Checklists and doctor 'copilots' cut deaths in half

ICU checklists, coupled with a reminder from a colleague, can cut ICU deaths in half, according to a new study published in the American Journal of Respiratory and Critical Care Medicine.

Researchers at Northwestern Medicine looked at data from Northwestern Memorial Hospital's ICU and found that the checklist alone does not produce an improvement in mortality rates, according to a statement released yesterday. The key to the checklist process is a reminder from what study authors call a "copilot," that is, an ICU colleague who prompts the physician of details that m­ay be otherwise overlooked.

Even though checklists have been commonly used in aviation since before WWII, checklists in medicine are still a relatively new concept, most recently touted by patient safety advocates, such as Atul Gawande and Peter Pronovost.

"We observed that physicians sometimes wrote information on the checklist but were not using it to improve their decision making," said Curtis Weiss, MD, fellow in pulmonary and critical care medicine at Northwestern University Feinberg School of Medicine, in the statement.

Instead, the prompter subtlety helps the physician to decide how long a patient would stay on a ventilator or use antibiotics and central catheters. For example, the prompter might say "do you plan to continue the antibiotics today?" rather than a mandated "you should stop the antibiotics."

Researchers concluded that hospitals need not hire specific physicians to be prompters; instead, Weiss advises that perhaps a nurse or even an electronic prompt could be equally effective.

For more:
- read the Northwestern press release
- here's the study