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2006 Philip Kittredge Memorial Lecture. What to do when protocols fail.

Though advances in medical science have created improved therapies, often these are not widely provided throughout the health-care system. Also, there is growing recognition of the lack of safety in health-care delivery. The development of evidence-based, best practice, national guidelines has been encouraged to reduce unnecessary variation in care and for improving quality. Adoption of guidelines through local protocols has been disappointingly slow. This paper explores the parallel developments in safety and quality-of-care assessment, evidence-based medicine, guideline creation, and how development of national and international quality-improvement campaigns are promoting rapid change in care delivery processes. I discuss how this new opportunity can improve the quality of respiratory care and enhance the adoption of respiratory care protocols.