Checklist in ICU - A 'new' idea! Saving 28,000 Lives a Year

[Marc]

Although I haven't flown in some years, as a pilot I was a checklist fanatic. I still am a checklist fanatic in general. I almost couldn't believe it when I read this, but.... The New Yorker is running a piece by Atul Gawande that starts by describing the everyday miracles that can be achieved in a modern medical intensive care unit, and ends by making a case for a simple and inexpensive way to save 28,000 lives per year in US ICUs, at a one-time cost of a few million dollars. This medical miracle is the checklist. Gawande details how modern medicine has spiraled into complexity beyond any person's ability to track — and nowhere more so than in the ICU.

"A decade ago, Israeli scientists published a study in which engineers observed patient care in ICUs for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions — but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail. This is hard."

The article goes on to profile a doctor named Peter Pronovost, who has extensively studied the ability of the simplest of complexity tamers — the checklist — to save lives in the ICU setting. Pronovost oversaw the introduction of checklists in the ICUs in hospitals across Michigan, and the result was a thousand lives saved in a year. That would translate to 28,000 per year if scaled nationwide, and Pronovost estimates the cost of doing that at $3 million.

[Mike S.]

A similar article appeared in Reader's Digest a few months back. The 5 item checklist started with "Wash your hands". I have a copy on my desk as a reminder of the potential power of the checklist.

[Marc]

What are the other 4 items on the checklist?

[Caster]

Originally Posted by Marc

I still am a checklist fanatic in general. .

I like them too, and I did some checking to see where the air line checklist came from, check out the second to last paragraph on this article!

http://www.airforce-magazine.com/Mag...4/1004fort.pdf

[Marc]

Originally Posted by Caster

I like them too, and I did some checking to see where the air line checklist came from

Well, I was speaking as a pilot. Each aircraft had its own specific checklists. There were different ones for different situations:

Pre-Flight was one. Engine out was another.

[Complaint CAPA Guy]

A new study was just released regarding a simple checklist used in surgery. The study used a really basic checklist - that the right patient is on the gurney and the correct body part is being operated on; that antibiotics have been administered within an hour of the first incision; and that all instruments are accounted for at the end of the operation -- and none is left inside the patient.

They reduced complications by one third! They pause at three points in an operation - before anesthesia is administered, before the incision and before patient is taken out of the operating room. Staff orally verify each time that the precautions have been taken.

Do a Google search for Surgery Checklist Saves Lives and you can find a bunch of detailed articles. Amazing stuff - sometimes simple is best.

Gary