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Rockville, MD: Agency for Healthcare Research and Quality; September 10, 2012.
The near elimination of central line–associated bloodstream infections (CLABSIs) in intensive care units (ICUs) in Michigan stands as one of the landmark accomplishments of the patient safety field. Although the checklist for CLABSI prevention has been widely publicized, equally important components of the intervention included the comprehensive unit-based safety program (CUSP) and interventions to improve safety culture in participating ICUs. The Agency for Healthcare Research and Quality subsequently sponsored an effort to extend the success of the Michigan initiative nationwide, centered around implementation of the CUSP. The initial results, presented in this press release, indicate another remarkable success, with CLABSI rates being reduced by 40% across 1100 participating ICUs. It is notable that these reductions were accomplished even though the baseline rate of CLABSI was already lower than in prior studies. The developer of CUSP, Dr. Peter Pronovost, was interviewed by AHRQ WebM&M in 2010.
Journal Article > Study
The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs.
Waters HR, Korn R Jr, Colantuoni E, et al. Am J Med Qual. 2011;26:333-339.
One of the seminal achievements in the patient safety field, the Keystone ICU project accomplished impressive short-term and long-term reductions in health care–associated infections in Michigan ICUs by implementing checklists and improving safety culture. This follow-up study also demonstrates the cost-effectiveness of the program, as the money saved by preventing infections greatly outweighed the cost of the intervention itself. Substantiating the business case for quality in this fashion will further stimulate wide dissemination of proven safety interventions.
Journal Article > Study
Neily J, Mills PD, Young-Xu Y, et al. JAMA. 2010;304:1693-1700.
Classic studies have demonstrated that operating rooms are rife with communication and teamwork problems, and suboptimal teamwork has been linked to poor postoperative patient outcomes. In this rigorously designed study, surgical teams at 74 Veterans Affairs (VA) hospitals underwent teamwork training through the VA's Medical Team Training program. The training also included implementation of preoperative and postoperative checklists. The teamwork training was associated with a striking reduction in mortality compared to other VA hospitals that had not yet implemented the program, and a dose–response effect was also evident, with continuing training resulting in further reductions in mortality. An accompanying editorial lauds this study as an example of how to conduct a rigorous, evidence-based evaluation of a safety intervention, and stresses that addressing teamwork and safety culture are as essential to improving safety as technical and procedural interventions such as checklists.
Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out.
Pronovost P, Vohr E. New York, NY: Hudson Street Press; 2010. ISBN: 9781594630644.
Over the past decade, Johns Hopkins intensivist Dr. Peter Pronovost has emerged as the world's most influential patient safety researcher. In this book, written with Eric Vohr, Pronovost describes how his work was inspired by two deaths from medical mistakes: of young Josie King at Johns Hopkins Hospital (chronicled by her mother Sorrel in another book) and of his own father. The meat of the volume is a detailed chronicle of Pronovost's journey from neophyte faculty member to internationally acclaimed researcher and change agent. In earnest and plainspoken prose, he describes the inside story of interventions and studies that have transformed the safety world: the Comprehensive Unit-Based Safety Program (CUSP), the use of ICU goal cards, and most importantly, the use of checklists to reduce central line infections in more than 100 Michigan ICUs, a story also recently described by Dr. Atul Gawande in The Checklist Manifesto. Dr. Pronovost was the subject of an AHRQ WebM&M interview in 2005.
Gawande A. The New Yorker. December 10, 2007;83:86-95.
This article by bestselling author and surgeon Atul Gawande illustrates the complexity of intensive care and profiles Peter Pronovost, the Johns Hopkins intensivist and safety leader whose efforts to standardize safety practices led to remarkable reductions in ICU harm in Michigan hospitals. It goes on to a broader discussion of how checklists and decision support have reduced errors and transformed safety in critical care. Gawande also reflects on how implementation of standardized approaches often conflicts with the traditional physician culture, which prizes individual expertise over all else.
Journal Article > Study
Pronovost P, Needham D, Berenholtz S, et al. N Engl J Med. 2006;355:2725-2732.
Catheter-related bloodstream infections (CRBSI) remain a common and deadly patient safety issue in intensive care units (ICUs), although prior research has defined several effective preventive strategies. In the ''Keystone ICU'' project, funded by the Agency for Healthcare Research and Quality (AHRQ), 103 ICUs in Michigan participated in a statewide safety initiative, including instituting five evidence-based preventive strategies recommended by the Centers for Disease Control and Prevention (CDC). The project focused on changing provider behavior through addressing safety culture, incorporating a centralized education program for team leaders at each institution, and closely collaborating with infection control personnel. The intervention was remarkably successful, nearly eliminating CRBSI entirely in most ICUs over an 18-month follow-up period. A related editorial lauds the success of the intervention and calls for all U.S. hospitals to adopt similar programs.