Critical pathways, guidelines, and protocols have all been advocated as means to reduce variation in clinical practice, reduce costs, and improve outcomes in adult intensive care. Each can be a useful tool for creating change in an organization, but sustaining those gains requires more than a form, a flow diagram, or an order sheet. If it were that easy, every hospital intensive care unit would have a highly functional, standardized environment of care without errors or preventable complications. The following article will summarize literature support for these initiatives, while providing some practical insights into the developmental process required to create an environment of enduring change.
Director, Critical Care Services, Phoebe Putney Memorial Hospital, Albany, Georgia
Correspondence to William A. Brock, MD, Director, Critical Care Services, Phoebe Putney Memorial Hospital, 417 Third Avenue, P.O. Box 1828, Albany, Georgia, 31702–1828, USA; e-mail: firstname.lastname@example.org