Newsmaker: Peter Pronovost, M.D.

Every year tens of thousands of Americans die because of medical mistakes. There’s nothing mysterious about these cases, and it’s quite clear what needs to happen to prevent them. It’s just that, for one reason or another, it doesn’t happen.

“Far too many people suffer preventable harm,” says Peter Pronovost, M.D., a critical care researcher at Johns Hopkins University. “Our efforts to mitigate that over the last decade have been pretty abysmal. We’ve been talking a lot, but we don’t have a lot to show for it.”

Except, of course, for hospitals that have taken Pronovost up on his supremely easy approach to turning the tide. His idea? A to-do list that has been so successful, it earned Pronovost a 2008 MacArthur Foundation “genius award” of $500,000 as well as a spot on Time magazine’s list of the year’s 100 most influential people.

In 2001 Pronovost developed a checklist of five key steps doctors and nurses must take when inserting a catheter into a major blood vessel. Inserting these central lines to administer medicine or fluids to a patient is very common. Unfortunately, so are bacterial bloodstream infections resulting from the insertions—some 250,000 cases a year, according to the U.S. Centers for Disease Control and Prevention, leading to as many as 62,000 deaths and as much as $6 billion in extra costs.

Pronovost’s goal was to get clinicians to practice known preventive measures with rigor and consistency. In contrast to the medical practice guidelines that often run to hundreds of pages full of conditional statements (“if such and such, then such and such”), his handy tool for professionals at the bedside would be “ruthlessly simple,” he says. “Five things. All worded as behaviors. No wiggle room, here’s what has to happen.”

Did the doctor wash his or her hands with soap? Check. Wear a sterile gown, mask, gloves and cap? Check. Clean the patient’s body with antiseptic? Cover the patient with sterile drapes? Place a sterile dressing at the catheter site? Check. Check. Check.

It worked. It worked at Johns Hopkins Hospital, where central line bloodstream infections were nearly eliminated. Then it worked in the state of Michigan, where with help from the federal Agency for Healthcare Research and Quality (AHRQ) more than 100 hospital intensive care units adopted the protocol. More than half of participating institutions reduced central-line-related infection rates to zero within three months; 18 months of follow-up demonstrated a sustained cut in overall infection rates of up to two-thirds. Now AHRQ is putting $3 million toward rolling out the program to hundreds, perhaps even thousands, of hospitals across the country.

Of course, the checklist solution isn’t quite as easy as it sounds. Pronovost leads the safety research team at Hopkins, which is now trying to standardize a procedure for boiling down decades of medical evidence into must-do checklists for a host of other ailments and situations that harm patients. This, he says, involves tapping “the wisdom of crowds,” the accumulated knowledge of practiced clinicians as well as the practical experience of patients. Once developed, the effective implementation of checklists depends upon monitoring results in a way that’s open and technically sound. It also requires working with treatment teams to promote a cooperative, safety-conscious culture.

When it works, says Pronovost, the checklist does more than present evidence. It establishes a common language that allows doctors, nurses and patients to talk to one another about what needs doing—and to help each other make sure that, in a complex and often hurried world, those simple things get done.

See “Dr. Checklist,” a video broadcast of Peter Pronovost’s interview with Greg Williams, host of AARP’s My Generation.