We need medical checklists to prevent medical error.
A checklist to reduce medical errors seems like a no brainer right? But it’s not. A CNN article about medical researcher Peter Pronovost notes that in the U.S., hospital-acquired infections affect 1 in 10 patients, killing 90,000 of them and costing as much as $11 billion each year. The troubling thing is that many of these infections were the result of small, cumulative medical errors.
Research from the early 1990’s showed that patient care in ICUs required 178 individual actions per day, many of which must not only be performed but be done in the proper sequence.
The same research showed that nurses and doctors made errors in just one percent of these actions, an amazingly low amount. But these tiny missteps added up to two errors a day per patient. Furthermore, during a review of physician practices for one month, nurses found physicians skipped at least one procedural step in more than 33 percent of patients.
Pronovost came up with the idea to implement checklists for health care personnel to follow. In so doing he convinced a small number of hospital administrators to give nurses the authority to stop physicians if they saw them skipping a step on the checklist. After one year of implementation in a test group ICU, the 10-day infection rate went from 11 percent to zero. After 15 months, only two line infections had occurred. In this one hospital, the checklist prevented 43 infections, eight deaths, and $2 million in costs.
Pronovost then broadened his test to a large group of hospitals in Michigan. These hospitals began implementing Pronovost's checklists in ICUs in 2003. An article in The New Yorker found that within three months, hospital-acquired infections at typical ICUs in the state dropped from 2.7 per 1,000 patients to zero. More than 1,500 lives were saved in the first 18 months.
The truly amazing thing is that for such profound results, Pronovost estimated that the checklist program could be implemented nationwide within two years for a cost of only $2-3 million. In this day and age of stratospheric health care costs and the daunting price tag associated with certain versions of health care reform, implementing checklists seems an easy decision.
Sadly it is not, for two reasons. First, with no high profits or vast markets to sell it to the big players in American health care – drug companies and investors – no one is interested in helping promote the program. Second, the Office of Human Resource Protection has shut down Pronovost’s program, citing a lack of written informed consent from all providers and patients involved.
This is mind boggling. There are no apparent detrimental side effects to implementing checklists in hospitals. To the contrary, checklists only ensure that patients receive the care they are supposed to receive. Hospital checklists improve healthcare for everyone and save money. Why is this not standard practice everywhere?
For more on this issue, check out the following links where I got this information from:
Maggie Mahar "Pilots Use Checklists, Doctors Don’t. Why Not?"
Anne S. Kimbol. J.D., LL.M "Why a Checklist Will Not Be Saving Your Life"
The 2008 Time 100- Peter Pronovost
The New Yorker "The Checklist" Share this post :
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