He developed that strategy and pilot-tested it from 2001 to 2003 at Johns Hopkins, where it virtually eliminated infections, he says. Pronovost then tested and perfected it in the state of Michigan in an effort that ran from 2003 to 2005 called "The Keystone Initiative," which most hospitals in Michigan participated in. Infection rates came tumbling down and the checklist—individualized to each hospital—is credited with saving 2,000 lives a year and about $200 million in avoided cost of care, he says.
Some of it was just using simple logic of what it takes to place a catheter, he explains. "When I walked through the process of the process, what I found was that there was no central place to store all the equipment you need. Gowns were in one place, masks were in another, and caps in another," increasing the opportunity for the process to carry infection.
"So we made a line cart. We got all the equipment and got eight steps down to one."
That made a huge dent in the infection rate. "But what really got us to zero was then we investigated every infection as a defect. That is, when infection occurred, we looked to see where the catheter was placed. Some placed in operating room, some in the emergency department," Pronovost says. "So we went to those places with the data to say, 'These are infections you guys own. You've got to put this program in place.'"
The checklist is only part of the strategy. Equally important is changing hospital culture so that any member of the care team—a nurse or physician's assistant—can stop the process if the doctor neglects one step.
Now, state-by-state, versions of the checklist are being adopted, and Pronovost notes "many states have cut their infection rates by more than half."