For their part, Pritchard and other officials say there's nothing to prevent a hospital from implementing programs to improve care, such as hand sanitizers or a computer upgrade that tracks a patient's progress. "If you're implementing what established as a best practice or something you think will help, that's not research," Pritchard said.
In Michigan, Pronovost focused on checklists designed to prevent ventilator-assisted pneumonias and infections from central venous catheters, which are tubes inserted in most intensive care patients.
The study was part of an effort to improve overall Michigan ICU safety known as the Keystone Initiative. "The number one savings was in lives," said Sam R. Watson, executive director of what is now the Keystone Center for Patient Safety and Quality.
Within 18 months after Michigan hospitals introduced the checklists in 2004, central line infections dropped by two-thirds. But according to Watson, the biggest achievement was a permanent change in attitudes among medical personnel.
"You need to make a significant effort to change a culture, so the tool, in this case the checklist, doesn't become just a passing fad," he said.
In New Jersey, a similar project reduced central line infections by 73 percent. Ventilator-associated pnuemonias there declined by 55 percent, according to Alene Holmes, a vice president of the New Jersey Hospital Association.
Pronovost, working with experts in other fields, has developed checklists for patient care in surgery, emergency medicine, pediatrics and other specialties. He said he hopes to begin checklist projects with medical groups in Tennessee, California and Washington state.
"Doctors and nurses are so busy, we spend a lot of our time just putting out fires," said Pronovost, whose efforts were profiled in a recent New Yorker article.
Pronovost has been in Switzerland this week to help the World Health Organization set up safety programs for hospitals around the world. "It's inefficient for every hospital to invent his own wheel," he said.
Checklists are hardly new ideas: They have been standard tools for years in the automotive and airline industries.
But patient safety experts began to consider them about eight years ago. That's when the first of two reports from the Institute of Medicine showed that hospital deaths were often caused by the failure of doctors and nurses to take routine precautions, such as washing their hands.
