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The Checklist
Posted by: Jonathan 5:04pm, Friday, 7 December 2007
Surgeon/writer Gawande describes how forcing brilliant people to use annoying little checklists yields staggering improvements in their performance.
A study of forty-one thousand trauma patients—just trauma patients—found that they had 1,224 different injury-related diagnoses in 32,261 unique combinations for teams to attend to...Mapping out the proper steps for each is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much. In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try.
Jonathan says: Lots of great stats and anecdotes, including how to treat someone who's been dead for an hour and a half.

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Posted by: Jonathan 12:20am, Sunday, 6 January 2008
In an op-ed in the NYT, Gawande writes that the federal Office for Human Research Protections has shut the checklist program down. Apparently they found that implementing the checklist and analyzing the results was non-exempt human subjects research, which has requirements Johns Hopkins didn't follow (like getting informed consent from the patients).
(no subject)
Posted by: AJ 1:08am, Wednesday, 30 January 2008
Wow, that's totally crazy. I wonder if the people who made that decision knew they were following the letter but not the spirit of the law.
Vast right-wing conspiracy?
Posted by: Jonathan 6:22pm, Thursday, 31 January 2008
One idea that occurred to me, although this is probably way off base, is that the ruling was a PR/political move to drum up support for reducing government regulation of human subjects research. There are presumably business and political interests that would like to see human subjects requirements loosened, which would be consistent with the pro-business, anti-regulation stance of the current administration. Maybe they're hoping for a change in the law. If PR was their motivation, it seems to have worked. Gawande's op-ed in the NYT includes the following passages:
"the Office for Human Research Protections. Its aim is to protect people. But lately you have to wonder. Consider this recent case...Over 18 months, the [checklist] program saved more than 1,500 lives and nearly $200 million. Yet this past month, the Office for Human Research Protections shut the program down...The government’s decision was bizarre and dangerous...There need to be as few barriers to such efforts [as the checklist program] as possible...Now that the [quality improvement] work is becoming more systematic (and effective), the authorities have stepped in. And they’re in danger of putting ethics bureaucracy in the way of actual ethical medical care. The agency should allow this research to continue unencumbered. If it won’t, then Congress will have to."

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