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Wed., Feb. 18, 2009

Smart Bombs: First, check your ego

If you are about to undergo surgery, here are two simple tips that could save your life. State your name and ask the physicians if they have been introduced to everyone who will be in the room. These two items are part of a 19-item checklist that reduced the death rate by 40 percent and medical complications by one-third, according to a recently published study of eight hospitals worldwide led by Dr. Atul A. Gawande of the Harvard School of Public Health.

Stating your name prompts the surgical team members to confirm they have the right patient. Short introductions embolden junior team members to speak up. Other cost-free items on the checklist include confirming that instruments have been sterilized, all necessary equipment is present and enough blood is on hand. Another suggestion is to count the number of instruments before and after to make sure nothing was left inside the patient.

Gawande was also the author of a New Yorker article on how Michigan hospitals nearly eliminated infections associated with central lines (a tube in the chest) by following a five-item checklist.

According to Time magazine, five states plan to require that hospitals use checklists like those in the Gawande study. Washington is one of them. What’s the hold-up in the other 45 states? It’s troubling how resistant the medical community has been to simple, proven safety methods over the years. Pilots use checklists. They don’t complain. But suggesting them for doctors is somehow insulting.

In an age when health care costs are affecting everyone, can we afford to have doctors who associate safety with an assault on their intelligence?

That’s just stupid.

Sure thing. When Washington state launched the Guaranteed Education Tuition program in 1998, families had a choice between mutual funds and other investments that were bringing in huge returns or locking in tuition prices for later use. Then-Gov. Gary Locke touted the GET program, saying, “This is a sure thing – 100 percent guaranteed.”

The hope of state officials was that they could take the prepaid tuition and get a return on investments that outpaced the annual rise in college costs. But now that the market has tanked and college costs have continued their inexorable rise, the state may have to end this sure thing. The value of GET’s assets has dropped to 89 percent of future liabilities. GET has enough money to cover 15 years, but then it gets dicey. The state either needs to kick in more money, raise the price per unit or end the program.

So much for that solution to making college more accessible. Now what?

Smart Bombs is written by Associate Editor Gary Crooks and appears Wednesdays and Sundays on the Opinion page. Crooks can be reached at garyc@spokesman.com or at (509) 459-5026.


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