5 ms·

Often the medical errors happen on very common procedures like central-line catheters or IV insertions. Staff are overworked and tired, or they get distracted a

by jobu 10y ago

Often the medical errors happen on very common procedures like central-line catheters or IV insertions. Staff are overworked and tired, or they get distracted and miss one step and it results in a patient blood infection and often death. John's Hopkins came up with a five-step checklist for central-lines that reduced overall hospital deaths by 10% http://www.hopkinsmedicine.org/news/media/releases/safety_checklist_use_yields_10_percent_drop_in_hospital_deaths http://www.hopkinsmedicine.org/news/media/releases/safety_ch...

maxerickson 10y ago
A key aspect of that checklist program was that nurses were empowered to make sure doctors followed the checklist. Doctors are resistant to adopting such programs. https://en.wikipedia.org/wiki/Peter_Pronovost#Work https://en.wikipedia.org/wiki/Peter_Pronovost#Work
- Eric_WVGG 10y ago
  There’s a related bit regarding pilots and copilots. http://www.publicspeakingtoolkit.com/ethnic-theory-of-plane-crashes.html http://www.publicspeakingtoolkit.com/ethnic-theory-of-plane-... (take w/ the usual Gladwell-grain-of-salt)
jdudek 10y ago
The story of this checklist has been covered in “The Checklist Manifesto” by Atul Gawande. It’s a great read on how diligence in work can literally save lives. We can advance medicine by breakthrough discoveries that push our knowledge further, but improving how we apply the existing knowledge is just as (or even more) important.
- mariodiana 10y ago
  Gawande's essay (and book) on the subject came up just recently in discussion on Hacker News. What it all boils down to is that the medical profession in hierarchical and conservative: doctors don't want to change and don't want anybody telling them what to do.
  - crzwdjk 10y ago
    So was the piloting profession (in part because many pilots were ex-military), and yet somehow, that culture was changed to one of standard procedures, checklists, and Crew Resource Management. I'm still hopeful that the same can happen in medicine.
    - dragonwriter 10y ago
      The relationship between the military and piloting actually may explain why standard procedures, checklists, and Crew Resource Management were more natural than in medicine, despite both being hierarchical and conservative. I mean, the military is itself a hierarchical and conservative organization in which standard procedures, checklists, etc. are not exactly out-of-norm.
      - jluk 10y ago
        Fair statement but the military also has medical professionals. A wild speculative guess from my perspective is that airlines view it as an objective profession, you do these things to handle the machine and that is end of the story. Medical fields are somewhat subjective since we don't really understand the human body like we do airplanes - we didn't build humans from the ground up. We need to make the medical industry absolutely objective and quantitative in order for procedures and checklists to be effective. It still weirds me out how you need second "opinions" on a diagnosis, it just highlights our inability to understand ailments.
        dragonwriter 10y ago
        > Fair statement but the military also has medical professionals. Sure, the military has medical professions, but the military is not as dominant a source of medical professionals as it has been for professional pilots. So, it seems (to me, at least) plausible that military culture might have a substantially stronger impact on the piloting profession than medicine.
flubert 10y ago
>Staff are overworked and tired Yes, I wonder if anyone has studies the medical error rate as a function of how many hours the provider has worked previously that day, and the time of day. One thing I found crazy was that nurses were working three 12-hours shifts per week, but then there was overtime. This might be okay for a 7AM-7PM shift, but what about the 7PM-7AM shift? What if they changed to five 8 hour days instead? How would that effect the error rate?
- cmdrfred 10y ago
  Also, if demand is so high that they need to work such hours why doesn't the nurses compensation reflect that? Shouldn't they all be making 300k a year?
  - flubert 10y ago
    Oh, they are still working 40 hour weeks, just with a crazy schedule.
- jonwachob91 10y ago
  Typically a nurse working 12 hour shifts will do 3 days one week and 4 days the next week. The 7pm - 7am shift is actually EASIER then the day shift because a lot less happens. The patient is sleeping, the doctors are away, family is gone, and the test labs are closed. At that point the nurse has one job and one job only, keep the patient alive until morning (a hospitals real job is not to fix you, but to keep you alive. It's your primary's job to fix you). Of course the ED plays by none of those rules :)
- cloverich 10y ago
  The Catch-22 there is that a majority of medical errors occur during shift changeover. (Google will reveal an abundance of commentary / articles). In my personal experience (Medical school) the shift change's amongst Doctors could occasionally be profoundly short, unprofessional, and unregulated (think Resident handing off to Intern, in a rush, late in the evening, using a some notes hastily written on a notepad).
peckrob 10y ago
It always surprises me when I learn that more industries haven't adopted standardized approaches like this. Using a checklist when doing anything that may have the chance to seriously injure or kill, like for many things in medicine, just seems like a really good idea to me. Even if it takes a couple extra minutes to run. I'm a pilot in my spare time; every single thing we do usually has a checklist associated with it. Preflight cockpit, external and cabin, pre-engine start, engine start, pre-taxi, engine runup, pre-takeoff, takeoff, after takeoff climb, cruise, descent, before landing, base and final, after landing, shutdown and park. Every phase of a flight has a checklist associated with it. Emergencies or unusual situations also have their own checklists. Hell, even walking into many FBOs, there are signs reminding you to turn off your master switches and close your flight plans. In training, it is drilled into new pilots to always, always follow the checklist to the letter. Because when we don't, we stand a good chance of missing something. In extreme cases (just like in medicine), just one missed item on a checklist can get you killed [0]. I've found this obsession with checklists seeping into other areas of my life. I have a 15-item checklist for leaving the house when I go out of town, for instance. And in software development, I have a 10-15 item checklist I always go through before rolling code to master (this has saved me countless embarrassments on the low side and potentially bringing the site down on the high side). TL;DR checklists are good, and more people should use them. [0] http://www.rapp.org/archives/2015/12/normalization-of-deviance/ http://www.rapp.org/archives/2015/12/normalization-of-devian...
- kevan 10y ago
  A fundamental difference between medicine and flight is motivation. When pilots screw up they die, when doctors screw up, someone else dies. Medicine idolizes heroes, a single doctor doing everything and saving the day. In air travel the heroes tend to die. The origin of the airline checklist is when Major Ployer P. Hill, one of the best test pilots in the Army, forgot to release the elevator lock on a B-17 prototype before takeoff and died as a result.
  - peckrob 10y ago
    I don't disagree. Aviation generally has a safety conscious culture, which is easy for pilots because we're putting our lives on the line each time we get in the cockpit. I like not dying, so I'm going to do all things I can to avoid screwing up. :) Ironically, failing to release the gust lock was exactly what killed the pilot and passengers in the article I linked. Although like most crashes that was just the final result of a long string of failures.
matwood 10y ago
When I had my ACL fixed, the nurse doing the IV asked if I was worried about the surgery. I told her the only thing I was worried about was catching some hospital bound staff infection or being given the wrong medicine while I was under. She seemed a bit taken back, since it was not about my knee (I had already done the "This leg!!!" in sharpie), or her currently sticking me with an IV. She continued to chuckle a bit until she realized I was serious.
- fokinsean 10y ago
  Currently my reason for procrastinating on getting my wisdom teeth pulled. I freaked myself out by reading many stories of things going wrong. Ugh.
  - jandrese 10y ago
    You don't have to be put all the way out for a wisdom tooth extraction. They can do it on local. It's safer and cheaper although you might get grossed out by the sound of your tooth shattering when they have to break it to get it out--probably not though, the drugs are very good. You're lucid enough to feel them going for the wrong tooth or something.
lbhnact 10y ago
Just FYI, many hospitals other than JH were doing this long before JH. JH is actually on the traditional/conservative end of the healthcare spectrum when it comes to process/algo/checklist style care, for better or for worse.

