A checklist. Atul Gawande tells the story of how much of a difference checklists made in a hospital ICU:
Pronovost and his colleagues monitored what happened for a year afterward. The
results were so dramatic that they weren’t sure whether to believe
them: 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.
Pronovost recruited some more colleagues,
and they made some more checklists. One aimed to insure that nurses
observe patients for pain at least once every four hours and provide
timely pain medication. This reduced the likelihood of a patient’s experiencing untreated pain from forty-one per cent to three per cent.
They tested a checklist for patients on mechanical ventilation, making
sure that, for instance, the head of each patient’s bed was propped up
at least thirty degrees so that oral secretions couldn’t go into the
windpipe, and antacid medication was given to prevent stomach ulcers.
The
proportion of patients who didn’t receive the recommended care dropped
from seventy per cent to four per cent; the occurrence of pneumonias
fell by a quarter; and twenty-one fewer patients died than in the
previous year. The researchers found that simply having the doctors and
nurses in the I.C.U. make their own checklists for what they thought
should be done each day improved the consistency of care to the point
that, within a few weeks, the average length of patient stay in
intensive care dropped by half.
Gawande has written a book on the subject, The Checklist Manifesto: How to Get Things Right.
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