Patient safety has become a major defining issue for healthcare at the beginning of the 21 st century. Viewed from the perspective of reliability of delivery of best practice, healthcare systems demonstrate a degree of imperfection which would not be tolerated in industry. In part, this is because of uncertainty about what constitutes best practice, combined with complex interventions in complex systems. The acutely ill patient is particularly challenging, and as the majority of admissions to hospitals are emergencies, it makes sense to focus on this group as a coherent entity. Changing clinical behavior is central to improving safety, and this requires a systems-wide approach integrating care throughout patient journey, combined with incorporating reliability training in life-long learning.
To err is human: Building a safer health system. Institute of Medicine. Washington: National Academy Press; 2000.
World Health Organisation. Available from: http://www.who.int/patientsafety/en/.
Estimating hospital deaths due to medical errors: Preventability is in the eye of the reviewer. JAMA 2001;286:415-20.
Discrepancies between explicit and implicit review: Physician and Nurse Assessments of Complication and Quality. Health Serv Res 2002;32:483-98.
Profiling quality of care: Is there a role for peer review? BMC Health Services Res 2004;4:9.
The stepped wedge trial design: A systematic review. BMC Med Res Methodol 2006;6:54.
An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725-32.
Introduction of medical emergency teams in Australia and New Zealand: A multi-centre study. Crit Care 2008;12:R46.
Introduction of the medical emergency team (MET) system: A cluster randomised controlled trial. Lancet 2005;365:2091-7.
Introduction of medical emergency teams in Australia and New Zealand: A multicentre study. Crit Care 2008;12:151.
Improving hospital safety for acutely ill patients: A lancet quintet. I: Current challenges in the care of the acutely ill patient. Lancet 2004;363:970-7.
Improving patient safety-five years after the IOM report. N Engl J Med 2004;351:2041-3.
Consensus Development of an International Competency-Based Training Programme in Intensive Care Medicine. Intensive Care Med 2006;32:1371-83.
National Hospital Ambulatory Medical Care Survey: 2000 emergency department summary. Advance data from vital and health statistics. No. 326. Hyattsville, Md.: National Center for Health Statistics, 2002. (DHHS publication no. (PHS) 2002-1250 02-0259.)
Explaining differences in English hospital death rates using routinely collected data. BMJ 1999;318:1515-20.
UK: Department of Health; 2002.
Available from: http://www.who.dk/emergservices.
Acutely ill patients in hospital: Recognition of, and response to, acute illness in hospitalised adults. National Institute for Clinical Excellence. Available from: http://www.nice.org.uk/CG50. 2007.
Gaps in the continuity of care and progress on patient safety. BMJ 2000;320:791-4.
Views of practicing physicians and the public on medical errors. N Engl J Med 2002;347:1933-40.
The architecture of safety: Hospital design. Curr Opin Crit Care 2007;13:714-9.
Available from: http://www.survivingsepsis.org/.
Preventable medical injuries in older patients. Arch Intern Med 2000;160:2717-28.
A prospective before-and-after trial of a medical emergency team. Med J Aust 2003;179:283-7.
The quality of health care delivered to adults in the USA. N Engl J Med 2003;348:2635-45.
The underutilization of cardiac medications of proven benefit, 1990 to 2002. J Am Coll Cardiol 2003;41:56-61.
Epidemiology of severe sepsis and septic shock in Germany - Results from the German Prevalence Study. Infection 2005;33:49.
Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 2008;299:2294-303.