Saturday, December 29, 2007

The New Yorker, December 10, 2007

from "The Checklist" by Atul Gawande, in "Annals of Medicine":

Yet it's far from obvious that something as simple as a checklist could be of much help in medical care. . . . In 2001, though, a critical-care specialist at John Hopkins Hospital named Peter Pronovost decided to give it a try. He didn't attempt to make the checklist cover everything; he designed it to tackle just one problem . . .line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient's skin with chlohexidine antiseptic, (3) put sterile drapes over the entire paient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklistjust for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctos if they saw them skipping a step on the checklist. . .

. . . Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren't sure whether to believe them: the ten-day line-infection rate rate from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in cost.

. . . The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you're worrying about what treatment to give a woman who won't stop seizing, it's hard to remember to make sure that the head of her bed is in the right position.) A second effects was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. In a survey of I.C.U. staff taken before introducing the ventilator checklist, he found that half hadn't realized that there was evidence strongly supporting giving ventilated patients antacid medicine. Checklists established a higher standard of baseline performance.


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Question: if you were to come up with a beginner's checklist for revising poetry, what would it look like?

(1) Have your writing make sense (garyg's admonition).
(2) Describe your sentences grammatically. (E.g. Subject [noun phrase] + Main Verb + Indirect Object [noun clause] + Direct Object [noun])
(3) Remove all adjectives and adverbs and see if that makes a difference.
(4) Mark the significant sounds in your first line, and then the recurrence of those sounds in the poem.
(5) Circle the images in the first line(s), and then related imagery in the poem. (Suggestion: use different color pens for different image clusters.)

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