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Checklists Not Enough, Checklist Doctor Says


 

Peter Pronovost, MD, PhD, an intensivist and patient-safety researcher at Johns Hopkins University School of Medicine in Baltimore, has been widely profiled as the “checklist doctor” for his celebrated five-step checklist to reduce the incidence of central-line infections. But he objects to the label.

Just handing doctors and nurses a piece of paper is not likely to improve patient safety without two other essential steps: “We must also measure the results and give clinicians feedback, and we must change the culture so that they work collaboratively together,” he explains.

Dr. Pronovost shares his personal story as a safety expert who borrowed from aviation in developing his first checklist in 2001 in a Johns Hopkins surgical ICU in his new book, Safe Patients, Smart Hospitals, co-authored with Eric Vohr (New York: Hudson Street Press, 2010).

Dr. Pronovost says he still encounters resistance to the checklist in many U.S. hospitals. “Nobody debates that we should be doing the things on the checklist,” he says. “The evidence is strong. The barrier is culture or medical hierarchy. In what other industry would there be an accepted standard that failure to comply with it kills, in this case, 30,000 people per year, and yet we’re not comfortable having one worker question another about compliance with it?”

Hospitalists have a huge role in hospital quality and safety, he adds.

“I envision that they could take almost any practice guideline that’s out there and convert it into a checklist,” he says, emphasizing that hospitalists should appoint an interdisciplinary team to work on the project and make the checklists specific to one time and place. It also is important for hospitals to support hospitalists with dedicated time to work on such projects. “But in return, the hospitalists have to commit measuring safety performance and producing positive results,” he says.

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