Man versus machine: what's the standard?

At 2:45 pm on Thursday, May 6, 2010, the Dow Jones Industrial Average was already down 3.9% on fears that the Greek economy was in free-fall. Suddenly, in 5 minutes, the index plunged 573 points. Less than 2 minutes later, the Dow had rocketed back up 543 points, going on to finish the day down 3.2%. The “flash crash,” as it was described, was attributed to computerized trading on the part of several high-frequency trading firms. The machines that were making so much money for their corporate masters nearly caused a second market downturn during a time of tenuous market recovery.1 The concept of a computer-driven trading environment is a reality Wall Street investors deal with daily. Is this the future of medical care as well? Following the Institute of Medicine’s report “To Err is Human: Building a Safer Health System,”2 the specialty of critical care medicine hastily began to institute protocols and care bundles into routine clinical practice, with the belief that through standardization and simplification of tasks based on best-practice guidelines, caregivers would be more likely to deliver error-free care to the critically ill.3 Providers are now witnessing the natural progression of this type of standardized care as medical knowledge is integrated into computerdriven protocols. Such care protocols are being incorporated into the medical devices we use daily in the intensive care unit and are becoming part of the reality of critical care practiced in 2011.