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In a 1999 report on patient safety, the Institute of Medicine estimated that as many as 100,000 patients died of medical errors of commission in the United States, with a cost of over $50 billion per year. Patients in the intensive care unit (ICU) are thought to be particularly at risk for errors. Published reports estimate that 1.7 errors per patient per day occur in the ICU, with 148,000 life-threatening errors predicted annually in ICUs in teaching hospitals alone. Despite the publicity generated by the Institute of Medicine report and all of the efforts made to improve patient safety, some questions remain regarding the empiric evidence that safety has been improved, especially in the ICU. Healthcare has suffered from lapses in quality and safety because, unlike other industries, the delivery and organization of healthcare has historically not been viewed as a science. A new approach for improving safety in the ICU, which includes safety tools (eg, daily goal sheet, critical care bundles, a comprehensive unit-based safety program) and a framework for measuring safety in the ICU has recently been implemented and tested. The initial results of this approach show potential for improving safety in critically ill patients.