Changing physician behavior: a review of patient safety in critical care medicine.

The publication of the Agency for Healthcare Research and Quality (AHRQ) report in July 2001 entitled "Making Health Care Safer: A Critical Analysis of Patient Safety Practices," represents a significant perceptual change in health care ideology. It can be argued that this compilation recognizes not only that medical errors occur in the health care system, but also that there are significant learning opportunities that may arise in the identification of these errors that are otherwise known as medical misadventures. The report concluded and outlined a series of 11 highly rated practices whose usage are associated with increased safety. The AHRQ report also articulated that there is a need to investigate methods used to align medical practice with evidence regarding patient safety. In other words, after the identification of the 11 priority safety practices, it is thus important to determine the most effective methods to change physician behavior toward these practices that will intuitively result in increased safety performance. Five different educational-based strategies have been identified as techniques to change physician behavior: (1) Academic Detailing, (2) Audit and Feedback, (3) Local Opinion Leaders, (4) Reminder Systems, and (5) Printed Material. This article reviews these strategies in the context of critical care medicine and offers some opinions regarding setting the future research agenda in this investigative field. Copyright 2002, Elsevier Science (USA). All rights reserved.