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prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation

n a landmark paper published in 1978, Cooper and colleagues [2] described using human factors research methods to retrospectively analyze almost 350 preventable anesthesia incidents. (Human factors is a multidisciplinary field seeking to understand human capabilities and to design, develop, and deploy systems and services to augment those capabilities.) Using a critical incident analysis approach, the authors determined that human factors were responsible for the vast majority of incidents with only a minority attributed to equipment failures or other factors. That preventable harm was largely attributed to human factors (at that time mostly physician related) was a radical new idea. The anesthesiology community embraced this new knowledge, using it as a foundation upon which to build a strong culture of safety and risk aversion that has had considerable impact on patient-centered outcomes. At the heart of that culture is an acknowledgment that systems of health care delivery must be designed to minimize the potential for human error. The most obvious manifestation of this change was to re-engineer the physical artifacts in the environment – the anesthetic machine and physiologic monitors. But of equal importance were the re-engineering of the processes of care delivery (checklists, duty hours, rare event simulation) and mechanisms within the anesthesiology community for reporting, identifying and eliminating new errors. It would take until 1999 before the concept was more broadly articulated by the Institute of Medicine in their landmark report ‘To Err is Human’ [3]. What the anesthesiology response clearly highlights is the impact improved human factor ergonomics has on the ability of health care providers to perform safely within highly technical environments.