MGMA: Patient Safety Checklists Cut Costs at Physician Practices

Physician groups looking to make their practices more efficient and increase their bottom lines should develop patient safety lists that address emergent events and routine activities. That's the advice of Elizabeth Wertz Evans, RN, the executive director of professional practice for the Oncology Nursing Society in Pittsburgh.

Speaking in Las Vegas during a session at the annual conference of the Medical Group Management Association, Wertz admonished the audience members who didn't think that they had time for checklists to consider that The Johns Hopkins Hospital has saved $2 million with a five-item checklist that reminds hospital personnel to first wash their hands.

"Every physician office is trying to be more efficient. Checklists can be a simple effort that can save a practice time and money," said Wertz.

She noted that checklists have been developed across many industries -- most notably aviation. "What we know from other industries is that developing a checklist clarifies processes so the same steps are taken each time. It establishes priorities, makes sure everything that needs to get done gets done, and it reduces errors." She added that it can also prompt the physician office staff to function better as a team.

During the session, and perhaps unsurprisingly, Wertz provided a checklist of her own, which describes four steps a physician group should take as it develops checklists for an office practice.

1.Develop the best checklist for the task

Wertz explained that some checklists are "do-confirm" while others are "read-do." Do-confirm is a memorized list that is often used to address an emergency where staff needs to jump into a task—a patient faints in the waiting room, for example.

A nurse would follow the steps from memory, but stop at a certain point to review the checklist to confirm that everything that needs to happen is happening. Read-do is a typical checklist. The order the items are completed may not matter. What matters is that they are completed.

2.Keep it short, precise, practical

Wertz suggests between five and nine easy-to-remember items. "Checklists should only include the most critical and important steps in a complex process and assign responsibility for those steps. The steps need to be clearly written and in simple language." So, a checklist for an office emergency would state: Office manager calls 911 not just "call emergency personnel."

3.Focus on "killer items"

Medication and dosages immediately come to mind here, but Wertz said this can also mean something as basic as making sure the physician or the physician assistant has the correct patient records in the examining room. "Checklists can help avoid situations that could not only harm a patient but that could embarrass a doctor.

If a physician starts going through the wrong patient records that could make a patient question the physician's competence." Wertz said a checklist that makes sure every patient is identified as they move through the office will help.

That could be something as simple as referring to the patient by name as the staff goes through the process of taking blood pressure, doing lab work, putting the patient in an examining room, confirming prescriptions and taking payment.

Wertz said this step means more than setting aside office time to review the checklist with the staff. "You need everyone to actually perform the checklists tasks." She explained that practice will identify tasks that may not be properly performed as well as out-dated tasks that are no longer necessary.

Wertz stressed that a key to developing effective checklists is to empower any member of the team to stop the process if one item on the checklist isn't followed. "We need to encourage everyone to be an advocate for quality patient care. That's what checklists are all about."