

Surgeons in England to adopt checklists - expect to halve death rate - mhb
http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/right-patient-right-limb-two-questions-that-have-almost-halved-death-rate-at-one-hospital-1366705.html

======
dcurtis
Finally.

The idea for a checklist in clinical settings was originally conceived by
Peter Pronovost at Johns Hopkins. Last year, Gawande wrote an awesome essay
for the New Yorker about the ICU checklists that were attempted in the US
(saving hundreds of lives) but eventually cancelled by regulatory
authorities-- "If you're changing the way things are done, you need to perform
controlled FDA-approved studies."

[http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_...](http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande)

Also, you should read his book _Better_ , which is just page after page of
interesting stuff; Atul Gawande is the Malcom Gladwell of medicine, but I
think his stuff is far more engaging.

~~~
Alex3917
This combined with How Doctors Think made me realize that our doctors in the
US are really no better than witch doctors. In fact in some ways going to a
shaman is probably better. They are less likely to cure you, but they are also
vastly less likely to kill you by accident. A pretty good tradeoff,
considering that medical accidents are the leading cause of death in the US.

<http://www.ourcivilisation.com/medicine/usamed/deaths.htm>

<http://www.ourcivilisation.com/medicine/usamed.htm>

And this isn't even counting the fact that none of our antibiotics are working
anymore because our medical system sees fit to use over 70% of our total
antibiotics produced each year in animal feed.

~~~
omouse
I'm going to be as nice and polite as I can be here.

Medical science has had a long history, at least a few hundred years and
performs studies/experiments/etc. to make sure that things work.

Witch doctors try random shit and see what sticks to the wall even if it means
the patient dies.

Do you see the difference?

If doctors were killing a lot of people, I'm sure journalists would have
jumped all over it by now and a lot of doctors would have malpractice suits
filed against them.

Antibiotics do work. There have been studies to prove that. This isn't the
small-time, this isn't the minor leagues, these pharma-companies are paying a
big chunk of change to make sure _something useful_ happens when you take
those pills.

If you want lies and deceit, I suggest you go to a "natural" "organic"
pharmacy that sells homeopathic garbage.

~~~
RK
_these pharma-companies are paying a big chunk of change to make sure
something useful happens when you take those pills._

Unfortunately, it's not always clear that those drugs do work. The problem
isn't in the scientific process, but how it's often carried out and reported
by the companies, who know exactly what it takes to get FDA approval (this is
BIG business). I'm interested in how this process can be improved.

The "alternative/complementary" medicine thing is a red herring, to be polite.

Here's an interesting article that discusses some of the _less than ideal_
ways that pharmacy companies report the science behind the drugs they develop,
among other things.

<http://www.nybooks.com/articles/22237>

I think it's an important and interesting issue that needs to be addressed
better (probably by the government).

~~~
omouse
You are correct of course. I remember reading about some pill right after WW2
that caused many birth defects but was approved for the public. It is a big
business which is precisely why there needs to be an overseeing body.

Alternative medicines isn't a red herring, it relates directly to witch
doctors. None of these alternative medicines are tested properly in an
objective matter to prove that they do in fact work. These people still
haven't gotten to step 1 on the stairs of science, while pharma companies are
at step 123901823091283 though still need to climb a few more.

~~~
Alex3917
"None of these alternative medicines are tested properly in an objective
matter to prove that they do in fact work."

Many have been tested and proven to work. The only reason they are
"alternative" is that doctors only prescribe medicines that the pharma
companies promote. So they will prescribe people statins to lower their
cholesterol, but they would never advise someone to take red rice even though
it does the exact same thing with less risk of complications.

~~~
maximilian
"Many have been tested and proven to work."

Are they in the journals though? (i'm asking honestly, i'd be very interested
to know)

~~~
Alex3917
Yes, but I'm not an ND or MD so I don't know which journals are reputable and
which are not. I get the feeling that research on botanical medicine mostly
gets published in the same journals that publish normal pharmaceutical
research, it's just that doctors only prescribe things that come in pill form.

------
kcy
I'm a med student and a programmer. I think there are a lot of similarities
between these two disciplines.

The body is an incredibly complex system that you or a pathological process
can perturb in a variety of ways, just like any other system. The results of
those perturbations may be evident immediately or may take a long time to
present themselves. The results are output in the form of physical signs and
symptoms. The way this particular system works is that there are more
potential pathologies than there are physical signs and symptoms, so sometimes
you end up with collisions in the pathology to sign/symptom mapping. In these
cases you can use instruments like labs, radiological tests, and sometimes
invasive methods like surgery to further investigate. These tests are
imperfect and are themselves perturbations to the system.

If you can come to a final diagnosis of the underlying pathology using the
tools at your disposal (history, physical exam, labs, tests, and procedures)
you can then engage in a therapy. The more precise your diagnosis, the more
precise your therapy can be. Again, therapies are also perturbations to the
system. Ideally these perturbations move the system back into its normal
functioning state though they may also cause undesired results that must then
be diagnosed and treated.

This entire process takes place within the context of a social interaction
that can itself help or hinder. Both doctors and patients have their own
social idiosyncrasies that may or may not match up well with each other.

I believe that most physicians operate by generating a gigantic hash table.
Essentially they know several patterns of physical signs/symptoms that act as
the key. The value is whatever knowledge they have of that disease process. As
medical knowledge progresses some physicians update their hash table
keys/values with new information, most don't. Almost all physicians update
their hash table (i.e. learn) using information gathered in the process of
seeing their own patients and recognizing the difference between the predicted
outcome and the actual outcome. This is often a subjective process. I think it
is because of this approach that most physicians find it hard to believe that
medical diagnosis and treatment can be highly systematized and is at least
partially such an obvious idea even needs a study to support its use.

------
gravitycop
Here's the checklist:
[http://www.who.int/patientsafety/safesurgery/tools_resources...](http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.pdf)
[PDF]

~~~
andreyf
_Before the patient leaves operating room, make sure that instrument, sponge
and needle counts are correct._

And I always thought that was a joke... guess not.

~~~
iamelgringo
That's what OR nurses generally do, count sponges, needles and instruments.
They also have to be willing to nose to nose with a crabby surgeon and tell
him to re-open the patient and try to find the missing sponge when the count
is off

------
a-priori
As a member of the general public, I do find it hard to believe this sort of
thing isn't done already.

As a victim of a minor surgical mishap myself (general anaesthesia applied
when it shouldn't have been), I can definitely believe "incidents" happen all
the time.

