Another checklist victory

There's a new paper in BMJ on the use of checklists. In this study 8 care bundles, each with an associated checklist (available on the BMJ website), were introduced in the hospitals of the North West London Hospitals Trust. Five of the bundles were related to prevention or management of infections (central line insertion, ventilator associated pneumonia, MRSA, diarrhea and vomiting, and surgical site infections). Changes in mortality were monitored for diagnoses that would be expected to be impacted by the bundles as well as overall mortality. Significant reductions in mortality were noted beginning one month after implementation of the checklists. It is important to point out that this is a quasi-experimental study and confounders may be at play. Nonetheless, it's another piece of evidence that supports the checklist concept. After having now read both Peter Pronovost's and Atul Gawande's books on checklists, I am convinced that these simple tools can have huge impacts by their ability to drive high levels of compliance with practices that we know reduce risk. Ironically, the implementation of a simple and effective checklist turns out to be enormously complex given the culture of medical care which has traditionally bowed to doctor's autonomy (i.e., their egos). I was talking to one of my favorite surgeons last week about these issues, and he summed it up well: "The young surgeons get it. As for the old ones, I think we'll have to wait for them to die off."