Wednesday, December 10, 2008

Sprinting to Safety?

It was also a pleasure to see and hear from Atul Gawande at the IHI National Forum. It was a bit ironic to do so Nashville in that Atul practices roughly 500 yards from my office, at our sister institution, Brigham and Women’s Hospital. (Sometimes you have to travel far to see someone close to you.) He is deservedly widely read on quality and safety issues and is very well spoken on these topics.

Atul has been working with many people and hospitals to design and implement the WHO Surgical Safety Checklist. The checklist has a number of simple steps that should take place during the sign-in, time out, and sign-out phases of a surgical procedure. While there will soon be published formal documentation on the efficacy of this checklist in reducing harm during surgery, it was clear from Atul’s presentation that its use really makes a difference.

Noting that it usually takes about 17 years for an advance in medical treatment to reach the general public in a pervasive way, Atul and Don Berwick proposed a new approach to the diffusion of the Checklist. Terming it a “remarkable social experiment,” they challenged the audience and those not in attendance to engage in The Sprint. The idea is to try to get thousands of hospitals to actually adopt the Checklist in one or more ORs within the next 90 days.

I think this is a great idea. We recently adopted this kind of checklist procedure in our ORs -- as a direct result of a wrong-side surgery in our hospital and as a consequence of our broad-based transparency about that error. The procedure takes only 90 seconds to carry out.

As someone said today, there are two types of hospitals, the kind that have had a wrong-side surgery and the kind that will have one. A Joint Commission staff member told us recently that there are six wrong-side surgeries per day in the United States. This would be a good thing to change. Atul and his colleagues have provided the tool. Let’s grab the baton and sprint with it.


Anonymous said...

I copied and sent both this post and John Halamka's to the CEO of my former healthcare system just now. But then I realized exactly what he's going to do with them - skim them and forward them to his (marginally effective) VP for Quality, where they will drop into the same black hole I experienced for 20 years. THIS is why it takes 17 years for diffusion of this knowledge - people just plain don't get it. Conversion to a quality and safety person is almost a quasi-religious experience, which most have missed so far. BIDMC doesn't know how lucky they are for their CEO to be enlightened.

Anonymous said...

oh ps, above post signed,


Anonymous said...

Mr. Levy
I had the pleasure of sitting with one of your perioperative staff RNs during an all day workshop on the surgical safety checklist during IHI.
Her passion for patient safety is commendable. She also referenced your committment to safety and transparency as creating a cultural imperative at BIDMC to learn and improve.
With that type of wonderful support and focus she feels care can be safe.
I tried to recruit her but she would not come (-:
jen periop director

Anonymous said...

if all hospitals adopt your checklist, there will still be two types of hospitals-ones that have had wrong-side surgeries and ones that will have them.
pretty pessimistic outlook. that's uncharacteristic for you.

Anonymous said...

Hmm, not sure what you mean. I was suggesting that this could change.

Anonymous said...

Under the blog the checklist has a number of simple steps that should take place during surgical procedure.