Peter Pronovost, M.D., thinks that health care might be at its man-on-the-moon moment. The famed Johns Hopkins Medicine physician, researcher and patient safety guru made the assertion last month while taking part in a press briefing to detail how a federal-private sector partnership resulted in a dramatic decline in health care-acquired infections.
The Comprehensive Unit-based Safety Program, a joint effort among the American Hospital Association's Health Research & Educational Trust, Johns Hopkins and the Agency for Healthcare Research and Quality, focused on reducing the rate of central line-associated bloodstream infections in adult critical care units. More than 1,100 ICUs participated and, over the course of four years, saw a 40 percent drop in CLABSIs. That meant infections were prevented in more than 2,000 patients, 500 lives were saved and there was a cost avoidance of $34 million, AHRQ Director Carolyn Clancy said during the press briefing.
CUSP built off the success Pronovost had in the early 2000s working with the Michigan Health & Hospital Association to reduce infections in more than 100 ICUs across the state.
"This could be health care's man-on-the-moon moment," Pronovost said, referencing President Kennedy's 1961 declaration that America would literally shoot for the stars. "With these results, health care is taking a giant step forward."
CUSP is a multipronged approach that embraces such evidence-based interventions as removing unnecessary central lines and ensuring proper hand hygiene; a culture change that encourages team work and empowers front-line staff to be equal partners with physicians when it comes to enhancing patient safety; and measuring results and providing constant feedback to the teams. Along with releasing the results, AHRQ made public a toolkit to help hospitals implement CUSP.
Just as important, the program changes the mindset among clinicians and hospital leaders.
"Like many other systems, we were operating under the assumption that infections like these were an inevitable part of being sick and being in the hospital," Michael Tooke, M.D., chief medical officer of Shore Health, a two-hospital system in eastern Maryland, said during the press briefing. Then they starting taking note of Pronovost's work in Michigan and realized that, in fact, HAIs were not a routine part of doing business. "I don't think I can overstate how profound was the shift in our thinking. It was actually possible to eliminate what we had come to accept as inevitable."
Tooke rattled off some impressive stats of his own: 810 days (and counting) since the last CLABSI at Memorial Hospital and 1,025 days (and counting) at Dorchester General; no ventilator-associated pneumonia in either ICU since February 2010; and, 1,245 days (and counting) without a catheter-associated urinary tract infection at the system's 20-bed rehab unit.
After implementing CUSP in its ICU, Peterson Regional Medical Center has eliminated CLABIs, said Theresa Hickman, R.N., nurse educator, at the 124-bed hospital in Kerrville, Texas. She said CUSP is the "most powerful program" she's seen in her 32 years as a nurse.
Both Hickman and Tooke said it is important to continually feed data back to staff and to celebrate achievements. Once staff see how they can dramatically improve patient safety, they want to keep driving toward zero.
"Success is like rocket fuel," Tooke said.