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David Mittleman
David Mittleman
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Simple Michigan hospital program that saves lives and money shut down by federal government

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A certain amount of government involvement in medical care is unavoidable, and is usually beneficial. You certainly don’t want to undergo surgery by a doctor who is not licensed, or be prescribed medications that have not been tested on human beings. But there are times when the Federal Government goes from a friendly father figure to a crazy uncle, and the results can be deadly.

On any given day, nearly 100,000 people receive treatment in a hospitals intensive care unit (ICU). The majority of these patients have a central line catheter, which is essentially an I.V. that goes straight into your heart to deliver medications and fluids. This is a wonderful benefit to the patient, but also increases the probability of infection by a significant amount. Infections resulting from central line catheters cost billions of dollars every year in increased treatment and hospital stays.

All of this could change, if only a simple five (5) step checklist were followed when treating patients with central line catheters. In 2001, Dr. Peter Pronovost, a critical care specialist at Johns Hopkins Hospital, created a simple and straightforward checklist for doctors to follow when treating patients with central line catheters. This check list required

Doctors [] to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in.

These steps would hopefully decrease the probability of infection for patients with central line catheters.

After following the checklist on every patient with a central line catheter embedded for more than 10 days in the ICU for the next year, the results were difficult to believe. The infection rate went from eleven (11) percent of patients to zero (0). Dr. Pronovost continued monitoring the effectiveness of the checklist for an additional fifteen months, and during that period of time on two (2) infections occurred related to central line catheters. This resulted in the prevention of fourty-eight (48) infections, eight (8) deaths, and a savings of two (2) million dollars.

Dr. Pronovost eventually caught the attention of the Michigan Health and Hospital Association, who asked him to give his checklist a try in three Michigan hospital ICUs. He first asked the participating hospitals to provide data regarding central line catheter infection rates, so he would have a baseline to judge the effectiveness of the checklist. Michigan infection rates were higher than the national average, and sometimes dramatically increased.

After following the checklist for three (3) months, the infection rate decreased by sixty-six percent. Some Michigan ICUs cut there infection rate to zero. In the first eighteen (18) months, participating hospitals saved nearly one hundred and seventy five (175) million dollars and more than fifteen hundred (1500) lives. Simply amazing results which were published in the New England Journal of Medicine.

At this point, it was clear the checklist was a revolutionary idea that saved lives and money. However, the federal government decided the checklist was infringing on patient privacy and shut down the checklist program. The government argued that each patient was required to sign off on releasing the health care information vital to tracking infection rates, and without approval of each patient the program violated medical ethics. The Office for Human Research Protections determined the checklist was similar to an new drug, and therefore required patient consent and federal monitoring.

It makes no sense for the government to simply shut down a program that, if implemented nationally, could save hundreds of thousands of lives and potentially billions of dollars. If the government has privacy concerns, then it should address them with the program directors and not shut it down completely. There is a simple and effective way to save money and lives, but the government is more concerned about collecting non-identifying health care information. These priorities seem misplaced.