On the CUSP: Stop BSI A National Initiative

1. On the CUSP: Stop BSIA National Initiative John R. Combes, MD John Wiesendanger American Health Quality Association February 26, 2009

2. Overview Background Current project Goals States/State consortia Role of QIOs Hospital interventions Q&A

3. Background HAIs risen consistently since 2000 250,000 CLABSI infections annually Up to 62,000 deaths result from CLABSI each year Average cost: $45,000 each Most are preventable

4. Background (cont.) Keystone ICU Project 2003 AHRQ-funded initiative in Michigan with JHU and Michigan Hospital Association 108 ICUs Implemented CUSP to reduce CLABSI After 3 months, CLABSI rate decreased from 2.7 infections/1000 catheter days to 0 in most ICUs. Rate maintained during the 18-month study

5. Current Initiative On the CUSP: Stop BSI AHRQ funded 3 year initiative HRET/AHA Johns Hopkins Quality and Safety Research Group MHA’s Keystone Center for Patient Safety & Quality

6. Goals Nationally replicate success of Keystone ICU project: Eliminate central line-associated bloodstream infections (CLABSI); state mean <1/1000 catheter days, median 0 Improve safety culture by 50% Learn from one defect per month Build infrastructure for future efforts

7. Project Organization Statewide effort coordinated by State Hospital Association Collaborative model (two face-to-face meetings, monthly calls) Standardized data collection tools and evidence Local ICU modification of implementing interventions

8. Participating States 10 states with at least 10 hospitals in 2008-2011 California North Carolina Colorado Ohio Florida Pennsylvania Massachusetts Texas Nebraska Washington

9. Hospital Interventions Assemble team Comprehensive Unit-based Safety Program (CUSP) CLABSI prevention behaviors

10. Assemble Teams Start in ICUs – spread throughout hospital Multi-disciplinary ICUs teams – clinical and administrative Executive leadership involvement

11. CUSP Culture survey (pre and post) Educate staff on science of safety Create executive partnership Use learning from defects tool Implement teamwork and communications tools

12. CLABSI Prevention Remove unnecessary lines Wash hands prior to procedure Use maximal barrier precautions Clean skin with chlorhexidine Avoid femoral lines MMWR. 2002;51:RR-10

13. Data Collection Baseline & monthly CLABSI rates Hospital Survey on Patient Safety Monthly survey on teamwork barriers

14. State Consortia Members State hospital associations QIOs PSOs Public health departments Payers Government officials Business

15. State Consortia & Sustainability State consortia key to sustainability: Train-the-trainer education to build capacity for future patient safety innovations, e.g., On the CUSP: Decubiti Evaluation component to identify lessons, including critical success factors and barriers

16. State Hospital Associations Serve as project coordinator for state consortia and participating hospitals Facilitate conference calls and in-person meetings with HRET/JHU/MHA faculty Oversee collection of CLABSI and safety culture data

17. Role of QIOs Part of state infrastructure—lend expertise and other resources to support initiative Participate in conference calls, in-person meetings

18. Questions?

19. Contact Information John Wiesendanger, CEO West Virginia Medical Institute and Quality Insights 304-346-9864 jwiesendanger@wvmi.org John R. Combes, MD American Hospital Association 312-422-2117 jcombes@aha.org