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To link generic research on patient safety and the reliability of care to the specific context of the critically ill patient and the environment of the intensive care unit.Many improvements in patient safety could be implemented through changes in clinical behaviour and within existing resources. These changes require high-level institutional support and leadership combined with ownership by front-line clinicians. Reducing complexity, increasing standardization, and improving teamwork to create a culture of safety are key elements. The evidence base for some interventions needs further research. Competency-based training provides the mechanism for incorporating best practice across different specialities and disciplines.Patient safety initiatives, clinical care and medical education need to be better integrated to follow the continuum of the acutely ill patient's journey through the hospital system. Key elements include improving the reliability and standardization of processes of care, reducing unnecessary variation and complexity, and encouraging teamworking.