Streamline Training & Documentation: Checklists as a Quality Tool

Saturday, March 22, 2008

Checklists as a Quality Tool

Highly recommended: "The Checklist," by Atul Gawande, in the December 10, 2007 issue of the New Yorker.

Gawande addresses the question of what to do when expertise is not enough to maximize successful treatment of hospital patients. In other words, after providing all kinds of training to medical professionals, right up to the most advanced level, what else can you do?

Dr. Peter Pronovost of Johns Hopkins came up with the idea of using checklists to force consistent application of best practice in basics like preventing central line infections. With a checklist, one is no longer entirely dependent on memory during delivery of treatment in the inherently complicated context of caring for patients. Gawande's article details the highly positive results that hospitals adopting the checklist approach in critical care have achieved — far fewer infections, fewer deaths, and substantial dollar savings.¹

An example of a hospital checklist used to help minimize central line infections is shown below.

(click to enlarge)
Source: www.ntinewsonline.org
Gawande explains the two main benefits of Pronovost's checklists:

First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. ... A second effect was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. ... Checklists established a higher standard of baseline performance.

A key element in implementing use of checklists is having senior hospital executives visit the hospital units in question at least monthly to "hear people's complaints, and help them solve problems."

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¹ " An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU," by P. Pronovost, D. Needham, S. Berenholtz, D. Sinopoli, H. Chu, S. Cosgrove, et al. (New England Journal of Medicine, Vol. 355, December 2006, pp. 2725-2732). See also "Erratum: An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU" (New England Journal of Medicine, Vol. 356, June 2007, p. 2660).

You can read about the temporary disruption of data collection in a Michigan implementation of checklists in two reports in the Baltimore Sun, one in January of this year, and the other in February.

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Labels: Expertise, Management practices, Organizational culture, Professionalism, Quality, Risk management

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