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8 December 2007  |  Misc

Checklists? Check!

So I just read an article in this week’s New Yorker that really blew me away. It was about Peter Pronovost, an ER doctor who realized that there were hundreds of steps doctors and nurses had to take each day to care for patients in ICUs. He realized that with so many procedures, it would be easy for docs and nurses to forget a step here or there, so he designed a checklist for one of the procedures and got all the docs and nurses at John’s Hopkins (where he worked) to use it. The checklist was simple: there were 5 items on it, things like: “wash your hands”, “wear a mask”, “cover the patient in sterile drapes.” Then they tracked the results for a year and what they found was pretty astounding.

“The ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.”

Some folks were skeptical that the checklist would work in hospitals that had fewer resources and less staff, but after hospitals in Michigan tried out Pronovost’s checklist, it was clear that the numbers from John’s Hopkins were no fluke.

In one hospital in Michigan, the line infection rates were higher than the national average, higher than 75% of American hospitals. Here’s what happened after the Michigan hospitals implemented Pronovost’s checklist:

“Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six percent. The typical I.C.U….cut its quarterly infection rate to zero. Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the… first eighteen months, the hospitals saved and estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years.”

Pronovost estimates that it would cost 2 million dollars to get the checklists into hospitals across the country. 2 million dollars, that’s it. Yet still the medical community has not been quick to get on board. It blows me away, because as it says in the article: “If a new drug were as effective at saving lives as Peter Pronovost’s checklist, there would be a nationwide marketing campaign urging doctors to use it.” Isn’t that the truth.


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