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.
