidence-based interventions and reduce preventable harm.

  • Translating evidence effectively into practice involves four key processes:

    1. Summarizing the evidence

    2. Identifying local barriers to compliance

    3. Measuring performance

    4. Ensuring that all patients receive the therapy

  • A culture of teamwork is vital to improving the quality and safety of care provided to patients.

  • Significant investment in a patient safety infrastructure is required to fulfill a commitment to safe and high-quality care.

  • Chosen quality measures should be clinically important, scientifically sound (valid and reliable), useful, and feasible.

  • An ICU quality and safety scorecard can be developed locally to demonstrate a broad overview of patient safety performance over time, or relative to a benchmark.

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A QUESTION OF SAFETY

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A decade after the To Err Is Human report,1 the global health care community still struggles to state definitively whether patients under our care are safer. An estimated 98,000 fatalities result from medical errors every year in the United States.2 That number at least doubles if nosocomial infections and other sources of preventable harm are included. This statement is true despite amazing advances in biomedical science that have led to cutting-edge, lifesaving therapies—in part because patients receive only about 50% of recommended evidence-based interventions.3 Although the epidemiology of preventable harm is an immature science, preventable death is a leading cause of death. In addition to increased patient morbidity and mortality, this crisis of patient safety has increased health care costs and lowered public confidence in health care.

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PREVENTABLE VERSUS INEVITABLE HARM

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The past 10 years have seen a national focus on reducing adverse events, with an increase in research and interventions designed to ensure that patients are receiving safe and high-quality care. Unfortunately, most investment and interest in patient safety has been reactive in nature, addressing egregious, although relatively rare, examples of preventable harm, such as operating on the wrong body part. Other types of preventable harm are more common yet also more nuanced. Within the critical care unit, the acuity and complexity of patient disease lead many to believe that complications and morbidity are inevitable. Central to advancing patient safety improvements and optimizing care delivery is the ability to distinguish preventable harm from inevitable harm.4

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In commercial aviation, all fatal crashes are deemed preventable. The implicit idea of preventable harm is that an error occurred that caused harm, but if the error had been prevented, no harm would have occurred. Health care differs substantially from aviation because it is complex and dynamic, and patient conditions not always controllable. Despite receiving the best-known medical therapies, some patients will inevitably die or sustain complications. With ever-advancing scientific knowledge and often expensive technologies, what is inevitable now may be preventable in the future.

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Valid measures of preventable harm require clear definitions ...

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