by jobu 10y ago

maxerickson 10y ago

A key aspect of that checklist program was that nurses were empowered to make sure doctors followed the checklist. Doctors are resistant to adopting such programs. https://en.wikipedia.org/wiki/Peter_Pronovost#Work https://en.wikipedia.org/wiki/Peter_Pronovost#Work

Eric_WVGG 10y ago
There’s a related bit regarding pilots and copilots. http://www.publicspeakingtoolkit.com/ethnic-theory-of-plane-crashes.html http://www.publicspeakingtoolkit.com/ethnic-theory-of-plane-... (take w/ the usual Gladwell-grain-of-salt)

jdudek 10y ago

The story of this checklist has been covered in “The Checklist Manifesto” by Atul Gawande. It’s a great read on how diligence in work can literally save lives. We can advance medicine by breakthrough discoveries that push our knowledge further, but improving how we apply the existing knowledge is just as (or even more) important.

mariodiana 10y ago
Gawande's essay (and book) on the subject came up just recently in discussion on Hacker News. What it all boils down to is that the medical profession in hierarchical and conservative: doctors don't want to change and don't want anybody telling them what to do.
- crzwdjk 10y ago
  So was the piloting profession (in part because many pilots were ex-military), and yet somehow, that culture was changed to one of standard procedures, checklists, and Crew Resource Management. I'm still hopeful that the same can happen in medicine.
  - dragonwriter 10y ago
    The relationship between the military and piloting actually may explain why standard procedures, checklists, and Crew Resource Management were more natural than in medicine, despite both being hierarchical and conservative. I mean, the military is itself a hierarchical and conservative organization in which standard procedures, checklists, etc. are not exactly out-of-norm.
    - jluk 10y ago
      Fair statement but the military also has medical professionals. A wild speculative guess from my perspective is that airlines view it as an objective profession, you do these things to handle the machine and that is end of the story. Medical fields are somewhat subjective since we don't really understand the human body like we do airplanes - we didn't build humans from the ground up. We need to make the medical industry absolutely objective and quantitative in order for procedures and checklists to be effective. It still weirds me out how you need second "opinions" on a diagnosis, it just highlights our inability to understand ailments.
      - dragonwriter 10y ago
        > Fair statement but the military also has medical professionals. Sure, the military has medical professions, but the military is not as dominant a source of medical professionals as it has been for professional pilots. So, it seems (to me, at least) plausible that military culture might have a substantially stronger impact on the piloting profession than medicine.

