Check, list

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Last week’s New Yorker had a fascinating article about how a simple medical checklist is transforming the complex, high stakes arena of intensive care. One of the most common complications in intensive care are so-called line infections, or contaminations of the synthetic tubes that doctors insert into patients’ veins in order to administer fluid, medication, or nutrients. Line infections occur in eighty thousand people each year in the U.S. alone, writes the author, Atul Gawande, and they are fatal between 5% and 28% of the time.

In 2001, a Baltimore doctor named Peter Pronovost designed a five-step checklist to help prevent line infections. The list is shockingly straightforward; doctors are instructed to:

(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.

The final step? Instructing hospital nurses to ask doctors whether or not any lines need to be removed each day. In the hospitals where Pronovost’s checklists have been implemented, they have made a remarkable difference. (In one hospital, the line infection rate dropped from 11% to 0 over the course of a single year.) The success, Pronovost speculates, is not just about mundane memory recall, but about making explicit the minimum, expected steps in complex procedures.

In the face of such intricacy, it’s amazing how simple life can be.

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