Interventions to reduce mortality among patients treated in intensive care units.
OBJECTIVE
Using sensitivity analysis to estimate the impact, in terms of patient lives, of the failure to use proven therapies known to reduce mortality in critically ill intensive care unit patients.


METHODS
We identified high-impact interventions published in the last 5 years in the Journal of the American Medical Association or New England Journal of Medicine, extracted the absolute risk reduction associated with each intervention and gleaned the national incidence of each condition and the percent of the population not receiving the cited therapy from the literature. From this information, we calculated national estimates of the excess deaths from failure to use these therapies.


RESULTS
With consistent and appropriate implementation of the 5 cited evidence-based interventions, we found a total of 167,819 lives could be saved per year, with a range of 137,670 to 197,965 lives saved per year.


CONCLUSIONS
Mistakes of omission are common in the critical care setting and lead to significant preventable mortality. There is a significant gap between the discovery of effective interventions and their use in clinical practice. By viewing the delivery of healthcare as a science and increasing funding for health services research, we may be able to increase the use of effective therapies and, as a result, reduce patient mortality.
Pronovost
Peter J
PJ
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. ppronovo@jhmi.edu
Rinke
Michael L
ML
Emery
Katherine
K
Dennison
Cheryl
C
Blackledge
Charles
C
Berenholtz
Sean M
SM
D003422:Critical Care / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012306:Risk; D016019:Survival Analysis