The Power of a Checklist

Great article on The Checklist – If something so simple can transform intensive care, what else can it do? by Atul Gawande

A decade ago, Israeli scientists published a study in which engineers observed patient care in I.C.U.s 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.

In the early years of flight, getting an aircraft into the air might have been nerve-racking, but it was hardly complex. Using a checklist for takeoff would no more have occurred to a pilot than to a driver backing a car out of the garage. But this new plane was too complicated to be left to the memory of any pilot, however expert. With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident.

Yet it’s far from obvious that something as simple as a checklist could be of much help in medical care. Sick people are phenomenally more various than airplanes. A study of forty-one thousand trauma patients—just trauma patients—found that they had 1,224 different injury-related diagnoses in 32,261 unique combinations for teams to attend to. That’s like having 32,261 kinds of airplane to land. Mapping out the proper steps for each is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much. In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try.

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.

Teams also complained to the hospital officials that the checklist required that patients be fully covered with a sterile drape when lines were being put in, but full-size barrier drapes were often unavailable. So the officials made sure that the drapes were stocked. Then they persuaded Arrow International, one of the largest manufacturers of central lines, to produce a new central-line kit that had both the drape and chlorhexidine in it.

Related: Why Isn’t Work Standard?Visual Work Instructionsposts on quality toolsEuropean Blackout not Human Error-Not

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4 Responses to The Power of a Checklist

  1. Ronald says:

    This hits the nail on the head and I agree that checklists are a valuable tool that has been overlooked. I have written about it as well,

  2. Anonymous says:

    It’s amazing to think that something as simple as a checklist could save 8 lives. With what is expected of doctors and nurses, you would think that every base would be covered. A good friend of mine just lost her grandmother to a misdiagnoses (they thought she had a kidney infection, not realizing that the real problem was her gallbladder failing). Literally the same week, my grandfather under the care of better doctors was diagnosed with gallbladder failure. If a simple checklist was implemented, my friends grandmother would still be alive today.

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