checklist https://scienceblogs.com/ en Simple checklist saves 1500 lives; feds axe it https://scienceblogs.com/neuronculture/2008/01/04/simple-checklist-saves-1500-li <span>Simple checklist saves 1500 lives; feds axe it</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>A New York Times piece by Atul Gawande gives some good news and bad news about a life-saving checklist developed to prevent fatal infections in intensive care units.<br /><br /> <br /><br /> <br /><br /> <img height="225" width="300" src="http://dobbs.typepad.com/smoothpebbles/checklist.jpg" /><br /><br /> <br /><br /> The good news:</p> <blockquote cite="http://www.nytimes.com/2007/12/30/opinion/30gawande.html?_r=1&amp;em&amp;ex=1199250000&amp;en=99bc5a8f83e06d58&amp;ei=5087%0A&amp;oref=slogin"><p><span style="font-family: Verdana; font-size: 11px;">A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.</span></p> <p><span style="font-family: Verdana; font-size: 11px;">The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.</span></p> </blockquote> <p>The bad news:</p> <blockquote><p><span style="font-family: Verdana; font-size: 11px;">Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.</span></p> <p><span style="font-family: Verdana; font-size: 11px;">The government's decision was bizarre and dangerous. But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is. Studying an experimental drug in people without federal monitoring and explicit written permission from each patient is unethical and illegal. Therefore it is no less unethical and illegal to do the same with a checklist. Indeed, a checklist may require even more stringent oversight, the administration ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk -- by exposing how poorly some of them follow basic infection-prevention procedures.</span></p> </blockquote> <p>Truly stunning. The <a href="http://www.nytimes.com/2007/12/30/opinion/30gawande.html?_r=2&amp;em&amp;ex=1199250000&amp;en=99bc5a8f83e06d58&amp;ei=5087%0A&amp;oref=slogin&amp;oref=slogin">Times article</a> is not long and is well worth reading, as is the <span style="font-style: italic;"><a href="http://www.nytimes.com/2007/12/30/opinion/30gawande.html?_r=2&amp;em&amp;ex=1199250000&amp;en=99bc5a8f83e06d58&amp;ei=5087%0A&amp;oref=slogin&amp;oref=slogin">New Yorker article from 12/10/2007</a></span> article from 12/10/2007 in which Gawande described the genesis of the checklist program. (That was before the Office for Human Research heard about it and gave it the shaft.)</p> </div> <span><a title="View user profile." href="/neuronculture" lang="" about="/neuronculture" typeof="schema:Person" property="schema:name" datatype="">ddobbs</a></span> <span>Fri, 01/04/2008 - 03:16</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/medicine" hreflang="en">medicine</a></div> <div class="field--item"><a href="/tag/atul-gawande" hreflang="en">Atul Gawande</a></div> <div class="field--item"><a href="/tag/checklist" hreflang="en">checklist</a></div> <div class="field--item"><a href="/tag/new-yorker" hreflang="en">New Yorker</a></div> <div class="field--item"><a href="/tag/medicine" hreflang="en">medicine</a></div> </div> </div> <section> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/neuronculture/2008/01/04/simple-checklist-saves-1500-li%23comment-form">Log in</a> to post comments</li></ul> Fri, 04 Jan 2008 08:16:31 +0000 ddobbs 142898 at https://scienceblogs.com