Checklists and Error Prevention on the TV Show ER
Hulu – ER: Old Times – Watch the full episode now.
Thanks to Bryan to bringing this episode of ER to my attention. I don't normally watch it, but my wife always DVRs it, so I was able to watch with her.
Thanks to hulu.com, I'm able to share some small clips from the episode (or click the link at the top of the post for the whole episode). All of the clips below are different even if they all feature a photo of George Clooney making a guest re-appearance on the show.
In the first clip (part of another subplot), you see some very poor service and caring from the gruff and unfriendly person at the front desk. Yes, the ER was crowded and overrun, but a curt “I'll be with you in just a second!” isn't what sick people are looking for.
The second clip, representing a different hospital actually, shows another example of less-than-perfect service — bringing food to Dr. Carter (as an inpatient) in his room and just throwing the tray in basically.
Now to the substantive issue of the episode… more important than service is quality care and patient safety. Dr. Carter (Noah Wylie) is in line for a kidney transplant and receives notification that surgery will happen today. What happens in the ER is summarized in an excellent comment from Bryan on a previous post about “stopping the line” in hospitals. There's no need for me to repeat the excellent summary he gave there, but you can see the video for yourself. The relevant sections are in the last 15 minutes of the episode.
With the surgeon walking in, pay close attention to the nurse saying “I'll have some solution sent up.” The surgeon didn't want his time wasted to follow the recommended patient safety checklist (read more about that here via these earlier Lean Blog posts). What are your reactions to this as a healthcare provider, employee, or patient?
Later in the surgery, this solution that the checklist prompted them for becomes very helpful:
Without the use of the checklist, the kidney would have been lost. The situation might be a little over dramatized (the surgeon's a**-hole behavior and the student asking, “Where can we get that checklist??”), but it's supposedly not an uncommon situation. I think those sets of video could prompt some excellent discussion in a hospital (if your firewall doesn't block this blog or the video clips!!!)
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It should be no surprise that Dr. Atul Gawande was consulted on the use of a checklist on the show, as this article shows: