Improving patient safety for the critically ill The challenges of implementation

This thesis focuses on the implementation of strategies for improving patient safety and quality of care for critically ill patients. Patient safety is an important issue in hospitals world-wide. One of the most challenging aspects of increasing patient safety in hospitals is the successful implementation of new evidence-based practices or guidelines. This is especially true if this requires changes to behaviour, clinical practices, the organization, or how physicians or nurses collaborate. Guidelines aim to reduce variability in clinical care and to increase adherence to evidence-based interventions. However, in many cases patients come to harm because guidelines are not followed consistently. They are often introduced rapidly, with no structured implementation plan available for changing behaviour. To improve patient safety and the quality of care, we need to understand those factors that facilitate or hamper successful implementation of evidence-based practices or guidelines. In our research we focussed on the implementation of a rapid response system on nursing wards and evidence-based care bundles in the intensive care unit. To encourage the implementation of such quality improvement interventions and to increase the chances of success, a tailored and often multifaceted implementation strategy is required to overcome existing barriers. Throughout the implementation process it is essential to continuously monitor and analyse data to track progress towards outcomes, and adjust the chosen strategy if necessary.