The Power of a Checklist
When Dr. Pronovost was a young medical student, his father suffered intense pain and eventually died after being misdiagnosed with leukemia when he actually had lymphoma. "I became convinced that patients deserved better than our healthcare system is giving them," he says. Patient safety became a passion of Dr. Pronovost's, and in 2001 he sought to reduce hospital-acquired infections at Johns Hopkins University's hospital. Such infections are common in the United States, killing 90,000 people and costing hospitals upward of $11 million a year, Dr. Pronovost says.
Dr. Pronovost's plan was to use a checklist to help reduce the number of infections caused when doctors put central-line catheters into a patient's body. The list requires doctors to follow five steps:
1. Wash their hands with soap.
2. Clean the patient's skin with chlorhexidine antiseptic.
3. Put sterile drapes over the patient's entire body.
4. Wear a sterile mask, hat, gown and gloves.
5. Put a sterile dressing over the catheter site once the line is in.
Some doctors at first rejected the checklist and Dr. Pronovost's suggestion that nurses make sure the doctors complete each step on the list. However, in a short amount of time, most came around to the idea and the number of patients who got line-infections went from 11 percent to zero. Since 2003, use of the checklist has been required in all Michigan hospitals. It saved more than 1,500 lives in the first 18 months it was adopted as policy and countless more since. Dr. Pronovost says his system works because it's simple. "Standardize what you need to do, create a checklists and then when things go wrong, learn from them," he says.
Dr. Pronovost has since developed more checklists to help end other hospital-acquired infections. While the United States has yet to adopt the checklists in all hospitals, Dr. Pronovost says you can put part of his method to work the next time you or a loved one is in the hospital. "When a doctor walks into your room, you should absolutely say, 'Did you wash your hands?'" he says. "Likewise, when they are leaving, you can say, 'I hope you wash your hands on the way out.'"