Joseph Simmons of Yale’s School of Management points to a nudge from Atul Gawande’s New Yorker piece that reduces doctor error in treating hospital patients. Because a single patient’s medical care can require hundreds of decisions each day, some doctors and hospital administrators have experimented with using checklists for certain treatments. The checklists contain simple, routine actions, all of which doctors learned in medical school but may simply forget to follow because of time constraints, stress, or distractions. For instance, the checklist designed by a critical care specialist at Johns Hopkins Hospital for treating line infections includes the following items:
(1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in.
Johns Hopkins’ doctors were stunned by the results from the line infection checklist.
The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.
The checklists provided two main benefits…First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you’re worrying about what treatment to give a woman who won’t stop seizing, it’s hard to remember to make sure that the head of her bed is in the right position.) A second effect was to make explicit the minimum, expected steps in complex processes. (The critical care specialist was) surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. In a survey of I.C.U. staff taken before introducing the ventilator checklists, he found that half hadn’t realized that there was evidence strongly supporting giving ventilated patients antacid medication. Checklists established a higher standard of baseline performance.