Guest editorial What makes a good ICU

The answer to the question "What makes a good ICU?" depends upon the perspective of the person who is being asked the question. Our group is comprised of three critical care research coordinators in a university-affiliated ICU, a haematologist involved in critical care research, and a study monitor. We believe that a good ICU is one that applies evidence from health research to bedside patient care practice in order to improve the outcomes of critically ill patients. To illustrate this perspective, we will present evidence developed by four members of our research group 1. In a systematic review of 79 hospital-based practices to improve the quality of patient care, more widespread use of deep venous thrombosis (DVT) prophylaxis was ranked number one 2. In an attempt to optimise our thromboprophylaxis practice, we critically examined our DVT prevention strategies which we viewed as an important patient safety practice. In Phase 1 (the observational phase) of this project, we recorded our DVT prophylaxis prescribing patterns, including pharmacological and mechanical interventions, as well as potential reasons for lack of DVT therapy. We found the rate of appropriate thromboprophylaxis to be 65%, which we judged to be grossly inadequate and which provided us with a catalyst to create an intensive multidisciplinary programme to ensure that ICU patients received optimal thromboprophylaxis. We understood that clinicians were aware of the need to provide their patients with thromboprophylaxis. We wanted to know why our patients were not receiving thromboprophylaxis 100% of the time. The answer to this question was complex.