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January 04, 2008

Checklists Get Nixed by the Gummint

When I read Atul Gawande's New Yorker article about how using checklists in hospitals can save lives, I had two thoughts:

  1. I hope if I wind up in the hospital, it's in one of the ones in Michigan that is using this technique.
  2. I hope this article will inspire/shame other hospitals into adopting it.

What actually happened, as Gawande explained in an op-ed piece in the New York Times last week, is that the government Office of Human Research Protections ordered the program shut down, because it was considered an experiment that had been done on patients without their consent (Gawande describes this as "blinkered logic". I can only dream that one day I will be a good enough writer to produce so apt an adjective in such a situation).

It would be quite sad if the New Yorker article was what alerted the authorities to the program and therefore led to the ban, but I doubt that government works that quickly (insert snide comment about readership of the New Yorker among Bush administration bureaucrats). The whole thing is quite depressing, because it seems so misguided. Gawande's argument is that this is not an experiment like a new drug; it's an experiment in healthcare delivery, which is different. He explains that this kind of work had previously been exempted from scientific research regulations, but now that it is becoming more scientific, ironically, it is being controlled. He points out that Congress could pass a law allowing it; of course this won't help the thousand people who will die next year because of the ruling.

Posted by AdamBa at January 4, 2008 04:02 PM

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Here is a bizarre twist on this story. On page 38, above the middle of the third column of the New Yorker dated Jan. 7 appears the statement, "The Office for Human Research Protections, in the Department of Health and Human Services, has jurisdiction only over research funded by the department." Since Gawande's article did not mention federal funding (the Michigan experiment was funded by the state), I cannot see where the federal jurisdiction comes from. The connection is the often deplorable conditions that (paid) volunteers in drug trials suffer.

Posted by: marble chair at January 5, 2008 08:43 AM

It could be argued that this is methodology that check medical personal performance, not the patients.

Anyway, I really recommend you to watch "Sicko", if you haven't done so already.

Posted by: Ivan at January 6, 2008 01:16 PM

It appears clear to me that checklists would help. No matter how well trained you are, when you are performing a series of tasks again and again, and trying to do it fast, it all starts blurring together.

Posted by: Nicole DesRosiers at January 8, 2008 10:45 AM

I find thier reasoning completely bizarre.
The point of the checklist is to help ensure that the patient receives exactly the care they should with the established best practices. How can a nurse just being doubly careful to do their job correctly be regarded as an experiment that could endanger the patient?

Perhaps they need to have the patient fill out a form asking, "During your treatment would you like our staff to make every effort to follow hospital proceedure, or do you just want to hope that they do the right thing by chance?" and count that as permission to use a checklist. I can't see many people opting for the latter option.

Posted by: Edward at January 10, 2008 05:32 PM

I invoked Godwin's law on the article as soon as the author mentioned "Nazi physician trials at Nuremberg".

Posted by: Neil at January 15, 2008 04:14 PM