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CUSP for Safe Surgery: The Surgical Unit-Based Safety Program. SUSP/Cohort 3 One Year Review. Sean Berenholtz, MD, MHS, FCCM February 11, 2014. First Year Review. The SUSP vision Where the project is right now Next Steps. The power of collective wisdom.

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CUSP for Safe Surgery: The Surgical Unit-Based Safety Program

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Cusp for safe surgery the surgical unit based safety program

CUSP for Safe Surgery: The Surgical Unit-Based Safety Program

SUSP/Cohort 3

One Year Review

Sean Berenholtz, MD, MHS, FCCM

February 11, 2014

First year review

First Year Review

The SUSP vision

Where the project is right now

Next Steps

Cusp for safe surgery the surgical unit based safety program

The power of collective wisdom

Many ideas grow better when transplanted into another mind than the one where they sprang up. —Oliver Wendell Holmes

The goals of the susp project

The goals of the SUSP Project

To achieve significant reductions in surgical site infection and surgical complication rates

To achieve significant improvements in safety culture

Why is your susp work important

Why is Your SUSP Work Important?

1 in 25 people will undergo surgery

7 million (25%) in-patient surgeries followed by complication

1million (0.5 – 5%) deaths following surgery

50% of all hospital adverse events are linked to surgery AND are avoidable

Cusp for safe surgery the surgical unit based safety program


* N Engl J Med; 370;4:341-351. (January 23, 2014)

A study that retrospectively examined a random sample of records for 61,523 hospitalized patients across 4,372 hospitals.

Patients examined were those with acute myocardial infarction, congestive heart failure, pneumonia, and those with conditions requiring surgery.

Adverse event-rates has declined significantly from 2005-2011 for those with myocardial infarction and congestive heart failure.

Adverse event rates remained steady for those patients that had conditions that required surgery; rates of infection-related and post-procedural adverse events increased among patients who required surgery.

Wrong patient wrong site wrong procedure events reviewed by the joint commission

*The Joint Commission, Sentinel Event Data;;29.

Wrong-patient, Wrong-site, Wrong-procedure Events Reviewed by The Joint Commission *

Polling question

Polling Question

Has increased compliance in SCIP measures reduced SSI rates in your organization?

Why might this be?

Key concepts adaptive and technical work

Key concepts: Adaptive and Technical Work



Key concepts adaptive and technical work1

Key concepts: Adaptive and Technical Work

How is susp different

How is SUSP different?

Informed by science

Embeds adaptive CUSP work into technical work

Led by clinicians and supported by management

Guided by measures

Susp can be tailored to your environment

SUSP can be tailored to your environment

  • No single SSI prevention bundle

    • Frontline staff identifies local defects

    • Develop a SSI prevention bundle to address local defects

  • Measure local safety culture using Hospital Survey of Patient Safety (HSOPS)

Cusp works in the or colorectal nsqip ssi rate at hopkins wick 2012


CUSP Works in the OR Colorectal NSQIP SSI Rate at Hopkins (Wick 2012)

Quarter 4

CUSP kickoff

Antibiotic deficienciesaddressed



Mechanical bowel prep with

oral antibiotics

Quarter 3

Skin preparationprotocol

Pre-op wash clothes


Pre-op warming

Enhanced sterile technique

Intervention checklist

Goal: 15%

*Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2).

Where is susp now where are we going

Armstrong Institute for Patient Safety and Quality

Where Is SUSP Now & Where Are We Going?

Where Is SUSP Now & Where Are We Going?

Where is susp now

Where Is SUSP Now?

State and hospital enrollment

SSI data update

HSOPS completion

Our path forward

Susp enrollment by coordinating entity

SUSP Enrollment by Coordinating Entity

SUSP Enrollment by Coordinating Entity

Susp enrollment by coordinating entity and cohort

SUSP Enrollment by Coordinating Entity and Cohort

A big thank you to all of our cohort 3 susp teams

A big THANK YOU to all of our Cohort 3 SUSP Teams!

