Tuesday, May 15, 2018

Siddhartha Mukherjee on checklists

Surgical Checklists Save Lives — but Once in a While, They Don’t. Why :”In 2014, Gawande’s team (now an organization called Ariadne Labs in Boston) started perhaps their most ambitious study on the impact of checklists. This time, the team focused its attention on the practice of childbirth in India: Could adherence to a checklist containing “essential birth practices” reduce the rates of infant and maternal mortality? The Ariadne team identified 60 matching pairs of facilities in cities like Lucknow and Agra in the state of Uttar Pradesh. A 28-item checklist was created: Was a clean towel provided at birth? Were there sterile scissors at hand? Did the birth attendant remember to wash his or her hands? Was the infant’s temperature measured after delivery? An intensive eight-month peer-coaching program to implement this checklist was used in half the paired hospitals. The study enrolled nearly 160,000 pregnant women. The chances of mother or infant dying, or of severe maternal complications, was measured. Despite the team’s strenuous attempts to implement this checklist, there was no discernible impact: The rate of adverse outcomes in the experimental group was identical to the rate in the control group — around 15 percent. About 7,400 babies were stillborn or died within the first week of life.”

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