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February 18, 2010

How a checklist can reduce hospital infections

Hospitals can reduce medical errors and cut unnecessary hospital-related infections with the use of a checklist. Dr. Peter Pronovost, a professor of critical care medicine at Johns Hopkins School of Medicine, showed this years ago in a 2003 study of Michigan hospitals.

Since then, Pronovost, who won a "genius award" from the MacArthur Foundation two years ago for the innovative checklist borrowed from the aviation industry, has been on a mission to have the program rolled out around the country and the globe.

This month, a new study in BMJ, shows how three years after instituting the five-step checklist for doctors to follow when placing a central-line catheter, Michigan hospitals virtually eliminated ICU infections. And this week, Pronovost is out with a new book, called "Safe Patients, Smart Hospitals" with stories of real Hopkins medical errors and explanations how he thinks the checklist can improve health care.

I caught up with Pronovost who explained the concept as more than a simple checklist. It's a three-pronged strategy that requires hospitals to measure results and change their cultures. 

"Could a new nurse go up to a senior doctor who doesn't wash his hands and the doctor respond in positive way?" he said. "Just having a senior executive saying 'I’m using a checklist,' is good, but if that nurse doesn’t feel comfortable speaking up to the doctor, it’s not really going to be used."

Doctors aren't perfect and no one wants to put patients at risk. But sometimes egos get in the way, Pronovost said.

"I really want to have a discussion about how we treat each other in health care," he said. "We often don’t act as if we’re on the same team. Patients are suffering and we’re suffering because we feel like we are battling every day when we should be collaborative."

The checklist has been met with praise (notably from Boston surgeon and New Yorker writer Dr. Atul Gawande, who also has a new book out extolling the virtues of checklists). But there's also been some resistance from hospitals who say they are following the checklist, but they don't bother measuring their infection rates.

To be effective, Pronovost stresses, hospitals must embrace the entire strategy.

With a grant from the Agency for Healthcare Research and Quality, Pronovost's  Quality and Safety Research Group is rolling out the checklist in 28 states with hopes of expanding across the nation as well as into the UK, Spain and Peru.
Posted by Kelly Brewington at 7:00 AM | | Comments (0)
Categories: General Health
        

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About Picture of Health
Meredith CohnMeredith Cohn has been a reporter since 1991, covering everything from politics and airlines to the environment and medicine. A runner since junior high and a particular eater for almost as long, she tries to keep up on health and fitness trends. Her aim is to bring you the latest news and information from the local and national medical and wellness communities.

Andrea K. WalkerAndrea K. Walker knows it’s weird to some people, but she has a fascination with fitness, diseases, medicine and other health-related topics. She subscribes to a variety of health and fitness magazines and becomes easily engrossed in the latest research in health and science. An exercise fanatic, she’s probably tried just about every fitness activity there is. Her favorites are running, yoga and kickboxing. So it is probably fitting that she has been assigned to cover the business of healthcare and to become a regular contributor to this blog. Andrea has been at The Sun for nearly 10 years, covering manufacturing, retail , airlines and small and minority business. She looks forward to telling readers about the latest health news.
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