Check it out

Much has been said about this excellent New Yorker article on checklists in medicine, by Atul Gawande, in which he talks with two checklist gurus -- intensivist Peter Pronovost from Hopkins (he wrote the Tintinalli chapter on ABG interpretation) and Markus Thalmann, an Austrian surgeon who led some truly incredible hypothermia arrest resuscitations.

The article gives a historical perspective to the concept of checklists -- from engineering to pilots -- and how it's moving into medicine. Checklists standardize complex activities like sterile line placement, leading to fewer complications, shorter ICU stays, and more lives saved. It's engagingly written and very relevant to ED practice.

Key grafs:

If someone found a new drug that could wipe out infections with anything remotely like the effectiveness of Pronovost’s lists, there would be television ads with Robert Jarvik extolling its virtues, detail men offering free lunches to get doctors to make it part of their practice, government programs to research it, and competitors jumping in to make a newer, better version. That’s what happened when manufacturers marketed central-line catheters coated with silver or other antimicrobials; they cost a third more, and reduced infections only slightly—and hospitals have spent tens of millions of dollars on them. But, with the checklist, what we have is Peter Pronovost trying to see if maybe, in the next year or two, hospitals in Rhode Island and New Jersey will give his idea a try.

Pronovost remains, in a way, an odd bird in medical research. He does not have the multimillion-dollar grants that his colleagues in bench science have. He has no swarm of doctoral students and lab animals. He’s focussed on work that is not normally considered a significant contribution in academic medicine. As a result, few other researchers are venturing to extend his achievements. Yet his work has already saved more lives than that of any laboratory scientist in the past decade.

I emailed the residents about this a month ago, but since then, the article has taken on additional significance, as I've committed to an informatics project on decision support. Not surprisingly, Gawande has covered this territory, as well.

So, there's not much more nuance I will add to what's already been said about Gawande's piece, other than to speculate that the Dr. Markus Thalmann that Gawande interviewd is the same man Austrian doctor listed as the winner of the 2003 Spartathlon. Runners like their checklists, too.