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initiation of effective antimicrobial therapy

During the last century, rapid advancements in medical technology and subspecialty care have transformed acute care hospitals into highly complex institutions offering a wide variety of medical and surgical interventions. Tremendous advances in emergency and critical care medicine, surgery, and anesthesia have enabled meaningful survival among patients suffering previously lethal conditions. Unfortunately, these benefits have been to a large extent offset by iatrogenic harm and failures in care delivery due to ineffective organization. Hundreds of thousands of hospitalized patients are injured or killed each year as a result of care that is well-intended but either poorly designed or poorly implemented [1]. Inappropriate financial incentives, neglect of human factors, and the lack of a systematic approach to the science of health care delivery still pose major obstacles to better hospital care. All too often, in our rush to advance the leading edge of science we have neglected to perfect the core interface between patients and the systems constructed to care for them.

Clearly, the mere presence of sophisticated equipment and an ever-expanding evidence base do not guarantee optimum care. These various elements must be integrated into highly organized and responsive systems that can facilitate safe, timely, consistent, and effective care. The following paragraphs discuss the barriers to safe and effective acute care delivery and highlight the changes that will shape the next generation of acute care hospitals (Figure