The Office for Human Research Protections recently shut down a Johns Hopkins University program that had intensive care units across Michigan following “a simple five-step checklist designed to prevent certain hospital infections.” The program resulted in dramatic improvements to patient infection rates, but the federal agency said it was unethical, because a checklist interferes with medical care in the same way an experimental drug does—and because a checklist may put doctors at risk by revealing which ones don’t “follow basic infection-prevention procedures.”

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

A large body of evidence gathered in recent years has revealed a profound failure by health-care professionals to follow basic steps proven to stop infection and other major complications. We now know that hundreds of thousands of Americans suffer serious complications or die as a result. It’s not for lack of effort. People in health care work long, hard hours. They are struggling, however, to provide increasingly complex care in the absence of effective systematization.

Excellent clinical care is no longer possible without doctors and nurses routinely using checklists and other organizational strategies and studying their results. There need to be as few barriers to such efforts as possible. Instead, the endeavor itself is treated as the danger.

“A Lifesaving Checklist” [New York Times]

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“The Checklist” [The New Yorker]
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