Word: checklists
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Dates: during 2000-2009
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...study - which included 7,688 patients in eight hospitals around the world - saw death rates drop from 1.5% before the checklist was instituted to 0.8% afterward. Serious complications fell from 11% to 7%. Study sites included Seattle, London, Toronto, New Delhi, and Ifakara, Tanzania. (See TIME's A-Z Health Guide...
...checklist comprised 19 items to be carried out throughout surgery: seven before anesthesia is administered, seven just before the first incision and the rest before the patient leaves the operating room. The study focused on six checklist items, all involving basic safety issues, such as whether the identity of the patient, site and type of surgery were confirmed correctly, whether enough blood was readily available in case of excess bleeding and whether all the sponges used in surgery were accounted for after the procedure. (See the top 10 medical breakthroughs...
Although having the checklist on hand improved compliance by surgical teams - 57% of the teams involved in the study carried out all six checklist items, up from 34% before the study began - there were many teams that did not adhere completely to the list. That's why Dr. Peter Pronovost, who won a MacArthur "genius" award for creating the concept of medical checklists and studying them in intensive-care units, remains skeptical of the study's remarkable results. "I wish checklists were Harry Potter's magic wand, but they're not," he says. "The behavior changed trivially, not enough...
Gawande disagrees with Pronovost's critique. "There's a synergy between the items on the checklist," he says. "Any one thing at any given time might not add up to much, but the net effect of all of it put together - especially making for more effective teamwork - matters...
Gawande believes his checklist has already saved at least one life in his operating room, where he performs eight to 10 procedures a week. Like many doctors, he resisted using it at first. "I thought, 'Oh, I've got to do this checklist because I designed the thing.' I didn't expect to see a difference...