Patient-safety and quality initiatives in the intensive-care unit.
OBJECTIVE
Patient safety has become the primary focus of health-care improvement in the last few years as an increasing body of evidence emphasizes the magnitude of harm posed to patients by medical errors. The intensive-care unit, by virtue of the high technology aggressive level of care the unit provides, has been identified as a significant source of patient harm. Consequently, the intensive-care unit also represents a tremendous opportunity to study and implement patient-safety initiatives, as significant improvements can be realized in this environment.


RESULTS
Several broad areas of successful patient-safety initiatives have been reported over the recent past including implementation of Comprehensive Unit-based Safety Programs, introduction of communication tools (for example daily goal sheets), application of care bundles (that is mechanical ventilation or sepsis), as well as team approaches that can eradicate catheter-related bloodstream infections. Specific interventions are gaining supportive evidence and widespread acceptance for their ability to reduce harm including tight glucose control and ultrasonography for reducing central-line placement complications. Recent data also demonstrate the value of an intensivist as the team leader for the critically ill within the intensive-care unit and potentially with rapid-response teams.


CONCLUSIONS
Many patient safety and quality-of-care initiatives that have broad application to all areas of medical care have been successfully developed in the intensive-care unit. The intensive-care unit appears to be a fertile ground for the development of safety initiatives.
Department of Anesthesiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA. bwinters@jhmi.edu
Bradford
B
Winters
Todd
T
Dorman
D001786:Blood Glucose / Q000378:metabolism; D003422:Critical Care / Q000592:standards*; D003428:Cross Infection / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D010361:Patients; D011785:Quality Assurance, Health Care / Q000379:methods*; D012449:Safety; D018805:Sepsis / Q000628:therapy
D001786:Blood Glucose