(p. 71) Patient safety in the ICU 

While patient safety and quality have become a major focus of health care providers, policy makers, and customers over the last decade and a half, progress has been limited and wide quality gaps, where patient do not receive the care they should, remain. While technical improvements have gone a long way in these efforts, adaptive improvements in the culture of safety need to be more vigorously addressed. Likewise, quality metrics and a scientific approach to patient safety is necessary to ensure that interventions actually work. The Comprehensive Unit Safety Program (CUSP) strategy and its embedded Learning from Defects (LFD) process are central to creating a sustainable improvement in the culture of patient safety and quality, and in real outcomes and process improvements. CUSP is a bottom-up approach that relies on the wisdom and efforts of front-line providers who best know the safety issues in their immediate environment. The LFD process seeks to translate evidence into practice (TRiP model) building interventions and tools to improve safety and close the quality gap. The development of these interventions and tools are guided by the principles of safe design and the application of the four E’s (engagement, education, execution, and evaluation) can be successfully implemented into the health care environment with substantial improvements in safety and quality.