Quality and safety in the intensive care unit.

Ensuring patient safety is becoming increasingly important for intensive care unit practitioners. The intensive care unit is particularly prone to medical errors because of the complexity of the patients, interdependence of the practitioners, and dependence on team functioning. This review provides historical perspectives, research foundations, and a practical "how to" guide to improving care in the intensive care unit. It also considers the organizational structure, the processes of care, and the occurrence of adverse outcomes in this setting. Effective intensive care unit quality and safety programs capitalize on institutional resources and have multidisciplinary input with clear leadership, input from quality improvement initiatives, a responsible yet nonpunitive culture, and data-driven assessment and monitoring to reduce medical errors. Intensive care unit practitioners need to capitalize on the benefits that patients and their families bring to the patient safety discourse. This provides opportunities for better understanding the risks of the intensive care unit and improving the consent process.