Researchers estimate that 28 infections were prevented in 2010 to 2011, resulting in an estimated cost savings of between $168,000 and $280,000 for the hospital in just one year. Assuming a nationwide annual incidence of 1.7 million total SSIs per year, researchers estimate widespread application of the Johns Hopkins safety program across all surgical specialties could save more than $100 million annually.
The team’s approach is based on a program developed and championed by patient safety experts in Hopkins’ Armstrong Institute for Patient Safety and Quality. The Comprehensive Unit-based Safety Program, or “CUSP" for short, emphasizes careful measurement of a safety issue, research to develop a likely solution and team-driven culture changes that eliminate barriers to challenging unsafe practice.
A similar CUSP program developed by Peter Pronovost, MD, PhD, Armstrong Institute director and senior vice president for patient safety and quality at Johns Hopkins Medicine, dramatically reduced central line-associated bloodstream infections in intensive care units, first in the state of Michigan and now in hospitals across the country and around the world. Designed to make mistakes more transparent and use it and other tools to improve the culture of safety, CUSP relies heavily on “local staff" training in the science of safety—how to identify problems, report them, measure them, plan and implement corrections and measure again, Wick said. It also embraces discussions about improving communication and teamwork.
“The benefits of a bottom-up versus a top-down approach to patient safety were immediately obvious," said Wick, noting that after the CUSP team formed, front-line staff were quick to point out inconsistencies in delivering preventative antibiotics. “We were able to clear up misconceptions and concerns related to nephrotoxicity and medication allergies pretty quickly," she said.
Based on an initial safety survey and monthly meetings, a CUSP team of surgeons, nurses, operating room technicians and anesthesiologists directly involved in the care of colorectal surgery patients identified six key interventions. Those included standardization of skin preparation; prescription of preoperative chlorhexidine showers; restricted use of by-mouth bowel cleansing solution before procedures; warming of patients in the pre-anesthesia area; adoption of enhanced sterile techniques for bowel and skin portions of the case; and addressing lapses in prophylactic antibiotics.
Active support and participation by a senior hospital executive—a necessary component for the success of CUSP—ensured that staff had access to resources needed for quick, evidence-based interventions to reduce risks to patients, Wick reported.
“By bringing together front-line providers with hospital administrators, the program bridges a growing divide in healthcare," Makary said, noting one effect of what he describes as a record number of hospital mergers and acquisitions in recent years.