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Ventilator discontinuation

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.

The practice of intensive care medicine shares many characteristics with anesthesiology. In terms of patient survival and resource utilization many of the most dramatic critical care interventions have derived from changes in the culture brought about by simple systems-based tools. Prominent examples include checklists for the placement of central venous catheters, daily patient care goal lists, and clinical practice guidelines [4]. When used consistently these tools are extremely successful; however, getting providers to accept them can be very challenging [5]. The barriers to adoption of evidence-based tools are multiple but often arise from one of the three broad domains: knowledge, attitudes and behavior [6]. In 2009 the critical care community joined in the signing of the Declaration of Vienna, which expresses a commitment to improve patient outcomes through a reduction in medical error [7]. A multimodal approach incorporating human factor ergonomics will be an important component of any future strategy for eliminating errors in ICU c