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 Primarily technical interventions: CVC line insertion CVC line management

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

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 Daily Goals Percent understanding patient care goals 5

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

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%

Culture of Safety- Michigan Teamwork Climate Across Michigan ICUs

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

"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”   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%.

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

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

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

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