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How to Save Many Lives
on February 18, 2010
Having already read Dr. Atul Gawande's popular book, The Checklist Manifesto, I wondered whether or not Safe Patients, Smart Hospitals, by Peter Pronovost, M.D., Ph.D., would capture and hold my attention. After one chapter, I had no doubts.
As hard as it may be to believe in a country as advanced as the United States, thousands of people die each year from preventable medical mistakes. This book addresses why this happens and what can be done to save many of these people. Dr. Pronovost begins with the tragic story of 18-month-old Josie King, who was accidentally scalded at home and developed second degree burns. She acquired an all-too-common bacterial infection from a central line catheter while in the hospital, and then she got a secondary infection when the antibiotics administered to control the original infection killed helpful bacteria in her digestive system. Then there was sepsis and dehydration, but even all of this would not have killed the young girl were it not for lack of sufficient coordination and cooperation among the medical staff treating her. Just one chapter into this book you are already grieving, and you want to know more. By the way, if the term "central line catheter infection" sounds familiar, Dr. Gawande writes extensively about this problem in his book (and he characterizes Dr. Pronovost's book as a "tough-minded and revealing story of a leading doctor's crusade against medical harm").
It turns out that Dr. Pronovost's own father died in part because his cancer was not correctly characterized early enough--so Dr. P. finally enlists in the army of reformers. Along the way, he distills an unwieldy 120-page set of guidelines to reduce central line infections from the Center for Disease Control down to five key steps: (1) Wash your hands using soap or alcohol prior to placing the catheter, (2) wear sterile gloves, hat, mask and gown and completely cover the patient with sterile drapes, (3) avoid placing the catheter in the groin in possible, (4) clean the insertion site on the patient's skin with chlorhexidine antiseptic solution, and (5) remove catheters when they are no longer needed. Believe it or not, straightforward procedures like this ultimately reduce infections by over 50% in many cases.
Dr. Pronovost tells of an encounter (argument, really) with a surgeon who refused Dr. P's urgent request to perform additional surgery on a recent surgery patient. Fortunately, this surgeon walked away, and another surgeon was persuaded to take up Dr. Pronovost's request. It turned out that the patient's intestine and pancreas had been punctured in the first surgery.
Enough examples--you get the story. Oh, one more. Did you know that estimates are that about 30% of the time physicians operate defibrillators incorrectly?
The point of Dr. Pronovost's book is not that surgeons, physicians or other health care professionals are intentionally careless. Rather, as Dr. Gawande notes in his book, medicine has become enormously complicated, and the more complicated things are, the greater the chance of errors. Further, the protocols addressing the ways medical professionals communicate with each other need to be adapted in order to solicit and use the best inputs and observations available.
One of the famous dictums applied to medicine is, "first, do no harm." That can be easier to say than to do, but with people like Dr. Pronovost and many other medical professionals dedicated to improving health care, the outlook for better care is growing better every day. Thanks for writing this book and sharing your insights, Dr. P.