In medicine, the four vital signs (pulse, blood pressure, temperature, and respiration) have become an important regular check on how a patient is doing. Missing one can be dangerous. Would a medical checklist help make sure that each step was completed?<\/p>\n\n\n\n
We’ll cover the benefits of medical checklists in a variety of medical fields and look at how they can significantly reduce complications and save lives.<\/p>\n\n\n\n\n\n\n\n
Medical practitioners didn\u2019t consistently measure and record the four vital signs until the 1960s, when nurses in Western hospitals designed patient charts that included them. Checking them off on a chart was a way of ensuring that in a busy and demanding environment, they wouldn\u2019t forget to make the checks every six hours. Hospitals have since added a fifth vital sign, the patient\u2019s pain level on a scale of one to ten.
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In 2001, a critical care specialist at Johns Hopkins Hospital, Peter Pronovost, decided to try a medical checklist for doctors, targeting a common problem in ICUs: central line infections. A central line is a type of catheter placed in a large vein that allows multiple IV fluids to be given and blood to be drawn. Pronovost\u2019s checklist listed the steps for avoiding infections: <\/p>\n\n\n\n
He asked nurses to watch doctors put lines in patients for a month and note and how often they carried out each step. More than a third of the time, doctors skipped at least one step<\/strong>. He then enlisted the hospital administration to authorize nurses to stop doctors if they skipped a step on the medical checklist.<\/p>\n\n\n\n Over a year, the line infection rate dropped from 11 percent to zero. Over 15 more months, there were only two line infections. Pronovost calculated that at just a single hospital, the medical checklist had prevented 43 infections and eight deaths and saved $2 million.<\/p>\n\n\n\n Pronovost tested more medical checklists in the Johns Hopkins ICU. For instance, his team created a checklist to ensure nurses checked patients for pain at least once every four hours and provided medication if necessary. The number of patients suffering untreated pain dropped from 41 percent to 3 percent.<\/p>\n\n\n\n They created another checklist for patients on mechanical ventilation or breathing assistance. Steps included making sure they received an antacid and propping up the head of the bed. The proportion of patients not receiving the specified care fell from 70 percent to 4 percent, incidence of pneumonias dropped by a quarter, and 21 fewer patients died than in the previous year.<\/p>\n\n\n\n Pronovost\u2019s teams also found that care improved when they had doctors and nurses in the ICU create their own checklists<\/strong> for what should be done. The average length of stay in the ICU declined by half. These medical checklists helped jog their memory and established the importance of basic steps<\/strong>, which even experienced staff had overlooked. They also set a higher standard for performance<\/strong>. For instance, before the ventilator checklist was implemented, half of the ICU staff hadn\u2019t realized the importance of giving patients antacid medication. In 2003, Michigan Health and Hospital Association implemented Pronovost\u2019s central line checklist throughout the state\u2019s ICUs; it became known as the Keystone Initiative. As part of the implementation process, each hospital assigned a senior hospital executive to hear staff concerns and help to solve problems. Executives learned that the right soap, shown to reduce line infections, wasn\u2019t available in more than two-thirds of ICUs. They quickly provided the soap to all Michigan ICUs. Other important supplies that were often unavailable were provided as well.Building on the Success<\/strong> of the Medical Checklist<\/h3>\n\n\n\n
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<\/p>\n\n\n\nStatewide Implementation<\/strong> of Medical Checklists<\/h3>\n\n\n\n
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