Silver Clipboard

Checklists Save Lives

The New Yorker ran a fascinating article on the medical profession and their use of checklists recently. Apparently, doctors don’t. Doctors who have to perform thousands of precise daily activities while under the burden of sleep deprivation and constant interruptions don’t feel the need to keep a basic checklist of activities.

Peter Pronovost has set out to change that, and he has the data to back him that it saves lives and millions of dollars.

Excerpt from the article:

A small crowd of Army brass and manufacturing executives watched as the Model 299 test plane taxied onto the runway. It was sleek and impressive, with a hundred-and-three-foot wingspan and four engines jutting out from the wings, rather than the usual two. The plane roared down the tarmac, lifted off smoothly… then it stalled, turned on one wing, and crashed in a fiery explosion.

An investigation revealed that nothing mechanical had gone wrong. The crash had been due to “pilot error,”… The Boeing model was deemed, as a newspaper put it, “too much airplane for one man to fly.”

They could have required Model 299 pilots to undergo more training… Instead, they came up with an ingeniously simple approach: they created a pilot’s checklist, with step-by-step checks for takeoff, flight, landing, and taxiing.

With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident.

Medicine today has entered its [Model 299] phase. Substantial parts of what hospitals do—most notably, intensive care—are now too complex for clinicians to carry them out reliably from memory alone. I.C.U. life support has become too much medicine for one person to fly.

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. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem: line infections.

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.

[Click here to read ‘The Checklist’ in The New Yorker by Atul Gawande]

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Header photograph by tallkev