Barriers to translating evidence into practice.
OBJECTIVE
The demand for high-quality care is increasing. A variety of therapies have been shown to improve patient outcomes in critical care. Nevertheless, relatively little research has focused on identifying how to deliver those therapies effectively and efficiently. As a result, the most cost-effective opportunity to improve patient outcomes will likely come not from discovering new therapies but from discovering how to deliver therapies that are known to be effective.


RESULTS
The authors review the evidence regarding changing behavior of physicians and discuss barriers to translating evidence into practice. They also provide practical examples of how they applied the concepts of teamwork, independent redundancy, and reduced complexity to change the behavior of physicians and improve quality of care.


CONCLUSIONS
Because quality is a multidimensional construct, it is unlikely that a single approach will be effective. ICU physicians and hospital leaders must assume a leadership role, implementing a combination of different approaches and developing appropriate systems for patient care.
Berenholtz
Sean
S
Departments of Anesthesiology & Critical Care Medicine Surgery, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
Pronovost
Peter J
PJ
D003422:Critical Care / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D006801:Humans; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care