The Agency for Healthcare Research and Quality’s Comprehensive Unit–Based Safety Program has proved effective for helping clinical teams tackle tough patient safety issues, and now the agency has introduced a tool kit to assist with implementation of the program nationwide.
The Comprehensive Unit–Based Safety Program, or CUSP, is a science-based change package initially conceived by Dr. Peter J. Pronovost of Johns Hopkins University, Baltimore, to help prevent potentially deadly central line-associated blood stream infections (CLABSIs) in hospital intensive care units, but with the help of the new tool kit developed with funding from the AHRQ, the program can be applied to any safety problem at the unit level. Numerous studies have demonstrated the effectiveness of the program for lowering infection rates, and preliminary results from a national study confirm those findings.
Implementation of CUSP at more than 1,100 adult intensive care units in 44 states over a 4-year period reduced the rate of CLABSIs by 40%, Dr. Carolyn M. Clancy, director of AHRQ, reported during a press conference held in conjunction with the AHRQ annual conference.
"This program offers hope for us about what’s possible when policy makers invest in the science of safety."
"That’s not just a number," she said, stressing that the 40% reduction equates to 500 lives saved, 2,000 CLABSIs prevented, and $34 million in health care costs avoided.
Some hospitals were able to achieve even better results, reducing the rate of CLABSIs to zero, she said.
One such hospital is Peterson Regional Medical Center in Kerrville, Tex., which has had zero CLABSIs in the entire hospital for more than 30 months since implementing CUSP.
"In my 32 years as a nurse, the CUSP program is the most powerful program I have ever seen," said Theresa Hickman, a nurse educator and the team leader for the 124-bed hospital’s participation in the national initiative.
Historically, those on the front lines in health care – such as nurses – have not been included in safety programs, but CUSP turns that model on its head, empowering frontline caregivers to make a difference, she said.
Indeed, CUSP combines clinical best practices with an understanding of the science of safety and improved patient safety culture to empower hospital teams to address identified safety issues, Dr. Clancy said.
The Society for Healthcare Epidemiology of America agreed. Within CUSP, "members of the health care team feel comfortable speaking up and learning as a team the lessons learned of each preventable infection. This demonstrated success shows culture change is possible by involving every member of the health care team in an effort that combines science with implementation," Dr. Jan Patterson, SHEA president, said in a statement. Dr. Patterson is director of the Center for Patient Safety and Health Policy at the University of Texas Health Science Center in San Antonio.
The tool kit is a multipronged quality improvement program developed by clinicians for clinicians. It is "modular, customizable, and self-paced," she said, noting that the package includes step-by-step instructor guides, presentation materials, implementation tools, and instructional videos, all of which can be used to address any patient safety issue.
Some of the hospitals that have successfully used the CUSP tool kit to reduce CLABSIs are now using it to fight other types of infections as well, such as urinary tract infections and ventilator-associated pneumonia, she said, noting that the tool kit can be modified to meet the unique needs of a specific unit, and that the concept of CUSP can be implemented facility-wide.
An important lesson from the dramatic results seen with CUSP is that health care–related infections should not be seen as an unfortunate but inevitable consequence of care.
"No one should become sicker due to the care they receive," she said, adding that results of the study have changed the idea of what is possible.
Rich Umbdenstock, president and chief executive officer of the American Hospital Association, which collaborated with AHRQ on promoting and implementing CUSP, agreed, saying that "by working together, we can achieve these positive results on a national level."
Already, hospitals are achieving infection rates previously believed impossible, Dr. Pronovost said, noting that "this could be health care’s ‘man on the moon’ moment."
"With these results, health care is taking a giant step forward ... this program offers hope for us about what’s possible when policy makers invest in the science of safety," he said.
The speakers reported having no relevant conflicts of interest.