This is off topic, but Janet sent it to me today and I googled the guy and he's very for real. Thought it was interesting.
ARS
February 11, 2008
Sinking a lifesaver; Feds need to get out of the way of ICU checklist
BYLINE: Charles S. Lauer
BODY:
A recent news story about intensive-care units is a lesson in just how hard it is going to be to reinvent the U.S. healthcare system. Even for someone who is used to witnessing the difficulty with which providers struggle to improve care, the story is incredible.
Here's the deal: About a year ago, a team of researchers at Johns Hopkins University published the results of a program they instituted in most ICUs in Michigan. The program is known as ''the checklist,'' and that is all it really is. The simple five-step program is aimed at reducing certain hospital infections, one of the leading causes of preventable medical mistakes and one that is threatening to get out of hand entirely, as antibiotic-resistant infections are soaring. In other words, people are dying needlessly, and the Johns Hopkins folks and Michigan hospitals are trying to do something about it, something that costs almost nothing and is replicable in every ICU in the U.S.
The checklist covers a few things that providers can do to ensure that when they insert intravenous lines into patients they don't introduce infections. The actions include handwashing and donning sterile gowns and gloves.
For such a simple protocol, the results were amazing. Within three months, the rate of bloodstream infections from IV lines fell by two-thirds. The average ICU cut its infection rate from 4% to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million across Michigan.
I am always fascinated by programs like this. So much of quality improvement isn't about installing expensive new technology, but about stopping and looking at some of the most basic things we do and making small changes that pay off big. Once I was invited into the flight deck of a Boeing 727 prior to takeoff and watched the co-pilot and the pilot go through their checklist to make sure the plane was in flying shape. It gave me a sense of comfort and security. So here we are in the 21st century and we find out that if the personnel in an ICU would simply go through an elementary five-point checklist, lives and millions of dollars could be saved.
I said this was an incredible story, but I haven't gotten to the incredible part yet. Here it is: The checklist is no more. It was shut down after a government bureaucracy called the Office for Human Research Protections-part of HHS-said that the researchers had proceeded without getting written, informed consent from each patient and provider, a breach of medical ethics. The Office for Human Research Protections compared the checklist to doing experimentation with a new drug without telling the patients they were administering it. Similar efforts under way at hospitals in New Jersey and Rhode Island were also shut down.
Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston and a noted New Yorker contributor, takes issue with the reasoning of the Office for Human Research Protections by noting the obvious-testing a checklist for infection prevention is not the same as testing an experimental drug. If it were, similar efforts to reduce pneumonia in hospitals, improve consistency of stroke and heart attack treatment and increase flu vaccination rates would also be unlawful.
We hope somebody will wake up and use common sense and get things back on track with the efforts the researchers at Johns Hopkins have undertaken.
It is hard enough to improve patient outcomes in the context of today's institutional challenges without establishing new, artificial barriers to saving countless lives.
A tragedy in the making. |
