Bureaucracy is apparently not pro-life

[brynndragon]

First, learn how an incredibly simple piece of organizational tech (so simple I hesitate to use the word "tech") means ICU staff spend less money to save more lives: The Checklist

Then, learn how the government decided we certainly can't let something this useful continue: A Lifesaving Checklist

Look, I'm a huge fan of ethics in research. I wish examining ethical issues with scientific research was a requirement for all science undergrads. But holding this research to the exact same standards as experimental drugs is a terrible mistake. We do need to be hella careful when dealing with the sickest of the sick, but you can take it too far and it looks like OHRP has. How many people will die of preventable infections before they figure out the standards this sort of research will require to satisfy Confucius' bastard child, bureaucracy?

Comments

[pezzonovante.livejournal.com]

There was a WaPo story a few months back about Institutional Review Boards pulling crap like this. The school they focused on had an IRB that was starting to regulate projects in areas like history and journalism. It was bizarre.

[australian-joe.livejournal.com]

I can sorta understand the concerns, but when the shutdown seemed more concerned about limiting doctor and hospital liability than with continuing to produce good patient outcomes, I don't have much sympathy for the position.

I wonder now what would happen if say a patient died of a line infection, and their family sued the hospital for not following a simple procedure that would have saved them? There's enough data now to support a claim that not using the checklists might form malpractice and negligence...

[digitalsidhe.livejournal.com]

Someone behind this move seems to be a complete and total droid.

Quis custodiet ipsos custodies?

[c1.livejournal.com]

I have to wonder, though...
The checklist becomes held as the gold standard of care: it's infallible, therefore I must be doing it right, and by following the checklist to the letter, I'm doing everything I need to be doing for this patient.
But is there something the checklist forgot? Is the checklist up-to-date with the latest research?
Nothing against the practice in general, but there was no mention of safeguards against practicioners getting railroaded into rigid lines of thinking.

(Off topic, but did anyone else notice the use of an umlaut in "cooperate" on page 8 of the New Yorker story?)

[glenmarshall.livejournal.com]

See http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1863

Also see http://www.leapfroggroup.org/for_hospitals/leapfrog_hospital_quality_and_safety_survey_copy/never_events

HHS and insurers are starting to not pay for the added cost of things that simply should never happen in hospital stays. The checklist article is bizzare. I know of many cases where deliberate steps are being taken to reduce the incidence of infections and other preventable complications, and the statistics are collected and used to prove those steps are effective.

I think the article is an abberation in what I'm seeing happen all over the place, in the US and elsewhere.

[mr-teem.livejournal.com]

WTF, over? Process improvement is not the same thing as new materials evaluation. I mean, its why doctors have been washing their hands since, what, the nineteenth century? Was someone complaining then about using too much water?

[citabria]

I see it this way.

The procedures at issue had been proper medical practice for some time before anyone started using a checklist and recording results. Therefore, a hospital that decides to focus on following proper protocols, without using a written checklist and keeping written records of it, is completely within its rights, even under the government's decision.

As for getting permission, all it takes is getting someone's permission when they're admitted. The checklist is only being tested in ICUs, which means that a blanket permission upon admission wouldn't be that difficult to secure, at least in hospitals where most ICU admissions are not the result of trauma.