The Keystone Initiative: A Checklist Success

From Atul Gawande’s The Checklist Manifesto: How to Get Things Right, p. 44:

In December 2006, the Keystone Initiative [which used checklists in the ICU and integrated executives to help remove roadblocks] published its findings in a landmark article in the New England Journal of Medicine. Within the first three months of the project, the central line infection rate in Michigan’s ICUs decreased by 66 percent. Most ICUs — including the ones at [Detroit's troubled] Sinai-Grace Hospital — cut their quarterly infection rate to zero. Michigan’s infection rates fell so low that its average ICU outperformed 90 percent of ICUs nationwide. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated $175 million in costs and more than fifteen hundred lives. The successes have been sustained for several years now — all because of a stupid little checklist.

This is the kind of thing that has to happen in every department of every hospital if we’re going to have affordable, first-class healthcare everywhere in the US. Unlike some other changes this one is relatively easy to implement and costs very little, with almost immediate payback.

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