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A List Maker Laments

Maureen Larkin, for HealthLeaders Media, January 17, 2008

When things get really busy, I depend on a "to-do" list to make sure that I complete everything that needs to get done in a given day.

Laundry? I can cross that one off the list.

Put the Christmas decorations away? Well, I'm making progress.

This column? Almost there.

Keeping a list not only helps me track all the things that need to get done at home and at work, but it also allows me a few moments of satisfaction every time I cross off one of the items.

I think my "list" habit is why the shutdown of a Johns Hopkins University study bothers me so much. By now you've no doubt read about the "checklist study" that the federal Office of Human Research Protections ended last month. Led by Peter Pronovost, MD, the study asked participating hospitals to use a five-item checklist for doctors and nurses in the intensive care unit. The "to-dos" were elementary--including washing hands and wearing sterile masks and gowns--but many medical professionals will tell you that they often observe their peers forgoing these simple tasks. Why? Maybe they've forgotten what they learned in medical school. Maybe they forgot to wash their hands just that one time. Maybe they were so focused on the procedure at hand that they needed a reminder to put on that mask and gown. If they're anything like me, a checklist is exactly what they need.

The OHRP says hospitals can use checklists to their hearts' content, but when an organization collects and reports data for a study without getting patients' consent, they might as well be giving them an experimental drug without their permission. OHRP says that if the 70 Michigan hospitals that participated in Pronovost's study want to start recording and reporting the data again, they must bring the study to institutional review boards for approval.

That can take months. Just imagine how many infections can be acquired in that time.

All hope is not lost. Pronovost's work has already gone a long way in proving the success of a checklist for doctors and nurses and I believe more and more hospitals will take notice of the results and implement checklists of their own. I also think the media attention that the OHRP's decision received has made patients more aware of the checklist, and it's likely they'll be asking doctors and nurses if they're following a checklist, or the steps on it.

The results the study produced are impressive and hard to dispute. At one hospital, the line-in infection rate went from 11 percent to zero in one year, and the hospital saved more than $2 million. Let's hope the industry recognizes the importance of this research and more doctors and nurses will find satisfaction in not only crossing items off their lists, but knowing they've provided quality patient care.

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.

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