Why do we fail to deliver evidence-based practice in critical care medicine?
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Purpose of review: The use of evidence-based practices in clinical practice is frequently inadequate. Recent research has uncovered many barriers to the implementation of evidence-based practices in critical care medicine. Using a comprehensive conceptual framework, this review identifies and classifies the barriers to implementation of several major critical care evidence-based practices. Recent findings: The many barriers that have been recently identified can be classified into domains of the consolidated framework for implementation research (CFIR). Barriers to the management of patients with acute respiratory distress syndrome (ARDS) include ARDS under-recognition. Barriers to the use of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle for mechanically ventilated patients and the sepsis bundle include patient-related, clinician-related, protocol-related, contextual-related, and intervention-related factors. Although these many barriers can be classified into all five CFIR domains (intervention, outer setting, inner setting, individuals, and process), most barriers fall within the individuals and inner setting domains. Summary: There are many barriers to the implementation of evidence-based practice in critical care medicine. Systematically classifying these barriers allows implementation researchers and clinicians to design targeted implementation strategies, giving them the greatest chance of success in improving the use of evidence-based practice.
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There is still a gap in the implementation of highly effective strategies in controlled studies, which fail to demonstrate such effectiveness after their implementation.
“It is evident that there is still a gap in the implementation of highly effective strategies in controlled studies, which fail to demonstrate such effectiveness after their implementation [15–17]”
From Conceptual framework of equity-focused implementation research for health programs (EquIR) (2019) · cites this paper as [17]
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Ibarra-Estrada, M. Á., Veith, J., & Mireles‐Cabodevila, E. (2022) · Medicina Intensiva (English Edition) · doi:10.1016/j.medine.2022.05.011 · Cited by 1 · see citing works
Why do we need guidelines and why do they fail us?
Brindle, M. E. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.11.035 · Cited by 1 · see citing works
Implementing change is a science
Ibarra-Estrada, M. Á., Veith, J., & Mireles‐Cabodevila, E. (2022) · Medicina Intensiva · doi:10.1016/j.medin.2022.05.001
Bass, G. D., Levy, E. P., Westover, J. E., Ndebele‐Ngwenya, P., Taichman, R. B., Costa, D. K., Weiss, C. H., Lane-Fall, M. B., & Kerlin, M. P. (2022) · Research Square · doi:10.21203/rs.3.rs-1713396/v1
Self-citationARDS, guidelines and ANZ practice: The persistent disconnect
Neto, A. S. (2024) · Critical Care and Resuscitation · doi:10.1016/j.ccrj.2024.08.005
Ervin, J. N., Dibble, M. R., Rentes, V. C., Sjoding, M. W., Gong, M. N., Hough, C. L., Iwashyna, T. J., & Sales, A. E. (2023) · Figshare · doi:10.6084/m9.figshare.22605079
Ervin, J. N., Dibble, M. R., Rentes, V. C., Sjoding, M. W., Gong, M. N., Hough, C. L., Iwashyna, T. J., & Sales, A. E. (2023) · Figshare · doi:10.6084/m9.figshare.22605076
Ervin, J. N., Dibble, M. R., Rentes, V. C., Sjoding, M. W., Gong, M. N., Hough, C. L., Iwashyna, T. J., & Sales, A. E. (2023) · Figshare · doi:10.6084/m9.figshare.22605082
Tume, L. N. (2026) · Nursing in Critical Care · doi:10.1111/nicc.70511
The Start of a Good Innings, 50 Years of Intensive Care Medicine
White, J. O., Hardcastle, T. C., Zonies, D. H., Robertson, S., & Baptista, S. F. (2026) · World Journal of Surgery · doi:10.1002/wjs.70388
- Authors
- Weiss, C. H.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Weiss, Curtis H.
- ORCID
- Weiss, Curtis H.
- Venue
- Current Opinion in Critical Care
- Published
- 2017-10
- Volume
- 23
- Issue
- 5
- Pages
- 400-405
- ISSN
- 1070-5295 (ISSN-L)
- 1531-7072
- PMC
- PMC5784774
- OpenAlex
- W2741538110
- Cited by
- 37
- References
- 56
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 1
- FWCI
- 0.24
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Current Opinion in Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL118139)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- evidence-based practice, implementation barriers, intensive care, Consolidated Framework for Implementation Research, acute respiratory distress syndrome, delirium management, early mobilization, sepsis bundle, mechanical ventilation, implementation strategies
- MeSH terms
- Critical Care, Respiration, Respiration, Artificial, Respiratory Distress Syndrome, Evidence-Based Medicine, Evidence-Based Practice
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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