ma icu safe care initiative: comprehensive unit based safety program (cusp)
DESCRIPTION
MA ICU Safe Care Initiative: Comprehensive Unit Based Safety Program (CUSP). October 25, 2010. CUSP and CLABSI Interventions. CUSP. CLABSI. Primarily technical interventions: CVC line insertion CVC line management. Improving the culture of safety: 1. Educate on the science of safety - PowerPoint PPT PresentationTRANSCRIPT
MA ICU Safe Care Initiative:Comprehensive Unit Based Safety
Program (CUSP)
October 25, 2010
CUSP and CLABSI Interventions
Improving the culture of safety:
1. Educate on the science of safety
2. Identify defects
3. Learn from defects
4. Assign executive to adopt unit
5. Implement teamwork tools
CUSP CLABSI
Primarily technical interventions:
• CVC line insertion
• CVC line management
Framework for MA ICU Safe Care Initiative Improvement Collaborative
Hospital Association and Patient Safety Organization Work together as state leads Recruitment of hospital teams and resources to the teams State “hub” for managing ongoing participation and improvement
Role of National Project Team Two Year Collaborative Data Collection – CareCounts website Improvement
Monthly Content Calls Monthly Coaching Calls
Resources at: www.onthecuspstophai.org/Stop-7611.html
Communication Among Care Providers:Percent Understanding Patient Care Goals
00.10.20.30.40.50.60.70.80.91
1 2 3 4 5 6
ResidentsNurses
5
Perc
ent u
nder
stan
ding
pati
ent c
are
goal
s
Daily Goals
Impact of Daily Goals on ICU Length of Stay
0
0.5
1
1.5
2
2.5
June
July
August
Sept
Oct
Nov Dec Jan
Feb
Mar
chApril
May
Avg
. LO
S (d
ays)
ICU LOS
6
654 New Admissions = $7 Million Additional Revenue
Daily Goals
WIC
U P
RE
CU
SP
WIC
U P
OS
T C
US
P
--S
ICU
PO
ST
CU
SP
--S
ICU
Tim
e 3 --
WIC
U T
ime
3
SIC
U P
RE
CU
SP
0
10
20
30
40
50
60
70
80
90
100
WIC U
P R E
C US P
WIC U
P OS T
C US P
--WIC U
T ime 3
% o
f res
pond
ents
with
in a
n IC
U re
porti
ng g
ood
safe
ty c
limat
eSafety Climate- Culture of Safety Survey
Culture of Safety- Michigan
0
10
20
30
40
50
60
70
80
90
100
2006
2004
Teamwork Climate Across Michigan ICUs
0
10
20
30
40
50
60
70
80
90
100
2006
2004
% o
f res
pond
ents
with
in a
n IC
U re
porti
ng g
ood
safe
ty c
limat
e Safety Climate Across Michigan ICUs
Culture of Safety- Michigan
84% 82%
41%47%
0
10
20
30
40
50
60
70
80
90
100
Safety Climate TeamworkClimate
2004 2006
"Needs Improvement“ Statewide Michigan CUSP ICU Results
•Less than 60% of respondents reporting good safety climate =“needs improvement”
•Statewide in 2004 84% needed improvement, in 2006 41%•Non-teaching and Faith-based ICUs improved the most•Safety Climate item that drives improvement: “I am encouraged by my colleagues to report any patient safety concerns I may have”
0
10
20
30
40
50
60
70
80
90
100
% o
f res
pond
ents
with
in a
n IC
U re
port
ing
good
team
wor
k cl
imat
eTeamwork Climate Across Michigan ICUs
No BSI 21%No BSI 21% No BSI 44%No BSI 44% No BSI 31% No BSI 31%
No BSI = 6 months or more w/ zeroNo BSI = 6 months or more w/ zero
The strongest predictor of clinical excellence: caregivers feel comfortable speaking up if they perceive a problem with patient care
Time period Median CLABSI rate
Baseline 2.7
Peri intervention 1.6
0-3 months 0
4-6 months 0
7-9 months 0
10-12 months 0
13-15 months 0
16-18 months 0
Pronovost NEJM 2006
2 yr CLABSI Results from ICUs in Michigan
4 yr CLABSI Results from ICUs in Michigan
Time period Median CLABSI rate
19-21 months 0
22-24 months 0
25-27 months 0
28-30 months 0
31-33 months 0
34-36 months 0
Pronovost BMJ 2010
Results
Lives Saved – 1,729*
Patient Days Saved – in excess of 127,000*
Dollars Saved – 0ver $246 Million*
Culture of Safety improved 28%
Teamwork improved 15%* Based on the Johns Hopkins Opportunity Calculator