Anyone who cares about health care quality, medical errors, hospital acquired infections and the like — Brigham & Women’s Surgeon Atul Gawande’s 12/10/07 New Yorker article — The Checklist: If something so simple can transform intensive care, what else can it do? — is simply must reading. We’ll be sending it to all our Consumer Council members, and you want to be as up-to-date as they are, don’t you?
Gawande, a 2006 MacArthur genius awardee, looks at the hospital Intensive Care Unit and all its marvelous curing capabilities and stunning opportunities for things to go wrong. He describes the work of a Johns Hopkins critical-care specialist named Peter Pronovost who discovered the extraordinary ability of the simple check-list to achieve quantum leaps in medical error reductions.
From Dr. Lucian Leape, I had learned that a consortium of Michigan hospitals had succeeded in reducing the rate of certain kinds of hospital infections to zero. I had no idea the key innovation tool they employed was a “stupid little checklist” (Gawande’s description).
In the future, when we hear how difficult and challenging it is to improve patient safety, infection rates, mortality, and the like, there’s a new retort — have you tried using a checklist?
John McDonough
John,
Atul’s story and conclusions are important, too, with regard to the post you wrote above this on controlling health care costs. Our experience with reducing central line infections and ventilator associated pneumonia mirrors the success stories he writes about. This all demonstrates not only the medical advantages of these rather straightforward programs, but also the cost savings that result. For example, every case of VAP avoided saves about $40,000 in hospitalization costs. We believe we have avoided over 300 cases of VAP in the last year, saving health care costs of $12 million. Here’s the story on VAP: http://runningahospital.blogspot.com/2007/09/teamworks-wins-against-vap.html and the one on central line infections: http://runningahospital.blogspot.com/2007/05/central-line-infection-report.html
I would like to know what is the check list. I’ve read that it is 5 items, but can’t find it anywhere.
Thanks
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Here is “the checklist” as published in Atul Gawande’s article: On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in.
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