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Hospital Deaths from Errors Lowered with Care Bundle Checklists

Kathleen Blanchard's picture

A study shows that hospital deaths could be reduced from medical errors by implementing a checklist, known as a care bundle. Three London hospitals have done just that, producing a fifteen percent reduction in hospital deaths from use of care bundles – checklist that can ensure safe patient care and fewer medical mistakes.

The study is timely, given the recent death of a 23 month old that resulted from heparin overdose in a Texas hospital. The care bundle checklist implemented in the London hospitals was developed by a group of senior clinicians whose goal was to reduce hospital deaths. The focus was on areas that have the highest rates of mortality- stroke, heart failure and chronic obstructive pulmonary disease (COPD).

The clinicians compared hospital death rates between 2007 and 2008 when the checklists were introduced to previous years, finding that care bundles reduced hospital mortality by fifteen percent.

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The most profound finding from using a checklist to ensure safe patient care was that hospital standardised mortality ratio (HSMR) was the lowest in England in acute care hospitals after implementation of care bundles. Death rates fell from 89.6 percent in 2006 to 71.1 percent in 2007-8.

The impetus for reducing hospital deaths from using care bundle checklists came after the North West London Hospitals that include Northwick Park Hospital, Central Middlesex Hospital and St Mark's Hospital, in 2005 and 2006, were highlighted in the media adversely. One such story was the death of a nurse who gave birth at her place of employment and died from hemorrhage after childbirth. The coroner ruled the cause as “neglect” from the staff at Northwick Park Hospital.

Since then and in an effort to reduce hospital deaths and boost hospital staff and patient confidence, the London hospitals have successfully decreased the incidences of hospital deaths by implementing care bundles. The authors say checklists for use in the hospital can be used for a variety of diagnoses that can save patient lives from medical errors and neglect of proper patient care.

BMJ-British Medical Journal