Stalling states

AHRQ’s in­fec­tion pro­gram sees slow en­roll­ment

Modern Healthcare - - The Week In Healthcare - Mau­reen McKin­ney

Six months af­ter the Agency for Health­care Re­search and Qual­ity an­nounced it would be­gin a na­tion­wide ex­pan­sion of a pro­gram cred­ited with suc­cess­fully re­duc­ing health­care-as­so­ci­ated in­fec­tions, some state or­ga­ni­za­tions and hos­pi­tals are tak­ing their time get­ting on­board.

The pro­gram, called the Com­pre­hen­sive Unit-Based Safety Pro­gram, or CUSP, was de­vel­oped by the Johns Hopkins Uni­ver­sity Qual­ity & Safety Re­search Group, and was used in a much-pub­li­cized ini­tia­tive known as the Key­stone project, which suc­cess­fully low­ered the rate of cen­tral-line-as­so­ci­ated blood stream in­fec­tions by twothirds in more than 100 in­ten­sive­care units in Michi­gan.

Af­ter Michi­gan’s suc­cess, AHRQ ex­tended funds to 10 more states in early 2009 to use the CUSP model, which em­pha­sizes team­build­ing and cul­ture change, as a strat­egy to re­duce blood stream in­fec­tions. In Oc­to­ber 2009, the agency ex­panded fund­ing fur­ther, award­ing $8 mil­lion to im­ple­ment the pro­gram in all 50 states, on a vol­un­tary ba­sis.

The project’s ini­tial fo­cus has been on cen­tral-line-as­so­ci­ated blood stream in­fec­tions, but AHRQ also al­lot­ted money to ap­ply the model to other fu­ture goals in­clud­ing re­duc­ing the num­ber of catheteras­so­ci­ated uri­nary tract in­fec­tions.

More than 30 states are cur­rently par­tic­i­pat­ing in the ini­tial project, called On the CUSP: STOP BSI, ac­cord­ing to Peter Pronovost, an anes­the­si­ol­o­gist and pa­tient-safety ex­pert, who heads the pro­gram.

But newly re­leased data show that each state varies widely in the num­ber of hos­pi­tals it has en­rolled and their level of in­volve­ment, Pronovost said. For in­stance, Con­necti­cut has some of the high­est en­roll­ment num­bers with 15 of its 27 hos­pi­tals, or 56%, en­listed to par­tic­i­pate. Thirty-five of Illi­nois’ 149 hos­pi­tals, or 23%, are en­rolled, while other states such as Min­nesota hover around the 9% mark.

That’s a prob­lem, Pronovost said, be­cause check­lists, de­spite their prom­ise of low-cost, high-im­pact qual­ity im­prove­ment, will likely do lit­tle to re­duce in­fec­tion rates if they are not ac­com­pa­nied by sig­nif­i­cant cul­tural changes.

“I al­ways ask, ‘If a nurse in your hos­pi­tal saw a se­nior physi­cian not com­ply­ing with a check­list, would he or she speak up?’ ” Pronovost said. “Al­most unan­i­mously, I am laughed at. ... But if that’s the case, your sys­tem is not work­ing.”

En­sur­ing that physi­cians, nurses, clerks and other hos­pi­tal staff work to­gether to achieve com­mon safety goals takes time and ef­fort, said Dar­lene Swart, vice pres­i­dent and di­rec­tor of the Ten­nessee Cen­ter for Pa­tient

Brexler: Im­prove­ments via process changes.

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