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Medical error is thought to contribute to a significant proportion of adverse events in hospitalized patients. An adverse event is an injury caused by medical management rather than the underlying condition of the patient []. Three sentinel studies which have examined adverse events in hospitalized patients include those of Leape et al., Bates et al. and Thomas et al. []–[]. The data on adverse events rates and preventable adverse events are detailed in Table 1.

Disasters, particularly earthquakes, volcanoes, floods, war-related complications, famine and infectious epidemics, have been a part of recorded human experience. From Pompeii to the Johnston Flood and World War II and the Black Plague to the Spanish Influenza, there have been catastrophic occurrences that will not long be forgotten by either legend or history books. Nevertheless, those occurrences were relatively few and far-between before the mid-twentieth century. Indeed, the nature of disasters has changed since then. From terrorists taking advantage of ‘new technology’ to weather-related events that cause trillions of dollars worth of damages and economic loss, the world has evolved.

Much of our clinical practice is historically based on the individual doctor-patient relationship. While this provides the foundation for the practice of medicine, we view work in a complex environment where care of the seriously ill has to be provided at the same level for 24 hours a day. Moreover, the care involves the seamless interaction between other areas of the hospital, such as emergency departments, general wards and operating rooms as well as between many different specialists. In order to evaluate these interactions and systems we will need to familiarize ourselves with the principles of Health Services Research (HSR).

Despite the tremendous technological advancements in the recent history of medicine, disparities in healthcare continue to exist. The preponderance of peer-reviewed literature on healthcare disparities focuses on conditions in the USA, yet disparities in one form or another exist universally throughout the world. Much attention has been focused on the USA because of a seminal publication from the National Academy of Sciences Institute of Medicine, entitled “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare” []. In this book, it is very clearly stated that minorities tend to receive a lower quality of healthcare than non-minorities, and that the sources of these disparities are complex and multifactorial. Directly relevant to the presence of disparities is that variations in healthcare and poorly managed-care results in expensive and avoidable complications. Disparities in healthcare are not simply related to patient insurance, income or access to healthcare. Nor are they wholly related to the delivery of medical care in our current healthcare systems. In this chapter, we will discuss the types of healthcare disparities identified in critically ill patients and the gaps in existing information, and explore how these disparities may differ from disparities in other conditions.

Since the first steps towards modern critical care during the Copenhagen polio epidemic in 1952, the use of intensive care to treat acutely ill patients has blossomed into an integral part of health care across the globe. Like other aspects of medical care, each country and culture has developed its own approach to building and using intensive care. Yet, little emphasis has been placed on fully understanding the multitude of differences that exist between countries with regard to resources, patients, and outcomes.