The complexity of medicine has been acknowledged as one of the contributing factors of healthcare-acquired infections (HAIs), in that a greater use of medical devices and interventions invariably results in potential complications and infections. It is the acceptance of these adverse patient outcomes that consternates patient safety experts who are endeavoring to change the mindset of clinicians while using simple tools and strategies proved to fight HAIs.
A wry illustration in an issue of The New Yorker captured the essence of that bastion of complexity in hospitals, the intensive care unit (ICU) – it accurately portrays and skewers the tremendous tangle of wires and hoses that snake back to dozens of machines that lend life to the sickest and most vulnerable of patients. Gawande (2007) describes the chaos: “Machines break down; a team can’t get moving fast enough; a simple step is forgotten. Such cases don’t get written up in The Annals of Thoracic Surgery, but they are the norm. Intensive-care medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered.”
Besides being complex, the ICU can also be a potentially dangerous place. As Gawande (2007) points out, “The average stay of an ICU patient is four days, and the survival rate is 86 percent. Going into an ICU, being put on a mechanical ventilator, having tubes and wires run into and out of you, is not a sentence of death. But the days will be the most precarious of your life ...A decade ago, Israeli scientists published a study in which engineers observed patient care in ICUs for 24-hour stretches. They found that the average patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just 1 percent of these actions but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail.”