The Checklist Manifesto: How to Get Things Right by Atul Gawande will finish off my trio of must-read medical books. A hospital, as the saying goes, is no place for sick people. It’s filled with potential disasters to your health, infections, missed diagnoses, dosage mistakes (think Dennis Quaid and the Heparin debacle with his newborn twins) and other complications that pop up from human error and in a hospital, human error seems a pretty sure bet.
But Dr. Peter Pronovost, a critical care specialist at the Johns Hopkins medical center in Baltimore, thought he knew how to minimize human error. The plan he put into effect was, as Dr. Atul Gawande describes in this book:
” . . . an idea so simple that it seemed downright loopy. In 2001 Dr. Pronovost borrowed a concept from the aviation industry: a checklist, the kind that pilots use to clear their planes for takeoff. In an experiment Dr. Pronovost used the checklist strategy to attack just one common problem in the I.C.U., infections in patients with central intravenous lines. Central lines can be breeding grounds for pathogens; in the Hopkins I.C.U. at the time, about one line in nine became infected, increasing the likelihood of prolonged illness, further surgery or death. He wrote down the five things that doctors needed to do when inserting central lines to avoid subsequent infection. Washing hands, wearing hospital gowns etc. but knew that about one-third of the time doctors were skipping at least one of these critical steps. What would happen if they never skipped any? He gave the five-point checklist to the nurses in the I.C.U. and, with the encouragement of hospital administrators, told them to check off each item when a doctor inserted a central line — and to call out any doctor who was cutting corners. The nurses were strict, the doctors toed the line, and within one year the central line infection rate in the Hopkins I.C.U. had dropped from 11 percent to zero.”
Dr. Atul Gawande, who in addition to practicing medicine, is also a popular writer for “The New Times,” heard about this study and wrote a series of articles on it and then decided to turn those into a book. As he states so elegantly,
“If something as simple as a list that reminds medical personnel to wash their hands and introduce themselves by name and job to everyone in the operating room can improve care, that’s reason enough to take the checklist concept seriously. What a powerful insight this is: In an age of unremitting technological complexity, where the most basic steps are too easy to overlook and where overlooking even one step can have irremediable consequences, something as primitive as writing down a to-do list to “get the stupid stuff right” can make a profound difference.”
-Norma
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