Modern storage includes all manner of exotica: nanowires; HAMR; clusters and more. But research has shown that a simple storage device can save tens of thousands of lives a year in hospitals around the world. So why aren't doctors using it?
Paper isn't sexy, but it works The simple storage device is a human-readable list, printed on a piece of paper. Pilots use lists to ensure that the hundreds of details required to safely pilot an aircraft are properly looked after. But doctors?
Lists? We don't need no stinkin' lists! Dr. Peter Pronovost is the Medical Director of the Center for Innovation in Quality Patient Care and an Assistant Professor at Johns Hopkins University's School of Medicine. His research has demonstrated that simple checklists can save lives - lots of lives - in Intensive Care Units (ICU).
Catheter infections in intensive care Catheters are tubes inserted into you to monitor conditions, administer drugs or to drain. Nationwide some 11% of catheters become infected, often leading to life-threatening - or -ending - conditions in patients who are already very ill.
Dr. Pronovost tried a simple experiment: develop a checklist for catheter insertion and see what happens. First, the list:
- 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
- put a sterile dressing over the catheter site once the line is in
How hard is that? Nothing any doctor doesn't know - but all too often doesn't do.
The results: Quoting from a great article in the New Yorker:
Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.
More checklists Dr. Pronovost and his team developed other checklists and observed similarly dramatic results:
They tested a checklist for patients on mechanical ventilation, making sure that, for instance, the head of each patient’s bed was propped up at least thirty degrees so that oral secretions couldn’t go into the windpipe, and antacid medication was given to prevent stomach ulcers. . . . . the occurrence of pneumonias fell by a quarter; and twenty-one fewer patients died than in the previous year.
Just having doctors and nurses create their own checklists cut average stays in intensive care by 50%, saving lives and money.
Wider validation Dr. Pronovost tested his program in 103 ICUs in Michigan, including some in inner-city Detroit, the poorest large city in the US. The results were equally dramatic. According to research published in the New England Journal of Medicine the checklist program
. . . resulted in a large and sustained reduction (up to 66%) in rates of catheter-related bloodstream infection that was maintained throughout the 18-month study period.
The hospitals saved an estimated $175,000,000 in costs and over 1500 lives. With checklists.
The Storage Bits take The US spends about a third more per capita on health care than the next most costly country, Switzerland, and our results are worse than countries that spend half of what we do. Medicare's expected cost increases dwarf the Social Security "crisis" so beloved of fear-mongering politicians. If we can fix spiraling health care costs, Social Security is easy.
Electronic medical records are touted as a money-saving technology - and they are - but until we have a system focused on helping people get and stay well, rather than cost avoidance, American's have little reason to trust that EMRs will help rather than hurt.
Dr. Pronovost's checklists don't require fancy technology or big capital expenditures to save lives and money. Which is why you don't see them in TV ads. If I ran marketing for Hammermill . . . .
Data storage takes many forms. However it comes it extends human capabilities in ways we are still learning to appreciate.
Comments welcome, of course. Do they use checklists at your local ICU?