CUSP for Safe Surgery:
The Surgical Unit-Based Safety
Program
March 3 & 5, 2014
Sean Berenholtz, MD, MHS, FCCM
Some quick administrative
announcements
• You need to dial into the conference line to
hear audio
– Dial in Number: 1-800-311-9401
– Passcode: 83762
• A copy of these slides can be found on our
SUSP recruitment website
• A recording of this webinar will be available
on the recruitment website by March 6, 2014.
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Learning Objectives
• Identify SUSP program
– Project goals and interventions
– Participation requirements and timeline
• Describe steps to enroll in SUSP
Why is Your SUSP Work
Important?
• 1 in 25 people will undergo surgery
• 7 million (25%) in-patient surgeries followed
by complication
• 1 million (0.5 – 5%) deaths following surgery
• 50% of all hospital adverse events are linked
to surgery AND are avoidable
http://www.who.int/patientsafety/chall
enge/safe.surgery/en/
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How is SUSP different than SCIP (Surgical
Care Improvement Project
Your Team Addresses Local Needs
• No single SSI prevention bundle
– Frontline staff identifies local defects
– Fix defects with executive support
• Measure local safety culture using Hospital
Survey of Patient Safety (HSOPS)
Questions? Email the SUSP help desk! SUSP@jhmi.edu
6
SUSP Project Overview
SUSP Project Overview
• AHRQ funding project
– Individual hospitals participate for 18 months
years
• Leveraging leaders in field
– Armstrong Institute, ACS NSQIP, AHRQ,
University of Pennsylvania, WHO
• All hospitals in any state, as well as hospitals
in the District of Columbia and Puerto Rico
are encouraged to participate.
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Who can join SUSP?
• Participation in the program is available to any
hospital in any state, as well as hospitals in the
District of Columbia and Puerto Rico.
• Hospitals may participate through their state
hospital association, state patient safety agency,
hospital engagement network (HEN) or other
convening group.
Questions? Email the SUSP help desk! SUSP@jhmi.edu
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SUSP Enrollment by Coordinating Entity
Armstrong Institute for Patient Safety &
Quality
Arkansas Hospital Association
Colorado Hospital Association
Connecticut Hospital Association
Florida Hospital Association
Georgia Hospital Association (HEN)
Premier Healthcare Alliance (HEN)
Hawaii Safer Care SUSP Collaborative
Iowa Healthcare Collaborative (HEN)
Maryland Hospital Association
Michigan Health & Hospital Association (HEN)
Nevada Health Insight (HEN)
Tennessee Hospital Association (HEN)
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Massachusetts Hospital Association
SUSP Enrollment by Coordinating Entity and Cohort
Coordinating Entity
Number of Hospitals Enrolled
Arkansas Hospital Association
11
Armstrong Institute
31
Colorado Hospital Association
8
Connecticut Hospital Association
5
Florida
Hospital to
Association
11
• Click
edit Master text styles
Georgia Hospital Association
14
– Second
Hawaii Safer
Care SUSPlevel
Collaborative
14
HealthInsight•Nevada
4
Third level
Iowa Healthcare Collaborative
13
– Fourth level
Maryland Hospital Association
18
» Fifth level
Massachusetts Hospital Association
8
Michigan Health & Hospital Association
46
Premier Healthcare Alliance
8
Tennessee Hospital Association
10
Total Enrollment
Cohort 1
10
Cohort 2
102
Cohort 3
47
Cohort 4
42
Total
201
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Our Shared Project Goals
• To achieve significant reductions in surgical
site infection and surgical complication rates
• To achieve significant improvements in safety
culture
Questions? Email the SUSP help desk! SUSP@jhmi.edu 12
How Are We Achieving Our Goals?
Translating Evidence
Into Practice
(TRiP)
1. Summarize the
evidence
Reducing Surgical Site
Infections
Comprehensive Unit
based Safety Program
(CUSP)
•
Emerging Evidence
1.
Educate staff on
science of safety
2. Identify local barriers
to implementation
•
Local Opportunities
to Improve
2.
Identify defects
3. Measure
performance
•
Collaborative
learning
3.
Assign executive
to adopt unit
4.
Learn from one
defect per quarter
5.
Implement
teamwork tools
4. Ensure all patients
get the evidence
• Engage
• Educate
• Execute
• Evaluate
Technical Work
Adaptive Work
http://www.hopkinsmedicine.org/armstr
ong_institute
13
We’re Building on Previous
Successes
• Michigan Keystone ICU program
– Reductions in central line-associated blood stream
infections (CLABSI) 1,2
– Reductions in ventilator-associated pneumonias
(VAP) 3
• National On the CUSP: Stop BSI program 4
1. N Engl J Med 2006;355:2725-32.
2. BMJ 2010;340:c309.
3. Infect Control Hosp Epidemiol.
2011;32(4): 305-314.
4. www.onthecuspstophai.org
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Percent of Units with Zero CLABSIs and
Achieving Project Goal (<1/1000 CL days)
*Data drawn from Interim Project Report – Figure 5 – Cohorts 1 through 3
www.onthecuspstophai.org
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We Focus on Systems,
Not Individuals
• Harm is preventable
– Many healthcare acquired infection and complications
are preventable; should be viewed as defect
• Technical and adaptive work
– Engaging frontline staff to identify and fix local
opportunities to improve
• Framing as social problem that can be solved
– Clinical communities
Questions? Email the SUSP help desk! SUSP@jhmi.edu 16
Wrong-patient, Wrong-site, Wrong-procedure
Events
Reviewed by The Joint Commission
The Joint Commission, Sentinel Event Data;
http://www.jointcommission.org/assets/1/18/E
vent_Type_Year_1995-2011.pdf;29.
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How is SUSP Different?
• Informed by science
• Led by clinicians and supported by
management
• Guided by measures
– local and national
Questions? Email the SUSP help desk! SUSP@jhmi.edu 18
SUSP Interventions
No single SSI prevention bundle
• Deeper dive into SCIP measures to identify local
defects
• Emerging evidence
– Abx redosing and weight based dosing
– Maintenance of normogylcemia
– Mechanical bowel preparation with oral abx
– Standardization of skin preparation
• Capitalize on frontline wisdom
– CUSP/Staff Safety Assessment
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Auditing tools
• Antibiotic
– Selection, dosing, redosing
• Normothermia
• Glucose Control
• Skin Prep
• SSI investigation
• Others
Questions? Email the SUSP help desk! SUSP@jhmi.edu
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Comprehensive Unit-based
Safety Program (CUSP)
1. Educate staff on science of safety
2. Identify defects
3. Assign executive to adopt unit
4. Learn from one defect per quarter
5. Implement teamwork tools
Questions? Email the SUSP help desk! SUSP@jhmi.edu
Briefings and Debriefings
• Reductions in communication breakdowns and
OR delays 1
• Reductions in procedure and miscommunicationrelated disruptions and nursing time spent in core
2
• Improved communication and teamwork, feasible
given current workload 3
• Reductions in rate of any complications, SSI and
Arch Surg. 2008;143(11): 1068-1072.
mortality 4
1
2J
Am Coll Surg. 2009;208:1115-1123.
3 Jt Comm J Qual Saf. 2009;35(8):391-397.
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4 N Engl J Med. 2009;360:491-9.
What data will teams need to collect?*
• Monthly NHSN and/or NSQIP SSI data by surgical
specialty area
– Numerator and denominator
• Annual teamwork/culture data using the AHRQ
Hospital Survey of Patient Safety (HSOPS)
• Will work with CEs to ensure data reporting meets
their needs
*If data is already collected/available (ie: ACS NSQIP or NHSN), we will work with
your team to import if you desire
Questions? Email the SUSP help desk! SUSP@jhmi.edu 24
Surgical Site Infection Data
Entry: NSQIP
• Target audience: Coordinating Entities and
hospital administrators
• Data transferred directly from NSQIP
• Unadjusted data transferred on a monthly
basis
• Adjusted data (Odds) transferred every 6
months
Questions? Email the SUSP help desk! SUSP@jhmi.edu 25
Surgical Site Infection Data
Entry: NHSN & Manual Entry
• Data transfer process – done by the
coordinating entities or hospital administrator
• Unadjusted data transferred on a monthly
basis
• Adjusted data (SIR) transferred every 6
months
Questions? Email the SUSP help desk! SUSP@jhmi.edu 26
What do teams need to do?
– Attend the Cohort 5 kickoff webinar (~2 hours)
• Monday, April 28 @ 10AM (EST) OR
• Wednesday, April 30 @ 2PM (EST)
– Assemble a multidisciplinary team
• Including Preop, OR and Postop staff
– Participate in monthly project webinars
• All webinars recorded and archived online
– Participate in monthly coaching calls
– Regularly meet as a team to implement
interventions and monitor performance
Questions? Email the SUSP help desk! SUSP@jhmi.edu
27
Once enrolled, the SUSP website is
your go to place for everything!
armstrongresearch.hopkinsmedicine.org
• Previously recorded cohort
project call webinars
• Manuals
• Toolkits
• Data portal
– Who uses the portal?
•
•
•
•
SUSP project leads
HSOPS coordinators
SSI data coordinators
Coordinating Entities
– What’s the portal used for?
•
•
•
Data viewing, summation, sharing
Hospital Survey of Patient Safety
(HSOPS)
Sharing of information
• Talk with other SUSP
hospitals on our social
network!
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CUSP Works in the OR
Colorectal NSQIP SSI Rate at Hopkins (Wick 2012)
Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program
to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2).
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Why should you be a part of SUSP?
• Improve patient outcomes
– ACS NSQIP comparative feedback
• Platform that links data collection, reporting, and
training with social networking to improve
communication and sharing
• Finding ‘value’ in our work
• Teams own their own data for publication
Questions? Email the SUSP help desk! SUSP@jhmi.edu 30
What are current SUSP hospitals
saying?
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Join us on our journey to improve
the safety of our patients!
How to enroll or recruit hospitals into SUSP
• Everything you need is online!
– Download ALL enrollment documents online!
– Complete the team registration form online!
Visit the SUSP recruitment website
Have questions? Email the SUSP help desk!
SUSP@jhmi.edu
32
State hospital associations:
Important due dates and deadlines
• By March 21: Complete the Coordinating Entity
Participating Agreement and email to SUSP@jhmi.edu
or fax to 410-637-4380.
• Download the Coordinating Entity Project Manual for
guidance on kick-starting your recruiting efforts
Everything you need is here: SUSP recruitment website
Have questions? Email the SUSP help desk!
SUSP@jhmi.edu
33
Hospitals:
Important due dates and deadlines
• By April 9: Have your hospital leadership complete the Hospital CEO
Participating Agreement
• By April 16: Complete three additional forms
– Online Project Team Registration Form
– Data Use Agreement
– Clinical Team Participating Agreement
• Upload copies of these forms when submitting the Online Project Team
Registration Form. You can also return the forms to the SUSP help
desk at SUSP@jhmi.edu or by fax: 410-637-4380
Everything you need is here: SUSP recruitment website
Have questions? Email the SUSP help desk!
SUSP@jhmi.edu
34
Next steps
• Visit our recruitment website
– CEs: begin recruiting hospitals
– Independent hospitals: Return all enrollment forms
to SUSP@jhmi.edu no later than April 16.
Have questions? Email the SUSP help desk!
SUSP@jhmi.edu
Questions? Email the SUSP help desk! SUSP@jhmi.edu 35
SUSP from the CE perspective
Dana Bonistalli
Project Manager, Quality Policy &
Advocacy Maryland Hospital Association
18 hospitals enrolled and engaged in SUSP!
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