Coordinating Entity: Maryland Hospital Association

Calvert Memorial Hospital

Carroll Hospital Center

Harford Memorial Hospital

MedStar Franklin Square Medical Center

MedStar Harbor Hospital

MedStar Montgomery Medical Center

MedStar St. Mary's Hospital

MedStar Union Memorial Hospital

Mercy Medical Center

Sinai Hospital of Baltimore

The Johns Hopkins Hospital

Upper Chesapeake Medical Center

Bon Secours Baltimore Health System

Holy Cross Hospital

Laurel Regional Hospital

Prince George's Hospital Center

University of Maryland St. Joseph Medical Center

Western Maryland Health System

Coordinating Entity: Armstrong Institute for Patient Safety & Quality

Canton-Potsdam Hospital

Cooper Health

Indiana University Health - Arnett

Lehigh Valley Health - Cedar Crest

Lehigh Valley Health- Muhlenburg

Sanford USD Medical Center

Southwest General Health Center

Ochsner Medical Center

Indiana University Health - Ball Memorial Hospital

Coordinating Entity: Iowa Healthcare Collaborative

Alegent Creighton Health Immanuel Medical Center

Alegent Creighton Health Lakeside

Alegent Creighton Health Mercy BLUFFS? Hospital

Alegent Creighton Health Midlands Hospital

Bergan Mercy Medical Center

Creighton University Medical Center

Coordinating Entity: Connecticut Hospital Association

Danbury Hospital

Coordinating Entity: Georgia Hospital Association

Gwinnett Medical Center – Lawrenceville

Gwinnett Medical Center- Duluth

Liberty Regional Medical Center

Spalding Regional Hospital

Atlanta Medical Center

Upson Regional Medical Center

Hamilton Medical Center

Medical Center of Central Georgia

Habersham Medical Center

Floyd Medical Center

Tift Regional Medical Center

Ty Cobb Regional Medical Center


Team calls and resources

Team Calls and Resources

Check out the SUSP website for great resources

  • SUSP Tools

  • CUSP Tools

  • HSOPS Toolkit

  • Recordings and Slide Presentations for SUSP Webinars

    -Using SUSP Audit tools

    -Executive Partnerships

    -Learning from Defects

    -Briefings and Debriefings

    -Optional SUSP Tools

    -HICPAC Guidelines

John muir video

SUSP Teams Are Engaged: Video submissions

John Muir Video

Susp teams a re engaged medconcert

SUSP Teams Are Engaged: MedConcert

Teams have initiated discussion via MedConcert:

  • Susan Overman– Wound classification documentation practices

  • Heidi LePard- Literature pertaining to c-section SSI’s

  • Dana Bonistalli– Forced air warming practices

    MedConcert Link:


Polling question1

Polling Question

  • What technical processes are you currently working on? (multi answer)

    -Skin preparation

    -Antibiotic timing/selection/re-dosing


    -Enhanced sterile techniques

    -OR Traffic

    -Glucose control


    -Other (type in the chat box)

Summary of ssi data submission

Summary of SSI Data Submission

Questions? Email the SUSP help desk!

Your data to date

Your Data to Date

*SSI rate (%) = (# of SSIs / Total # of cases)

Timely data reports guide your project improvement work

Timely data reports guide your project improvement work

  • Hospital teams can generate monthly SSI data reports after the CE transfers data files from NHSN

  • Currently, data submission rates are low because:

    -Competing priorities

    -Challenges with DUA’s

    -Hospital teams are less familiar with SUSP data reporting capabilities

  • Summary of plan to get more data into the portal

    -State Coordinators tracking the data transfer process

    -Plan to educate teams on generating SSI data reports during upcoming state coaching calls

How are you using your data to drive progress

How are you using your data to drive progress?

Is your hospital downloading progress reports to view your current SSI rates?

How have you used your SSI data to foster engagement with project stakeholders?

What can we do to help you be successful in sharing your data?

Polling question2

Polling Question

  • What tools/strategies have you been using to address adaptive challenges in your SUSP work?

    -Educate staff on the Science of Safety

    -Staff Safety assessment

    -Debrief HSOPS results with front line teams and leadership

    -Executive partnership

    -Learning from defects/investigating SSI

    -Briefing and debriefing tools


Why safety culture matters

Why Safety Culture Matters

Huang et al., 2010; Mardon et al., 2010; MacDavitt et al., 2007; Singer et al., 2009; Sorra et al., 2012; Weaver, 2011.

Safety culture is related to outcomes

  • Patient outcomes

    • Patient care experience

    • Infection rates, sepsis

    • Postop. hemorrhage, respiratory failure, accidental puncture/laceration

    • Treatment errors

  • Clinician outcomes

    • Incident reporting, burnout, turnover

  • Why safety culture matters1

    Why Safety Culture Matters

    Haynes et al., 2011; Morello et al., 2012; Van Nord et al., 2010; Weaver et al., in press

    • Safety culture influences the effectiveness of other safety and quality interventions

      • Can enhance or inhibit effects of other interventions

    • Safety culture can change through intervention

      • Best evidence so far for culture interventions that use multiple components

    Susp hsops baseline results

    SUSP HSOPS Baseline Results

    Follow up approximately 16 months after baseline administration

    HSOPS Re-Administration Schedule

    Follow-up (Approximately 16 months after baseline administration)

    Hsops review and debriefing

    HSOPS Review and Debriefing

    Have you reviewed your HSOPS results?

    What have you uncovered?

    Have you discussed these results with your SUSP team and staff?

    Have the HSOPS results driven your approach to your SUSP project?

    What will this next year look like

    What will this next year look like?

    • Project calls

      -A combination of technical topics and hospital team presentations

    • Re-administering HSOPS

      -Survey will open in October 2014

    • Select interviews

      -The NPT will be conducting quarterly interviews to learn more about your SUSP project.

    • On-going monthly state level coaching calls

    Cusp for safe surgery the surgical unit based safety program

    CUSP for Safe Surgery (SUSP) Project Call Schedule

    Implementation Phase

    Horizontal learning initiative

    Horizontal Learning Initiative

    • Medconcert professional networking site

    • Peer to peer sharing and collaboration

      • Hospital team presentations during cohort 3 project calls

      • State coaching calls

      • Other ideas

    Additional resources

    Additional Resources

    • Armstrong Institute Training Opportunities


    • AHRQ CUSP Toolkit


    • Armstrong Institute CUSP Tools


    Share your story

    Share your Story!

    We would like to spend some time hearing from you—

    What have been your breakthroughs?

    What are your hopes and expectations for the coming year?

    Content call evaluation

    Content Call Evaluation

    We want to ensure that the content calls provide useful and pertinent information for the SUSP teams. For this reason we request that you complete a brief evaluation following each call. The evaluation may be found at the following link:

    If you are not able to reach the link from the slide, please cut & paste the URL into your browser.

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