Tuesday, December 11, 2007

Simple Thing Make Huge Differences

Peter Pronovost's contribution to medicine will be as significant as Ignaz Semmelweis', and probably as well known.

Which will be too bad for us if the medical community ignores him as they did Ignaz for so long.

The problem: each ICU patient has 178 daily tasks required to keep them alive for another day. Each ICU nurse has between 4-8 patients to watch over each day, not including assisting any time there is an emergency in the unit. So each ICU has at least 712 tasks to do each day to keep their patients alive.

Could you imagine a Daily To Do list of 712 actions? Sure you can, but thinking about it probably made your head hurt and your heart quail. The amazing thing is that they get it right most of the time. For example, putting in a line (an IV to us average people) takes only 5 steps and they do all the steps 60% of the time and line infections only occur about 11% of the time.

But what happens when you add a checklist and a kit containing all the things you need in one convenient package? Line infections drop to almost 0%.

A medical breakthrough that reduces line infection rates to nearly 0% should be hailed as a major breakthrough, Nobel Prize winner talk should be going on, everyone should be changing to the new system with enthusiasm. Unfortunately, the response seems to be, "what? more paperwork?" I can appreciate that sentiment as the level of paperwork in hospitals and doctors offices now looks to be overwhelming even with computers to deal with the storage problem.

Don't forget the cost of learning this was 1 or more human lives.

The article goes into the story of the B-17 and it's first crash and how people called it "too much airplane for one many to fly." But adding a simple checklist make it much easier to fly. The writer also doesn't mention that all airliners come with a little clipboard attached to the yoke for the current checklist.

Heck, we went to the Moon of the power of checklists. The computers they used were less powerful then a $20 scientific calculator you can get at most grocery stores today.

This reminds me The Magical Number Seven Plus or Minus Two We can only hold about 7 things in our short term memory, 712 is way beyond that. While we can certainly chuck this stuff into something we can more easily handle it is important to realize that an interruption can cause us to forget what it was we were doing or what step we were at and we just forget.

When you are programming you can get into flowand be holding huge and complex data structures in your mind, but a "quick" interruption can make all that come crashing down, and it takes a long time, about 20 minutes to recover.

I know a lot of my first aid training came in the form of instilling checklists into our minds: breathing, bleeding, shock. When we had our car crash that checklist came to mind and that is what I did for us, even though I was trapped in the car and had 11 fractures.

I am thinking of doing more checklists for myself, that should make a number of things I need and want to do in life a lot easier.

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