~~~
m0nty
"I do find it hard to believe this sort of thing isn't done already."

I showed a similar article to my wife (has worked in healthcare for 20+ years)
and she said "Oh yes, we do that all the time. Everything has a check-list."
So if it makes a difference, I guess it is either mandated for higher-level
staff (surgeons and consultants who are often a law unto themselves) or
rigidly enforced at all levels.

Also, the study might show bias because people will do the lists if they know
it's being assessed for an experiment, but might ignore it on a day-to-day
basis.

~~~
dcurtis
Any doctor who reads the study and sees the 50% reduction in death rate in
surgeries and 90% reduction in accidental deaths in the ICU would be negligent
to ignore checklists.

If this surgery checklist and the ICU checklist were to be implemented in
every hospital, they would save more lives than all new medications introduced
in the last five years, _combined_. Ignoring results like that is just
asinine.

~~~
Alex3917
"Any doctor who reads the study and sees the 50% reduction in death rate in
surgeries and 90% reduction in accidental deaths in the ICU would be negligent
to ignore checklists."

Unless the government has made it illegal.

------
tome
Although it might not mean much to those outside the UK, this applies to
"England and Wales", not just "England".

~~~
delano
Of course, we love the Welsh!

Also, it was a world-wide study that's been implemented in many places. Canada
too:

[http://www.cbc.ca/health/story/2009/01/14/surgery-check-
list...](http://www.cbc.ca/health/story/2009/01/14/surgery-check-list.html)

------
gravitycop
There are three columns on the checklist. Here is the first column:

    
    
       SIGN IN
    
    
      □ PATIENT HAS CONFIRMED
        • IDENTITY
        • SITE
        • PROCEDURE
        • CONSENT
    
      □ SITE MARKED/NOT APPLICABLE
    
      □ ANAESTHESIA SAFETY CHECK COMPLETED
    
      □ PULSE OXIMETER ON PATIENT AND FUNCTIONING
    
         DOES PATIENT HAVE A:
      
         KNOWN ALLERGY?
      □ NO
      □ YES
    
         DIFFICULT AIRWAY/ASPIRATION RISK?
      □ NO
      □ YES, AND EQUIPMENT/ASSISTANCE AVAILABLE
    
         RISK OF >500ML BLOOD LOSS 
         (7ML/KG IN CHILDREN)?
      □ NO
      □ YES, AND ADEQUATE INTRAVENOUS ACCESS 
         AND FLUIDS PLANNED

~~~
gravitycop
Here is the second column:

    
    
       TIME OUT
    
    
      □ CONFIRM ALL TEAM MEMBERS HAVE
        INTRODUCED THEMSELVES BY NAME AND
        ROLE
    
      □ SURGEON, ANAESTHESIA PROFESSIONAL
        AND NURSE VERBALLY CONFIRM
        • PATIENT
        • SITE
        • PROCEDURE
    
         ANTICIPATED CRITICAL EVENTS
    
      □ SURGEON REVIEWS: WHAT ARE THE
        CRITICAL OR UNEXPECTED STEPS,
        OPERATIVE DURATION, ANTICIPATED
        BLOOD LOSS?
    
      □ ANAESTHESIA TEAM REVIEWS: ARE THERE
        ANY PATIENT-SPECIFIC CONCERNS?
    
      □ NURSING TEAM REVIEWS: HAS STERILITY
        (INCLUDING INDICATOR RESULTS) BEEN
        CONFIRMED? ARE THERE EQUIPMENT
        ISSUES OR ANY CONCERNS?
    
        HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN
        WITHIN THE LAST 60 MINUTES?
      □ YES
      □ NOT APPLICABLE
    
        IS ESSENTIAL IMAGING DISPLAYED?
      □ YES
      □ NOT APPLICABLE

~~~
danw
Sounds a bit like Scrum (the agile methodology).

The Surgeon/Anaesthesia/Nursing teams reviewing what has been/needs to be done
out loud to each other is similar to a daily stand up and the initial sprint
planning meeting in a scrum team.

Saying things out loud to each other makes a social bargain that they
will/have been done.

------
Jem
I had v. minor "surgery" before Christmas and I got asked that many questions
I started to think they were taking the piss. Based on that, it surprises me
that they don't already have this checklist thing in place!

------
prakash
Charlie Munger talks about this in his book, Poor Charlie's Almanac.

------
rgrieselhuber
Seems like such a no-brainer for hospitals everywhere.

------
yan
Ever since I started taking flying lessons, I have been tempted to use
checklists for everything else in life.

------
jsdalton
Does anyone here use checklists in a similar manner for application
development?

~~~
abstractbill
I don't, but people won't die if my software doesn't work.

~~~
yellowbkpk
I don't, but people may die if my software doesn't work.

Our managers do...

------
daniel-cussen
In other news: schools to start using Dvorak in 2045.

------
tjic
Given that the death rate used to be 100%, I find it really exciting that the
death rate will now be halved.

Downside: all the zombies.

