(This is the first in a two-part series about a patient-driven checklist for their safe hospital care. It discusses the rationale for such a checklist. The second column will be the recommended checklist.)
I used to think that if my nursing staff and my colleagues and I all did our jobs well we could keep you perfectly safe when you were a patient in the hospital. I was wrong. A depressing new study on hospital errors suggests that all we have been doing in hospital care to prevent errors is still not enough. The article — published this April in Health Affairs, that favorite journal of bedtime reading for insomniac health policy wonks — found hospital errors in patient care continue to be common and many go unrecognized.
That’s despite progressively vigorous efforts to reduce them, especially in the 12 years since the publication of the groundbreaking Institute of Medicine report on medical errors, “To Err is Human.” That and a presentation I recently heard by a remarkable young woman named Tiffany Christensen (sickgirlspeaks.com) made me think we in health care needed more help from patients preventing these errors.
I’ve said before that I need your help taking better care of you. This time, however, I’m saying your job as the patient needs to be more specific, and must be performed with a new tool for the work. The job is to be the safety co-pilot in your care, and the tool is a safety checklist for you to use to help us all keep you safe during your hospitalization. (I will detail the checklist in the second column of this series.)
Why a checklist? Checklists come to health care from the airline industry, arguably the safest of all high-risk, complex human endeavors. So does the idea of the co-pilot assigned the job of making sure the activities on the safety checklist actually get done. Despite its huge role in the improvement of air travel safety, the checklist’s flight from the airline industry to the health care industry was so turbulent it would have made Chuck Yaeger yack up his complimentary peanuts. For years, physicians in particular contemptuously rejected checklists as “cookbook medicine” unworthy of their elephantine brains.
Medical studies have now proven what physicians all knew when our egos were not thinking for us; our physician brains cannot remember all of the things that need remembering in complex patient care. Our brains need checklists and other reminder systems to keep track of everything that must be compulsively done every time to avoid some kinds of errors, just as you and I do if we are not to forget baby dill pickles among the 40 other things we need at the supermarket.
In recent years, two studies have driven a checklist stake through the heart of the memory-based list of things that must be done in patient care. First, Dr. Peter Provonost and his colleagues in several Michigan hospitals proved that deadly infections caused by big IVs in patient neck veins (ouch!) could almost be eradicated by the fastidious use of a checklist of key steps in the hospital team’s management of those IVs. Then, a 2009 study showed the use of a checklist in the care of surgical patients reduced their risk of complication and death from surgery.
One contributor to that study, the brilliant physician author Atul Gawande, then wrote a book about the use of checklists in health care, “The Checklist Manifesto.” In it he explains why checklists and other such order-out-of-chaos tools are required to minimize human errors in complicated, high-risk human activities such as flying airplanes, construction and your hospital care.
Which is why you, our co-pilot in your safe care, should have your own checklist of things you and we must all do for you in the hospital.
In two weeks — the hospital patient’s co-pilot safety checklist
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.