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An excess amount of the chaos and stress endemic to ICUs is due to poor systems engineering (think alarm fatigue); a rational, integrated approach to design & technology selection is needed to make ICUs more effective and safer for patients, argue Mathews & Pronovost. Academic health systems should fill the leadership vacuum, organize stakeholders and drive change by demanding more integrated systems from vendors and partnering with them to make them successful. JAMA 2011;305:934-935.