The post yesterday in “The Efficient Physician” blog brought out two recent articles on the use of checklists in medical settings. A Johns Hopkins physician designed a study that used a checklist (with all of five steps!) to prevent intravenous catheter infections in ICU settings. A DHHS funded study, administered by the Michigan Health and Hospital Association, was underway and was finding dramatic drops in infection rates. An Opinion piece in the December 30 issue of the New York Times details the situation.
Unfortunately, the program has been shut down by the federal Office of Human Research Protections. In a letter signed by one Kristina Borrer, PhD, the Office decided that the study needed to have informed consent signed by all patients and providers.
The ruling is bizarre. On this theory, no one could institute a change and then follow it to see if it works.
I’ve written in a number of posts in the past on the complexity of care, and how checklists have been a factor in decreasing errors and adverse events, such as in commercial aviation. One study of an ICU found some 178 staff-patient activities each day, all events that could lead to an error – something the study found averaged 1.7 times per day.
In an article in theDecember 10, 2007 issue of the New Yorker, Atul Gawande, a writer and surgeon at Brigham and Women’s Hospital in
Yes, a checklist can be viewed as paperwork, and health care folks go into anaphylactic shock at the mere mention of having to document what they do. Personally, I have to work to document my time and revenue and expenses in my consulting, speaking and training work. I love the work, but sometimes I’m moving fast and don’t want to stop to make some notes. But no one’s life is at stake, and I’m not trying to manage dozens of activities correctly and in sequence.
Read this article, and start to think about how to apply checklists in your office. Checklists can both organize the visit, and help staff to anticipate your needs. A checklist form can also double as a means of making notes as you go through the list. In place of the generic chart notes pages, a checklist based note page can be used instead.
I’d be very interested in experiences, formal and informal, in using checklists in medical practices. You can email me directly, or better still, share your Comments with everyone below.