Patient safety in intensive care medicine: the Declaration of Vienna

Abstract

Improving the outcome of critically ill patients remains an ideal that every practicing Intensivist strives to achieve. Every year there are many hundreds of research papers published that help us to better understand the physiology and pathophysiology of our patients and also how our treatment strategies interact and eventually alter a patient’s course. Many of these papers focus on discrete parts of the therapeutic regimes that we are able to deliver; however, few have had a significant impact on overall outcome measures that are relevant to patients themselves. One area of medicine that is often overlooked, but can impact significantly on relevant patient outcomes, is the process of care. The way we practice, the culture we work in, the climate that our professional demeanor creates can all dramatically impact on outcome measures. Unfortunately, these topics are often not easy to explain, difficult to study and do not attract research funding that stimulates scientific minds to address the problem. This paper describes how the European Society of Intensive Care Medicine (ESICM) aims to raise patient safety to the top of the scientific agenda with the hope of ultimately increasing the quality of care delivered to our patients and improving their outcomes. The Institute of Medicine (IOM) published in 1999 their seminal report entitled ‘To err is human: building a safer health system’ [1]. This paper described quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Safety was defined as the absence of clinical error, either by commission (unintentionally doing the wrong thing) or omission (unintentionally not doing the right thing) [2], and error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. The accumulation of errors results in accidents. The authors delineated just how common failure to provide quality care is, with between 44,000 and 98,000 patients dying each year in the USA as a result of a clinical error. This makes medical error the eighth leading cause of death, more frequent than motor vehicle accidents (43,458), breast cancer (42,458) and AIDS (16,516). Despite the awareness of patient safety and quality of care issues increasing in both patient and political arenas, this has not translated through to groundbreaking research studies that have ignited the topic with significant outcome benefits [3, 4]. To improve the profile of these subjects, the ESICM in 2009 has launched a major initiative that will bring together the representatives of Critical Care Societies from around the world (national and international) with the aim of pledging their efforts and resources towards improving the care of our patients. Together with the societies signing this Declaration of Vienna (Appendix 1) will be senior representatives from the political world, our partners in industry and of course patient representatives themselves. The meeting will assess problems and solutions from around the world irrespective of geographical, political or economic factors. This unique partnership will allow collaborations to be fostered and for partnerships to develop. We hope to be able to use this group to raise the profile of the patient safety agenda and therefore change the way we practice everyday with resultant benefits for all.