Lets be honest ,if you go to Jiffy Lube and get an oil-change, you get a checklist of what they did. It reassures you but more importantly, it reminds the Jiffy Lube employees not to miss someting important in the routine of their jobs.
So would a simple checklist help reduce medical mistakes in Maryland, the District of Columbia and nationwide?
Dr. Gawande made an appearance on January 6, 2010 on the much-loved Diane Rehm radio show to elaborate on "the Checklist" and many other topics. Among his conclusions, the widespread use of solitary confinement in this country constitutes torture or constitutionally proscribed "cruel and unusual punishment". http://wamu.org/programs/dr/10/01/06.php#29280
Dr. Gawande, while a proponent of checklists in intensive or critical care medicine, does not purport to have originated the idea. For that he focuses on Dr. Peter Pronovost of Johns Hopkins Hospital.
Dr. Pronovost put together a limited scope critical care checklist applicable to one of the biggest problems, infection.
Doctors had a simple list of procedures to which they were supposed to adhere when putting in a patient's central line: (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.
He then asked nurses to keep track of doctor's adherence to this checklist. The findings were shocking, more than one third of the time, physicians failed to follow these simple procedures. So he persuaded these observant nurses to point out to the physicians involved when they skipped a step and lo, line infections dropped from eleven percent to zero.
In one year 8 lives were saved, 43 infections avoided and more than two million dollars saved. This analysis does not even take into account the savings the hospital and its doctors enjoyed from avoiding medical malpractice lawsuits.
The success of this checklist led to more simple ones and the length of stays in the John Hopkins Intensive Care Unit, was reduced to half.
Dr. Pronovost took his ideas on the road to speak to physicians and hospital administrators who actively disliked "another form to fill out." Ultimately, his initiative came home to roost in Michigan where resistance was as usual, high. But the result of his checklists within the first three months, a drop in the rate of infection in Michigan's intensive care units of 66%. 66%!!
Sometimes the best medicine is simple. As a malpractice lawyer I see suspicious infections in many clients who have been in intensive care units. Yet, without a checklist there would be no way to catch the cause, in many instances a lazy shortcut from safe procedures by a doctor or nurse. Good prescription!
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