Cath Lab Digest

Dear Readers,
  I advise you not to read this unless you want to become more efficient and effective at what you are currently doing! Should you have some interest in reading more, I gladly suggest the following:

    •Quickly skim this article and decide if you want to read more or read it more thoroughly later
    •Consider reading/listening to The Checklist Manifesto by Atul Gawande, MD (http://gawande.com/)
    •Create a quick checklist for one aspect of your work or life

  In the realm of wound care, practicing evidence-based medicine can be daunting as there are so many potential things to address and evaluate. Although many clinicians bristle at the idea of following a protocol, the fact is that many areas of patient care have been dramatically improved by doing just that, and assuming that YOUR practice is different might be worth considering.

  The Checklist Manifesto is a must read by an established author, Dr. Atul Gawande. There are a number of important messages that can be gleaned from the text, but I believe there are two great principles that should be noted by those interested in improving their outcomes in clinical care:

    1. Checklists can be useful to improve care in various settings, especially when there are multiple people/programs involved in delivering the service.
    2. Checklists will always be bad the first time you create them!
      a. The key is making the checklist creation and utilizing a “process” that works to refine the utility of the document until it is genuinely useful for the desired outcome.
        i. So many people stop when they say, “we tried a checklist but no one used it,” rather than trying to figure out why the list they created was not working.
        ii. Checklist creation and utilization can be a teambuilding exercise that can have secondary benefits.

  Wound care is complicated by a great deal of product and practice options that are not always supported by excellent clinical data. That being said, a well-structured protocol, with measurement of outcomes, can be the beginning of useful information to substantiate successes and identify failures, ultimately improving patient care. Most people are drawn to wound care because they have seen the need for helping the wonderful patients who oftentimes suffer with significant problems. Checklists should be viewed as an important first step in the process of quality improvement. Please see the book as well as www.checklistmanifesto.com for more information and inspiration.

-Eliot N. Mostow, MD