The Vitamin Kid

Avoiding bad medicine and finding non-toxic treatments that actually work

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Location: Ankeny, Iowa, United States

Monday, January 07, 2008

New technology could save tens of thousands of lives, if doctors would use it

This amazing technology of which I speak is the paper and pencil, used to make a checklist.

This New Yorker piece describes how intensive care was improved, revolutionized, in the state of Michigan, by the use of checklists to make sure doctors performed certain procedures correctly in the course of treating the most desperately sick patients.

About five million Americans will be in ICU this year at some time. The most dangerous thing that can happen in an ICU is an infection developing in one of the tubes ("lines") the doctors put into the body to deliver medicine, transfer blood in and out, or for drainage. "I.C.U.s put five million lines into patients each year, and national statistics show that, after ten days, four per cent of those lines become infected. Line infections occur in eighty thousand people a year in the United States, and are fatal between five and twenty-eight per cent of the time, depending on how sick one is at the start."

Yet, when doctors are routinely required to follow a strict checklist to ensure clean hands, proper disinfectants used on the body, the body draped fully during installation of the line -- at Johns Hopkins, line infection rates went from 11% to zero! In a single hospital, eight lives and 2 million dollars in costs were saved from the simple use of a checklist.

Next, checklists for installing lines and two other procedures done in ICU's were instituted as standard policy in all hospitals in Michigan. "Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives." This is for a single state.

Other states are not rushing to follow Michigan's example. Why? Does this remind anybody else of Semmelweiss?

Instead of using these virtually costless techniques that could save tens of thousands of lives annually, millions are spent on research that will save a fraction of that number, even if a drug or new medical gizmo proves successful. I am increasingly convinced that for-profit health care works at cross purposes to the desired endpoint of better health.