Rethinking Healthcare

How checklists can keep you alive after surgery

Posting in Healthcare

Having correct procedures on hand, knowing them, and implementing them make the difference between patients surviving surgery and dying after it. If a low-tech checklist in the hands of a nurse can solve this problem, why are doctors continuing to resist?

A New England Journal of Medicine study of post-operative care finds that managing complications can be as important as avoiding them after an operation.

The University of Michigan study found that differences in post-surgical death rates were not due to the number of complications encountered, but how they were handled.

Said study author John Birkmeyer, "What distinguishes high quality hospitals and low quality hospitals is how proficient they are at rescuing people once a complication has happened."

There are low-tech and high-tech ways of making these improvements.

  • The low-tech method, pushed by MacArthur "genius" Peter Pronovost (right), is to have checklists covering procedures and follow them.
  • The high-tech method is to not only have quick alerts on complications but data delivered at the point of care on what to do.

The problem with the checklist, as Pronovost himself learned, is that their use and control sets off a power struggle. He recommends nurses control the checklist, so doctors resist the process, because they don't like taking orders from nurses.

The problem with relying on technology is that, sometimes, technology is the problem. Faulty setting of alarms is the biggest technology hazard hospitals face. Their setting, again, can be controlled through the use of a checklist.

Having correct procedures on hand, knowing them, and implementing them make the difference between patients surviving surgery and dying after it. If a low-tech checklist in the hands of a nurse can solve this problem, why are doctors continuing to resist?

Is their ego killing their patients? And might the difference between good and bad hospitals lie in how much authority nurses are given?

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Dana Blankenhorn

Contributing Editor

Contributing Editor Dana Blankenhorn has written for the Chicago Tribune, Advertising Age's "NetMarketing" supplement and founded the Interactive Age Daily for CMP Media. He holds degrees from Rice and Northwestern universities. He is based in Atlanta. Follow him on Twitter. Disclosure