"Protecting and developing health must rank even above that of restoring it when it is impaired." — Hippocrates

A couple of years ago, I cared for an adolescent with asthma. She had gone to a party at a friend’s house, and the friend had several cats and dogs. After several hours at the party, my patient didn’t feel well and called her parents to pick her up. She went outside to get some air and collapsed in the front yard. She was resuscitated but did not survive her hospitalization.

Was this a preventable death?
Prevention is not a major focus for those of us in the critical care community. Certainly, we pay attention to preventing complications of care in the intensive care unit (ICU), but we do not emphasize preventing admissions, or even preventing readmissions. Our primary care colleagues, especially pediatricians, spend a great deal of time on educational efforts to prevent injury and illness. Immunizations, smoking cessation, education about diet and exercise, seat belts, and car seats are all important areas of attention for primary caregivers.

Why should we in critical care focus on prevention, when we are so busy trying to care for our critically ill and injured patients? The first, most obvious answer is that prevention is what is best for our (potential) patients. How much better the world would be if no one ever needed care in an ICU! But another reason we should care about prevention is that by decreasing the need for critical care, we can help to address the worsening shortage of trained critical care personnel. By educating our patients about safer and healthier lifestyles, and by following our own advice, we can contribute to a better healthcare delivery system.

The healthcare community has been an advocate for legislation that has led to decreases in the severity of injuries based on preventative actions. Several years ago, after the state of New York passed a law requiring bicycle helmets for all children up to age 14, I noticed a substantial decrease in the number of children admitted to my ICU with severe head injuries from bicycle accidents. Advocating for safety laws, such as seat belt laws, car seat laws, bicycle helmet laws, and laws against drunk driving, is certainly within the scope of interest of the critical care community. Other injury prevention legislation deserves our attention, as well. We also have an important role in the recognition and reporting of child, elder and spousal abuse. Other areas such as drowning and poisoning prevention in children also deserve our attention.

“By educating our patients about safer
and healthier lifestyles, and by following our own advice,
we can contribute to a better healthcare delivery system.”

In addition to injury prevention, the critical care community can include disease prevention and management within the scope of our practice. I certainly understand there are many days that busy ICU staff must focus on moving one patient out to make room for the next (sicker) patient. But in the course of caring for the patient, we can begin the process of educating the patient and family about disease management and how to prevent another ICU admission. We cannot provide all the education a patient and family need, but we can, and should, begin the process. Just as discharge planning should begin on the day of admission, health education should begin immediately, as well.

In the case of the adolescent I described with asthma, more effective education about disease management might have prevented her ICU admission, and even her death. ICU admission from many acute and chronic diseases could be prevented with appropriate patient education and self-management, such as diabetes and chronic pulmonary diseases (including asthma). Other more acute disease processes can be less severe with early recognition. Significant improvement in the outcomes of patients with strokes or heart attacks has been in part the result of public education about early recognition. The Surviving Sepsis Campaign, for example, is working on improved early recognition of sepsis as one of the steps in decreasing mortality from sepsis worldwide.

It is important that the critical care community advocates for prevention, both for our potential patients and ourselves. We should care about prevention – lobby for it, demonstrate it in your own healthy lifestyles, and include it in your daily practice. Good patient education and public safety initiatives are everybody’s business.