• Peter J Pronovost, Michael L Rinke, Katherine Emery, Cheryl Dennison, Charles Blackledge, and Sean M Berenholtz.
• Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. ppronovo@jhmi.edu
• J Crit Care. 2004 Sep 1;19(3):158-64.

PurposeUsing sensitivity analysis to estimate the impact, in terms of patient lives, of the failure to use proven therapies known to reduce mortality in critically ill intensive care unit patients.Materials And MethodsWe identified high-impact interventions published in the last 5 years in the Journal of the American Medical Association or New England Journal of Medicine, extracted the absolute risk reduction associated with each intervention and gleaned the national incidence of each condition and the percent of the population not receiving the cited therapy from the literature. From this information, we calculated national estimates of the excess deaths from failure to use these therapies.ResultsWith consistent and appropriate implementation of the 5 cited evidence-based interventions, we found a total of 167,819 lives could be saved per year, with a range of 137,670 to 197,965 lives saved per year.ConclusionsMistakes of omission are common in the critical care setting and lead to significant preventable mortality. There is a significant gap between the discovery of effective interventions and their use in clinical practice. By viewing the delivery of healthcare as a science and increasing funding for health services research, we may be able to increase the use of effective therapies and, as a result, reduce patient mortality.

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