New perspectives on error in critical care

PURPOSE OF REVIEW: Despite unprecedented attention on the issue of medical error over the last 8 years, there is little evidence of widely available improvements in patient safety. The present review addresses some alternative approaches to the study of human error, and their implications for the characterization of medical error. RECENT FINDINGS: The complex nature of healthcare work has been proposed as a primary barrier to the implementation of effective safety measures. Approaches to error, based on individual accountability, cannot address this complexity. Strategies to eradicate error fail to appreciate that error detection and recovery are integral to the function of complex cognitive systems. Through investigation of the emergence of and recovery from error, one can identify new approaches for error management. SUMMARY: The present review discusses contemporary approaches to error that are able to address the complex nature of critical care work. Instead of producing situation-specific 'quick fixes', they are more likely to reveal generalizable mechanisms of error that can support widely applicable solutions.