A simple checklist to save thousands of lives

PUBLISHED : Monday, 22 March, 2010, 12:00am
UPDATED : Monday, 22 March, 2010, 12:00am

A simple procedure is saving thousands of lives. Although it has been known for many years, it has not been widely used. This approach shows how sometimes simple ideas that respond to real needs can have a dramatic impact on people's lives and health.

The rationale behind the development of this procedure was based on the several steps doctors have to follow when treating people in intensive care units (ICUs), or 'critical care'. On any given day, an estimated 90,000 people are in intensive care in the United States.

ICU patients undergo several procedures, most of them critical for survival: it is most important that some basic and necessary procedures are properly carried out - if they are not, patients can die.

In 2001, Dr Peter Pronovost, a professor at the Johns Hopkins University School of Medicine, began studying hospital-acquired infections. These infections affect one in 10 patients, killing 90,000 of them and costing as much as US$11 billion each year.

Pronovost began investigating this alarming situation at Johns Hopkins Hospital, focusing on bloodstream infections from central venous catheters used in intensive care units. He concluded that providing physicians with a chart reminding them of each step in some routine procedures could drastically reduce the number of errors leading to such infections.

Pronovost shortened lengthy guidelines into a simple checklist of five precautionary steps: doctors should wash their hands with soap; clean the patient's skin with chlorhexidine antiseptic; put sterile drapes over the entire patient; wear a sterile mask, hat, gown and gloves; and put a sterile dressing over the catheter site. Neglecting one or more of these simple procedures can lead to disastrous results.

Pronovost's initial findings were confirmed two years later in a Michigan study called the Keystone Initiative: in the first three months of the project, the infection rate in Michigan's ICUs decreased by 66 per cent. Within the initiative's first 18 months, the authors estimated that 1,500 lives and US$100 million were saved.

Based on his initial success, Pronovost and his colleagues later developed checklists for other situations in the ICU, such as mechanical ventilation.

Dr Atul Gawande, a surgeon and a professor of surgery at Harvard Medical School, enthusiastically promoted this approach. Working for the World Health Organisation, he brought the checklist idea to several hospitals around the world, with equally startling results: the rate of major post-surgical complications dropped by 36 per cent in the six months after the checklist was used, and deaths fell by 47 per cent in all the eight hospitals studied.

It is clear that using checklists for some situations can save lives and money in health care. Pronovost's approach is now being tried in California and Spain. If the results are equally positive, it will create new standards of health care performance both in the US and at the international level.

Cesar Chelala, MD, PhD, an international public health consultant, is a contributing editor to The Globalist