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  • The Checklist Manifesto

    Tue, 29 Dec 2009 05:29

    The New York Times takes a look at Atul Gawande's The Checklist Manifesto: How to Get Things Right:

    A hospital, as the saying goes, is no place for sick people. It's filled with hazards to your health, not least of which are the myriad infections, missed diagnoses, dosage mistakes and other complications that arise from human error. And in a hospital, human error seems all but inevitable. How can any one individual, or even any one team of individuals, keep all the tasks straight and anticipate all eventualities 100 percent of the time?

    But Dr. Peter Pronovost, a critical care specialist at the Johns Hopkins medical center in Baltimore, thought he knew how to minimize human error. It was, as Dr. Atul Gawande describes it in his provocative new book, The Checklist Manifesto, an idea so simple that it seemed downright loopy.

    In 2001 Dr. Pronovost borrowed a concept from the aviation industry: a checklist, the kind that pilots use to clear their planes for takeoff. In an experiment Dr. Pronovost used the checklist strategy to attack just one common problem in the I.C.U., infections in patients with central intravenous lines (catheters that deliver medications or fluids directly into a major vein). Central lines can be breeding grounds for pathogens; in the Hopkins I.C.U. at the time, about one line in nine became infected, increasing the likelihood of prolonged illness, further surgery or death.

    Dr. Pronovost wrote down the five things that doctors needed to do when inserting central lines to avoid subsequent infection: wash hands with soap; clean the patient's skin with chlorhexidine antiseptic; cover the patient's entire body with sterile drapes; wear a mask, hat, sterile gown and gloves; and put a sterile dressing over the insertion site after the line was in (more...)

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