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Saving 28,000 Lives a Year
The New Yorker is running a piece by Atul Gawande that starts by describing the everyday miracles that can be achieved in a modern medical intensive care unit, and ends by making a case for a simple and inexpensive way to save 28,000 lives per year in US ICUs, at a one-time cost of a few million dollars. This medical miracle is the checklist. Gawande details how modern medicine has spiraled into complexity beyond any person's ability to track — and nowhere more so than in the ICU. "A decade ago, Israeli scientists published a study in which engineers observed patient care in ICUs for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions — but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail. This is hard." The article goes on to profile a doctor named Peter Pronovost, who has extensively studied the ability of the simplest of complexity tamers — the checklist — to save lives in the ICU setting. Pronovost oversaw the introduction of checklists in the ICUs in hospitals across Michigan, and the result was a thousand lives saved in a year. That would translate to 28,000 per year if scaled nationwide, and Pronovost estimates the cost of doing that at $3 million.
So the checklist reduced infection rates. But then, how many lives were lost for other reasons because medical staff wasted time on these checklists, while nurses enjoyed obstructing physicians?
A few years ago, people were absolutely sure that millions of lives could be saved by having AEDs everywhere. How many lives are being lost by amateur do-gooders who unnecessarily electrocute people who are not having heart attacks? Plenty of medical problems can appear like heart attacks to the untrained eye.
he TRACKED 2 mistakes per patient per day. That might be forgetting to fluff your pillow, that might be grabbing a medicine you're allergic to that adds complications and causes treatment not to work.. the point is that you just don't know! Therefore science is not happening.
Medical professionals are very much luddites when it comes to things like computerized lists. 90%+ of diseases have known research as to the process and outcomes to heal the person. That's precisely what checklists are for, and to track information. In the age of computers, the computer should create the list from known research for each patient. Then when the data is input the results can be measured against the research to see if the person is being cured or has another problem, or a mistake was made.
This has nothing to do with the quality of people's training or work. People WILL make mistakes... failure to understand that, and use tools to prevent, catch, or undo that is a lack of scientific procedure. Remember two articles ago when we said that people don't pay attention to science, that vaccines might cause harm, etc.. the answer was science... and now those same people don't want to follow procedures that affect car, cheeseburger, and Lego brick trying to say they won't work on people, who's not interested in science now?