Saving 28,000 Lives a Year 263
The New Yorker is running a piece by Atul Gawande that starts by describing the everyday miracles that can be achieved in a modern medical intensive care unit, and ends by making a case for a simple and inexpensive way to save 28,000 lives per year in US ICUs, at a one-time cost of a few million dollars. This medical miracle is the checklist. Gawande details how modern medicine has spiraled into complexity beyond any person's ability to track — and nowhere more so than in the ICU. "A decade ago, Israeli scientists published a study in which engineers observed patient care in ICUs for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions — but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail. This is hard." The article goes on to profile a doctor named Peter Pronovost, who has extensively studied the ability of the simplest of complexity tamers — the checklist — to save lives in the ICU setting. Pronovost oversaw the introduction of checklists in the ICUs in hospitals across Michigan, and the result was a thousand lives saved in a year. That would translate to 28,000 per year if scaled nationwide, and Pronovost estimates the cost of doing that at $3 million.
Get rid of the dinosaurs (Score:3, Informative)
They reflexively cry out against 'cookbook' medicine and 'socialized medicine' while ignoring sound scientific advice.
We really do need an attitude change here in the same way that Detroit needs an attitude change. (Throw the dinosaurs out.)
Re:The numbers are off (Score:1, Informative)
Michigan is a state, not a hospital..
I dont know US demographics that well, but it could be that Michigan has 1/28th of the total US population..
Re:Just another fad (Score:1, Informative)
An AED will not send a jolt if it doesn't detect the correct electrical signal in the heart. That is what the A is for in AED.
Re:Get rid of the dinosaurs (Score:5, Informative)
Huh? WTF has concerns about cookbook medicine to do with the need for universal access to health care? I am one of those physicians who reflexively cries out FOR universal health insurance. Of course I don't call that 'socialized medicine' because its not different than our 'socialized' school, EMS, Fire, Police, and Highway systems to name a few.
And while I think that there are a lot of potential problems with 'cookbook medicine' there are also a lot of potential benefits. Its like any tool that can be used to help or hinder the practice of medicine. For example, an EMR that reminds me my diabetic patient is overdue for annual eye screen and should be on an ACE-Inhibitor is a great idea. However if the same system forces my hand on the ACE-I when I know that patient has had multiple episodes of fainting due to low blood pressure (which an ACE-I would exacerbate) its a problem. Similarly, if I spend all my time inputting data into the EMR it becomes more of a hindrance than a help.
In the case of ICU checklists, nurses every year are required to do more and more documentation (an average of 18 pieces of paper for a new non-ICU admission to my hospital) and every checklist or additional page you add to that is taking time away from patient care. So what sounds like a great idea may in fact cause worse outcomes because it puts the nurses focus on a paper rather than their patient.
Of course what I always find to be funny is the very same people who have zero tolerance for any risk or error and decry doctors for an untoward fear of cookbook medicine are the first ones to ask you to depart from standard practice for their personal special case... the antibiotics they want for a virus, the expensive lab test or MRI that is really not necessary, the pricey new drug on TV they want when a safer older drug with a proven track record works just as well. That innate lack of trust of health care providers and assumption of laziness or ill will translates to their own relationships with their physician in different but recognizable ways.
The actual paper (Score:5, Informative)
It's not as glamorous as discovering a cure for some new disease, but it works great.
Notice the other things mentioned in the New Yorker article:
In fact, the most important part of the whole article is in these paragraph:
This is a year old, but (Score:2, Informative)
But if it isn't being done yet, a reminder won't do any harm!
The most significant thing I find (going from a year-old memory) is that they had to get the bean-counters to increase the amounts of disinfectant and protection sheets they bought, since these amounts increased VERY significantly when check-lists were used!
Collecting and passing information is the problem (Score:2, Informative)
Each time the hand off was done mostly verbal, always asking the same basic questions time and again, and if they forgot to ask a question of the outgoing staff, they would interrogate my wife who was heavily sedated and mostly unaware of her surroundings. Each time I had to step in and clarify. We were lucky she had a seasoned doctor, and I personally witnessed him rip a few new a$$holes.
I had the same thing happen when I slipped a disk in my lower back and required an ambulance. Although in excruciating pain, I had to recite my history and present circumstances to each staff member I came in contact with. It was like watching the old telephone game, where the original spoken message to the first person rarely matches by the time it makes it to the last person.
If they just had a way to not only capture the patient background and case history but easily convey it to next nurse or doctor, I would bet it would reduce plenty of mistakes. Currently, the details are written on forms, then entered into computers, only to be requested again from the patient by the doctor or next specialist or consultant. It would seem they either don't have easy or convenient access to the data on the computer or the doctors don't have the time to read the narrative. Perhaps some form of speech synthesis would work. The doctor could step into the room, press a button and get the playback or some form of timeline with the ability to drill down into details.
On a final note, if you ever have someone you know in the hospital, never leave them alone. You should make every effort to oversee their care and babysit the doctors and nurses. I don't know if our case was indicative, but when I saw my wife, who was hanging on to life in the ICU, sit up and scream because the nurse attempted to reuse an expired IV point, it got my attention! Not two minutes early I just got done telling her that the reason they moved her from immediate care to intensive care was because they could no longer medicate her through her IVs since they had all expired.
Fortunately she pulled through and has little memory of the hospital events. By the way, I almost lost her and it was just a kidney stone that was stuck. Don't ever buy the line "oh, they are painful but they will just pass". If the stone backs up the kidney too long, it can create an infection, which will immediately pass into the bloodstream. The rest is pretty fast and scary.
Re:At $107 per life... (Score:5, Informative)
Yes the methodology is important - and in this case the article is a fascinating read - basically he compared the number of mistakes beforehand and afterwards, but also looked at the correlation with the number of deaths before hand and afterwards.
In this case the causes are a known problem (especially line infections) and they could directly correlate the adoption of checklists with a drop in the incidence of line infections, and subsequently with a lower death rate. Seems like fair enough science to me, and logical as well :-)
Treatment errors kill (Score:3, Informative)
Re:Get rid of the dinosaurs (Score:3, Informative)
Re:Yes, and it's called LifeWings (Score:3, Informative)
When we had our baby, it was against hospital policy to have visitors stay the night.
Re:Yes, and it's called LifeWings (Score:3, Informative)
Re:Yes, and it's called LifeWings (Score:4, Informative)
I'm sorry, you're right.
"worse" was the wrong word. "less qualified in the actual medical stuff"
Nurse support staff, as the other poster named ist.
Re:Yes, and it's called LifeWings (Score:3, Informative)
You apparently have no fscking idea what a nurse does.
One of best predictors of whether or not you survive your hospital stay is the quality of nursing care. [nih.gov]
Nurses are responsible for infection control, for monitoring and record keeping of vital signs and other diagnostic data, and for administering medication. They are often the primary providers of patient education, and are often the ones who keep harried doctors from making stupid mistakes - in a "primary nursing" environment, nurses are the ones who are tracking and coordinating all the varied aspects of care, the ones who see the "big picture".
If you want to live, go to the hospital with the best nurses.
Re:Yes, and it's called LifeWings (Score:3, Informative)
Uh, no.
It is true that more doctors are specializing rather than going into primary care. This has nothing to do with the roles of doctors and nurses.
If a person thinks this, then that person has no idea what a nurse does. Nurses have been giving direct care to patients since the days of Florence Nightingale.
No, we're seeing a situation in which massive ignorance of a vitally important medical profession leads to that profession being undervalued as mere doctor's assistants.
Forgive me if I am unsubtle here but my mother and both grandmothers were nurses - it hits home for me.