- "A decade ago, Israeli scientists calculated that an average patient on life support required 178 individual actions a day -- ranging from administering drugs to suctioning the lungs. On top of those procedures, doctors and nurses have to figure out how to cure the patient." Yikes! No wonder we're in a shortage of health care personnel--the ICU patients need everybody the hospital has.
- "The medical community has responded to complexity by increasing doctors' level of specialization." Wouldn't this be akin to having a chief navigator, assistant navigator, instrument expert, and communications expert, all in the same cockpit?
- "Critical care has become its own field. Yet intensive care's complexity might have reached the level that not even those experts might be capable of tracking all its moving parts"--a very dire prediction, indeed.
- "Tens of thousands of checklists would be necessary to cover the needs of every combination of medical problems." Yes? Couldn't we just train tens of thousands of specialists? *wink*
- "Yet [the] lists have proved powerful when applied to basic procedures, mostly through avoiding the one tiny slip that can make all the difference." Potentially one would need 178 lists...ah well. It's no worse than rushing and making mistakes.
- "A test at hospitals that belong to the Michigan Health and Hospital Association found that enforcing a checklist of anti-infection measures cut the infection rate at intensive-care units by 66%." Two thirds. Wow.
- And the clincher: "Had a drug or device saved as many lives as [the] checklist, it would be universally adopted." Ha! Sounds like a good analogy, no?
Monday, December 3, 2007
Making 178 lists, checking them twice
The Informed Reader (B11) scoops Dec. 10's The New Yorker. The topic: Checklists for pilots are standard, so why not for surgeons as well? Saith surgeon Atul Gawande: