AHRQ’s infection program sees slow enrollment
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.