1. MA ICU Safe Care Initiative: Comprehensive Unit Based Safety Program (CUSP)
October 25, 2010

2. 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
Primarily technical interventions:
CVC line insertion
CVC line management

3. On The CUSP Stop BSI PRIMARILY Adaptive (CUSP)
PRIMARILY Technical (CLABSI)
CVC Insertion
CVC Line Cart
1. Contents inventory
Evidence based BSI prevention – the bundle
(hands, site, skin prep, barrier, removal)
1. Presentation of evidence
2. CLABSI factsheet
3. Insertion checklist
4. Vascular access quiz
5. Vascular access manual/ policy 6.Annotated bibliography
CVC Management
1. Daily goals
2. Dressing change
3. Vascular access manual/ policy protocol
PRIMARILY Adaptive (CUSP)
Science of Safety Training
1. Science of safety presentation
2. Attendance sheet
Staff Identify Defects
1. Staff safety assessment form
2. Indentifying hazards presentation
Senior Executive Partnership
Briefings
Learning from Defects
LFD toolkit
Implement Tools for Teamwork and Communication
2. Shadowing
3. AM briefing
4. Call list
5. Team check up tool
Assemble a CUSP team,
Partner with a senior executive;
Baseline CLABSI Data
Exposure Survey and Technology Survey 3

4. 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:

5. Communication Among Care Providers: Percent Understanding Patient Care Goals
Daily Goals
Percent understanding patient care goals 5

6. Impact of Daily Goals on ICU Length of Stay
654 New Admissions = $7 Million Additional Revenue 6

7. Safety Climate- Culture of Safety Survey
% of respondents within an ICU reporting good safety climate
WICU- 35% to 52% to 87%
SICU- 35% to 68% to 70%

8. Culture of Safety- Michigan
Teamwork Climate Across Michigan ICUs

9. Culture of Safety- Michigan
Safety Climate Across Michigan ICUs
% of respondents within an ICU reporting good safety climate

10. "Needs Improvement“ Statewide Michigan CUSP ICU Results
Less than 60% of respondents reporting good safety climate =“needs improvement”
Statewide in % needed improvement, in %
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”
We do not know exactly what the goal for safety culture should be We typically set a goal of 80% of staff reporting positive safety culture. We also recognize that if safety culture is below 60% it is associated with worse clinical and economic outcomes. We reduced the percent of teams scoring below 60% by nearly 50%.

11. Teamwork Climate Across Michigan ICUs
The strongest predictor of clinical excellence:
caregivers feel comfortable speaking up if they perceive a problem with patient care
% of respondents within an ICU reporting good teamwork climate
No BSI 21%
No BSI 44%
No BSI 31%
No BSI = 6 months or more w/ zero

12. 2 yr CLABSI Results from ICUs in Michigan
Time period
Median CLABSI rate
Baseline
2.7
Peri intervention
1.6
0-3 months
4-6 months
7-9 months
10-12 months
13-15 months
16-18 months
Pronovost NEJM 2006

13. 4 yr CLABSI Results from ICUs in Michigan
Time period
Median CLABSI rate
19-21 months
22-24 months
25-27 months
28-30 months
31-33 months
34-36 months
Pronovost BMJ 2010

14. 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