Imagine you are sitting in first class on a plane, waiting for the plane to push off from the gate, when you see two people in uniform, the pilot and co-pilot, dash from the Jetway into the cockpit. A few seconds later, a voice comes over the intercom, saying, “This is Captain Jones, please be sure your seat belts are fastened. We’re ready for takeoff.” What crucial event could not have occurred in this scenario? The pilot and co-pilot did not go through their checklist of safety measures. Fuel tanks full? Check! Flaps up? Check! Checklists, along with scrupulous reporting of all accidents and near misses, have helped transform aviation from one of the most dangerous modes of transportation into one of the safest. Last year, there wasn’t a single fatal airplane crash in the lower 48 states.
From aviation to skyscraper construction to steel manufacturing, checklists and reporting of accidents have become an integral part of safety improvement in practically every complex and potentially dangerous human endeavor you can name. Every endeavor, that is, except for health care, which lags far behind other industries in terms of safety improvement.
The most recent evidence for this came out last week in a new report from the inspector general of the Department of Health and Human Services, which found that only about 1 in 7 incidents leading to patients being harmed in a hospital gets reported. The inspector general estimated that the true rate at which Medicare beneficiaries suffer an “adverse event” — a medical error or an infection acquired in the hospital — was 130,000 per month.
Hospital administrators have had plenty of time to do something about this problem, which first hit the news in 1999, when the Institute of Medicine issued a groundbreaking report, “To Err Is Human.” In that report, the institute estimated that more than 200,000 patients are killed each year by infections, medication errors or other adverse events. That makes medical mishaps the third leading cause of death in the U.S.
Some hospitals have made great strides in reducing errors and infections using — you guessed it — checklists. About 10 years ago, Dr. Peter Pronovost, an intensive-care specialist at Johns Hopkins Hospital in Baltimore, and a team of colleagues put together a series of checklists for some of the most common procedures performed in the intensive-care unit. For example, they created a list of steps for how to put in a central line — a tube for delivering medication directly into a vein in the patient’s chest — in a way that reduced the risk of infection. They made a checklist to prevent patients on a ventilator, or breathing machine, from contracting pneumonia. When Pronovost was given a grant to get every ICU in the state of Michigan to use just three of his checklists, the result was 1,500 lives saved and the state of Michigan saved $100 million.
Today, there are dozens of checklists for many of the most risky procedures. Atul Gawande, a physician, even wrote a best-selling manifesto about the efficacy of checklists. So you’d think every hospital in the country would have instituted every single checklist it could. But they haven’t. Until they do, check out The Patient’s Checklist, a book that was just published, for some of the precautions patients and their families can take. And if you or a loved one lands in the hospital, ask for information about its safety record. A little more scrutiny will help push hospitals to do a better job.