A four-year project undertaken by some units in 1,100 U.S. hospitals has reduced central line-associated bloodstream infections by 40%, more than 2,000 infections, saving more than 500 lives and avoiding more than $34 million in healthcare costs.
That was the message Monday from Johns Hopkins infection control guru Peter Pronovost, MD, who developed CUSP, the Comprehensive Unit-Based Safety Program, a culture change and teamwork model that uses "the science of safety" to achieve hospital results.
Pronovost sat beside American Hospital Association president and CEO Richard Umbdenstock, and Agency for Healthcare Research and Quality director Carolyn Clancy at a briefing to announce the good news.
"Until recently, these infections were thought to be an unfortunate consequence of care," Clancy said. "Our work to fight CLABSI using the toolkit demonstrates definitely that they are not."
She added, "There is no better rocket fuel than success. And when hospitals see how others are succeeding, it goes viral."
CUSP "has had a profound impact," said Michael Tooke, MD, senior vice president and chief medical officer for Shore Health, a two-hospital system based in Easton on Maryland's Eastern Shore. Through team building and protocols, he said, "it's been 810 days since our last CLABSI in the ICU at Memorial Hospital and 1,025 days at Dorchester General. And in February of 2010, we experienced the last ventilator-associated pneumonia in either of our ICUs."
Theresa Hickman, a nurse educator at Peterson Regional Medical Center, Kerrville, TX, added that in her 32 years as a nurse, "the CUSP tool is the most powerful program I've ever seen. Historically, front line caregivers—especially nurses, have not been included in safety programs. But CUSP turns that model on its head."
While the speakers did not give many precise examples of how the program works, they said CUSP is customizable to a hospital's unique situation. It functions in part by allowing hospitals to build teams of people at various levels of patient care to implement best practices, and empowers them to talk frankly about problems in their organizations.
In a section of the tool entitled "Identify Defects through Sensemaking" providers at various levels of hospital care, from pharmacy to nursing to physician staff, are seen in a video meeting talking frankly about an increase in readmissions because of poor handoff adherence. They also discuss the failure to stop antibiotic dosages in patients by 24 hours after surgery, which can increase antibiotic resistance. And they put it on a list to speak with providers about guideline compliance.
According to a news release, the toolkit "helps doctors, nurses, and other members of the clinical team understand how to identify safety problems and gives them tools to tackle these problems that threaten the safety of their patients."
Hickman said that one element of the program that helped her hospital succeed was that now, teams on each unit set 24-hour goals for each patient, and then bump that up to every 12 hours. That could hasten the removal of a central line that is no longer necessary, and eliminate increased risk of infection.
Another example of how unit-level attention and teamwork prevents errors is the problem of older nurses not being able to see the type of medication on an ampule because the type is too small. "We bought a whole bunch of magnifying glasses," which resolved the nurses' complaints, she said.
Tooke said that his hospital implemented the program after seeing Pronovost's success at Johns Hopkins and in the Keystone hospital collaborative in Michigan, which used a similar model to reduce infection rates there.
"It had a profound impact, a shift in our thinking, that it was actually possible to eliminate something we had come to think of as inevitable. It meant that the only acceptable target was zero.
"At Shore, we're the community's only healthcare system. Our patients are neighbors, coworkers, and often members of our own family, so targeting zero struck a very personal core."
Pronovost explained that CUSP was successfully only when providers think of it as one leg of a three-legged stool. "It's a checklist for best practices, CUSP—the culture change and teamwork program—and then it's measuring and feeding back (what you learn) from all three."