A simple storage device that saves lives

A simple storage device that saves lives

Summary: 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.

TOPICS: Health, Hardware, Storage

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?

Topics: Health, Hardware, Storage

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  • Procedure, not medium.

    It's the fact that there is a procedure and that there is some reminder to follow it.

    Paper pros:
    1. Cheaper
    2. No training to know how to write on it

    Electronic pros (handheld or similar):
    1. Paper is passive...a handheld can remind a doc or pharmacist of particular complications for a given patient, i.e. maybe something that needs to be done as a variant of the normal procedure. It can beep at ya if you haven't checked off a necessary step yet and should have...or w/e.
    2. You lose the handheld, you haven't lost all the data on it...it can be centralized and backed up in near real-time. You lose paper...or spill on it...and you may have lost all that data.

    Either *can* support the *processes* that need to be followed. And there are pros and cons to each.
    • Medium DOES matter

      Medium can make a vital difference in health care.

      Which is more likely to be followed: A printed list that comes with a catheter, or an electronic list that requires the user to remember to check a separate device.

      Keep in mind also that any re-usable device will at some point compromise cleanliness and sterility unless it can be effectively cleaned after use with each patient.
      • I hate speed cameras and like paper, but

        "Which is more likely to be followed"


        A neat simple and easy but also easily ignored damaged or lost piece of paper.

        Or a tiny (sealed and easily cleaned) gizmo worn by a medic or patient, or bolted to a bed, that wirelessly causes a checklist to be given, perhaps by voice synthesis and / or display on a screen (easily cleaned) on the wall?

        In the latter case the list is evident to all, i.e. patient (if conscious), anaesthetist, nurses as well as the main doctor(s).

        Not convinced? The electronic way can also mean that the system sounds an alarm (locally and / or wherever a supervising doctor is located) if it doesn't receive positive feedback that each (critical) item has been dealt with (with those carrying out the procedure having the option to record a decision to omit or modify an item and give the reason later). And the system can create a log file and perhaps a video recording.

        If I was a doctor I would probably dislike the electronic monitoring. But as a patient?

        Still not convinced? Talk to some lawyers and insurers ?
        • Which is more likely to be purchased?

          Who exactly would pay for those gizmos? Sounds great but when there is so much preesure on the medical care providers to accept lower and lower reimbursment it is difficult to keep a supply of pens and paper!

          One of the points I think this article brings out is that we must not loose sight of basic good practice and focus on the patient NOT placating some gizmo or electronic billing clerk.
          • Who would pay? Who usually pays...

            Got a mirror handy?

            But seriously, I certainly agree that we should not lose sight of basic good practice.

            Good paper checklists etc. would help a lot. And I think paper would be a lot cheaper if you were simply adding checklists to wards and operating theatres etc; they were followed, and that was about it. (I.e. when there was a problem the staff involved in the procedure would simply admit or deny having followed the procedure.)

            However, expensive as IT is, in other areas it is nontheless usually cheaper than employing people. And there is a trend towards computerising hospital administration. Thus my guess is that when you cost in a monitoring function, that I and another poster think insurers will come to insist on, this will be most cheaply and easily done electronically. As opposed to large quantities of completed chits being carted about and scrutinised. The database and processing support for the front line gizmo?s and screen etc. would be done as part of the IT systems hospitals have. It would probably require some of them to be upgraded, and there would presumably be an element of increased staffing. But there would be a good degree of standardisation. Not every hospital would have to develop every list and every system, itself.

            Further as regards costing, electronic monitoring systems would hopefully have sufficient advantages in being real time, and very accurate and reliable, to justify their cost by reducing the average time patients stay in hospital (because there were fewer infections and other problems consequent on errors).

            If the bed-days saved were not enough, surely a few expensive legal cases and claims avoided would pay for a lot of kit? Reduced insurance premiums?
    • Paper is easily attached to the patient record

      One of the points in the New Yorker article - written by a regular New Yorker
      contributor who is a physician - is that the completed checklists are made part of
      the patient's file.

      I can see the advantage in having all the records available electronically, but it
      appears that the larger benefit to electronic records comes when there is a handoff
      from one specialist to another.

      As long as insurance companies make money by denying people care, EMR will not
      be helpful.
      R Harris
  • RE: A simple storage device . . .

    I can offer a (recent) patient's take on this subject. It simply amounts to [b]paying attention to detail.[/b] Many times health care workers are rushed, so often due to under staffing, cost containment attempts, or dependence on 'agency' staff; that they fail to follow protocol at times. This is where [b]everybody[/b] has problems. While I was recovering, I noted [b]many times[/b] staff members working double shifts; and I was told that at times it (double shifting) was due to someone's failure to show up. After all, unlike a convenience store; [b]you just can not lock the doors and go home.[/b] So, when you are in a hurry or tired, s--- happens.
  • RE: A simple storage device that saves lives

    It is amazing how much trouble one spares himself and others, if basic common sense and care is applied. Conversely, lack of some basic sense or care can create very large problems....

  • As soon as Insurance companies read this

    This will become common.

    I saw a great computer system that included checklist for staff to follow and electronically sign (and I assume contained audit trails) during a relative's recent hospital stay. I thought it was pretty impressive. I think such a simple system would really help the hospitals in legal disputes, too, if they have the electronic checklists that are audited.
  • Who the hell is the ORHP? well.......

    I thought this was an interesting article and a mind-numbing example of bureaucratic ineptitude. Then I looked up this ORHP (Office of Human Research Protections) and found out it was created by Bush in 2000 to replace the small, underfunded Office of Protection from Research Risks (OPRR). OPRR reported to the NIH. OHRP, by contrast, reports directly to the Assistant Secretary of Health, putting it under the White House???s control. Why move it from the NIH (National Institutes of Health) to the White House? Well, I guess the OPRR was wasting its meager funds protecting, uh, human subjects of experimentation (think Tuskegee) when, in reality, it was poor defenseless stem cells that needed protecting.