flubert 10y ago

>Staff are overworked and tired Yes, I wonder if anyone has studies the medical error rate as a function of how many hours the provider has worked previously that day, and the time of day. One thing I found crazy was that nurses were working three 12-hours shifts per week, but then there was overtime. This might be okay for a 7AM-7PM shift, but what about the 7PM-7AM shift? What if they changed to five 8 hour days instead? How would that effect the error rate?

cmdrfred 10y ago
Also, if demand is so high that they need to work such hours why doesn't the nurses compensation reflect that? Shouldn't they all be making 300k a year?
- flubert 10y ago
  Oh, they are still working 40 hour weeks, just with a crazy schedule.
jonwachob91 10y ago
Typically a nurse working 12 hour shifts will do 3 days one week and 4 days the next week. The 7pm - 7am shift is actually EASIER then the day shift because a lot less happens. The patient is sleeping, the doctors are away, family is gone, and the test labs are closed. At that point the nurse has one job and one job only, keep the patient alive until morning (a hospitals real job is not to fix you, but to keep you alive. It's your primary's job to fix you). Of course the ED plays by none of those rules :)
cloverich 10y ago
The Catch-22 there is that a majority of medical errors occur during shift changeover. (Google will reveal an abundance of commentary / articles). In my personal experience (Medical school) the shift change's amongst Doctors could occasionally be profoundly short, unprofessional, and unregulated (think Resident handing off to Intern, in a rush, late in the evening, using a some notes hastily written on a notepad).

peckrob 10y ago

It always surprises me when I learn that more industries haven't adopted standardized approaches like this. Using a checklist when doing anything that may have the chance to seriously injure or kill, like for many things in medicine, just seems like a really good idea to me. Even if it takes a couple extra minutes to run. I'm a pilot in my spare time; every single thing we do usually has a checklist associated with it. Preflight cockpit, external and cabin, pre-engine start, engine start, pre-taxi, engine runup, pre-takeoff, takeoff, after takeoff climb, cruise, descent, before landing, base and final, after landing, shutdown and park. Every phase of a flight has a checklist associated with it. Emergencies or unusual situations also have their own checklists. Hell, even walking into many FBOs, there are signs reminding you to turn off your master switches and close your flight plans. In training, it is drilled into new pilots to always, always follow the checklist to the letter. Because when we don't, we stand a good chance of missing something. In extreme cases (just like in medicine), just one missed item on a checklist can get you killed [0]. I've found this obsession with checklists seeping into other areas of my life. I have a 15-item checklist for leaving the house when I go out of town, for instance. And in software development, I have a 10-15 item checklist I always go through before rolling code to master (this has saved me countless embarrassments on the low side and potentially bringing the site down on the high side). TL;DR checklists are good, and more people should use them. [0] http://www.rapp.org/archives/2015/12/normalization-of-deviance/ http://www.rapp.org/archives/2015/12/normalization-of-devian...

kevan 10y ago
A fundamental difference between medicine and flight is motivation. When pilots screw up they die, when doctors screw up, someone else dies. Medicine idolizes heroes, a single doctor doing everything and saving the day. In air travel the heroes tend to die. The origin of the airline checklist is when Major Ployer P. Hill, one of the best test pilots in the Army, forgot to release the elevator lock on a B-17 prototype before takeoff and died as a result.
- peckrob 10y ago
  I don't disagree. Aviation generally has a safety conscious culture, which is easy for pilots because we're putting our lives on the line each time we get in the cockpit. I like not dying, so I'm going to do all things I can to avoid screwing up. :) Ironically, failing to release the gust lock was exactly what killed the pilot and passengers in the article I linked. Although like most crashes that was just the final result of a long string of failures.

matwood 10y ago

When I had my ACL fixed, the nurse doing the IV asked if I was worried about the surgery. I told her the only thing I was worried about was catching some hospital bound staff infection or being given the wrong medicine while I was under. She seemed a bit taken back, since it was not about my knee (I had already done the "This leg!!!" in sharpie), or her currently sticking me with an IV. She continued to chuckle a bit until she realized I was serious.

fokinsean 10y ago
Currently my reason for procrastinating on getting my wisdom teeth pulled. I freaked myself out by reading many stories of things going wrong. Ugh.
- jandrese 10y ago
  You don't have to be put all the way out for a wisdom tooth extraction. They can do it on local. It's safer and cheaper although you might get grossed out by the sound of your tooth shattering when they have to break it to get it out--probably not though, the drugs are very good. You're lucid enough to feel them going for the wrong tooth or something.

lbhnact 10y ago

Just FYI, many hospitals other than JH were doing this long before JH. JH is actually on the traditional/conservative end of the healthcare spectrum when it comes to process/algo/checklist style care, for better or for worse.