Be a Nudge! Save a Life
It's reassuring to know when you get on a plane, that the pilot has an emergency checklist and a co-pilot backing him up. It should also be reassuring to know that ICU doctors may soon be following their lead.
Every year, some 200,000 patients contract infections during their stay in intensive care. Most of these are treatable with expensive antibiotics and a longer hospital stay. In some cases, these infections can be fatal.
The majority of infections develop because of the tubes that are inserted into the body—the lungs, the bladder or heart—to keep us alive while other organs aren’t functioning. Doctors are supposed to follow anti-infection procedures when placing or removing these tubes, but guess what? Doctors are human and with so many patients and 200 to 300 general procedures to recall, the routine duties sometimes get forgotten.
Add to this the fact that, when a doctor forgets to wear his mask or to apply a topical disinfectant, an ensuing infection may not show up for days, leaving him or her largely unaware of the consequences. The lesson of cause and effect gets lost in the time delay.
Peter Pronovost, a critical care doctor at Johns Hopkins came up with a double-headed solution. First, he distilled the anti-infection procedures down to six simple commands that appear on a checklist; doctors no longer have to rely on their memory. If the doctor forgets, the nurse standing by has the go-ahead to give that doctor a nudge.
At Johns Hopkins, this checklist procedure had astonishing results, bringing the ten-day IV line infection rate down from 11 percent to zero. It prevented an estimated 43 infections and eight deaths in two years. Costs came down, too, by $2 million.
Dr. Manoj Jain an infectious disease specialist, was skeptical at first. “For years I thought that hospital-acquired infection was the price we had to pay for intensive care,” he says. “I questioned how repeating such routine injunctions could have much effect on our infection rates.” When the ICU infection rate at his hospital dropped by 50 percent, saving $702 per patient, he became an ardent convert. “Checklists may be one of the great medical innovations of recent years,” he says. “If this trend continues,” he jokes, “I may be out of a job.”