Breaking high-tech news reported in the Washington Post:
“I cannot recall a clinical care innovation in the past 30 years that has shown results of the magnitude demonstrated by…”
Dr. Donald Berwick, president of the Institute for Healthcare Improvement, is talking about… a checklist.
Surgical teams, taking a clue from airline cockpit crews, used a checklist to ensure they confirm the patient’s name, make sure equipment has been sterilized, and administer antibiotics. An example:
Before skin incision, the entire team (nurses, surgeons, anesthesia professionals, and any others participating in the care of the patient) orally… confirms that all essential imaging results for the correct patient are displayed in the operating room.
Eight hospitals around the world (from London to Ifakara, Tanzania) tested a 19-point checklist on 7,600 non-cardiac patients. Early results say this reduced the rate of complications and death by more than a third.
A major obstacle to such checklists? Physician attitudes. As the article notes, doctors all know the importance of monitoring a diabetic patient’s blood sugar level during surgery — yet 10% of such patients aren’t monitored.
The real prescription isn’t necessarily “use cheat sheets.” True, when you can’t rely on memory (“Did they refuel the plane, or not?”), some type of performance support makes sense. The surgical team approach (which may mitigate against surgeon-as-deity) can create a work environment that encourages use of such tools.
- The New England Journal of Medicine article on surgical checklists
- The checklist