A long with improving patients' safety and reducing medical errors, one of the main challenges in medicine is implementing new strategies that have the potential to improve health outcomes. After the process of critically appraising clinical trials has finished, and the results of this appraisal are used to guide changes in clinical practice, it is then time to critically appraise the success of implementation.
In other words, are physicians really performing the new strategy in its entirety? If they are not, what are the barriers to implementation? Unfortunately, there is no “golden bullet” for successful implementation of new strategies in medicine [1,2]. However, common factors in the failure of implementation have been identified, including environmental factors and factors related to the strategy itself .
Critically ill patients without diabetes often develop hyperglycemia. Until recently, it was common practice to treat only marked hyperglycemia in these patients, since hyperglycemia was considered to be an adaptive response to critical illness. But clinical trials have shown that so-called intensive insulin therapy (IIT) aiming at normoglycemia (i.e., blood glucose concentrations [BGC] between 80–110 mg/dl) can significantly decrease mortality and morbidity of patients in the surgical and medical intensive care unit (ICU) [4–7].
We questioned whether IIT truly has become part of standard therapy in ICU patients and, if it is applied, to what extent? We performed a systematic search of the medical literature, in which we focused on surveys and reports on the practice of ITT (see Text S1). We searched for reasons why IIT had not been implemented. We compared factors that hindered implementation of IIT with factors hindering the adoption of other recently introduced strategies, both in ICU medicine and general medicine.