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The Armstrong Institute for Patient Safety & Quality. Taking Patient Safety to the Next Level Peter Pronovost, MD, PhD. CLABSI Rates in 103 Michigan ICUs. Pronovost NEJM 2006: Pronovost BMJ 2010: Sawyer CCM2010 . Michigan ICU Safety Climate Improvement. CCM 2011. - PowerPoint PPT Presentation
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© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011
Taking Patient Safety to the Next Level
Peter Pronovost, MD, PhD
1
The Armstrong Institute for Patient Safety & Quality
Median and Mean CRBSI Rate
0123456789
Time (months)
CRBS
I Rat
e
Median CRBSI Rate Mean CRBSI Rate
Pronovost NEJM 2006: Pronovost BMJ 2010: Sawyer CCM2010
CLABSI Rates in 103 Michigan ICUs
Michigan ICU Safety ClimateImprovement
Effect of CUSP on Safety Climate
87
47
0102030405060708090
100
Pre vs. Post Intervention
% "
Nee
ds Im
prov
emen
t" *
Pre-CUSP (2004) Post-CUSP (2006)
* “Needs Improvement” - Safety Climate Score <60%
CCM 2011
Impact of Statewide Quality Improvement Initiative on Hospital Mortality
Pre-implementation (12 months: Oct 02 - Sept 03)
Project Initiation (5 months: Oct 03 - Feb 04)
Implementation (12 months: Mar 04 - Feb 05)
Post-implementation (12 months: Mar 05 - Feb 06)
Post-implementation (12 months: Mar 06 - Dec 06)
0.700000000000001
0.800000000000001
0.900000000000001
1
1.1
Study Group Adjusted OR Comparison Group Adjust OR
Adj
uste
d O
dds
Rat
io
Impact of Michigan Keystone Project on Hospital MortalityLipitz: BMJ 2011
ICU ClABSI Down 60% across the U.S.CDC. MMWR 2011, 60 (8):243-248.
Measure and Improve Patient Outcomes
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
Translating Evidence Into Practice (TRiP)
1. Summarize the evidence in a checklist. • Wash your hand, clean skin with
chlorhexadine, avoid femoral site, use barrier precautions, ask daily if you need the catheter
2. Identify local barriers to implementation
3. Measure performance
4. Ensure all patients get the evidence• Engage• Educate• Execute• Evaluate
www.hopkinsmedicine.org/armstronginstitute
Fractal-
• common goal
Armstrong Institute for Patient Safety and Quality11
What Have We Learned
Work must be informed by sciencedifferent problems require different methods
Work must be led by CliniciansWork must be guided by valid measuresWork must be modified to fit local contextHarm must be seen as a social problem capable of being solvedPlatform to deliver programs must combine e learning, data collection and reporting, social learning, and CME or MOC
Armstrong Institute CLABSI Initiative
Annual Hospital Survey of
Patient Safety (HSOPS)
Clinical Registry of CLABSI Data
Comprehensive Unit Based
Safety Program (CUSP)
Monthly Team Checkup
Clinical Communities of Practice & Tools
for Improvement
Peer Driven QI Through Communities of Practice
Topic Based Clinical Communities of
Practice
Share Best Practices and
Results
Invite All Care Team Members to Participate
Roll Up Performance Data Across Unit, Hospital, or Initiative
View and Analyze Measure & Survey
Performance
System (INCOSE): noun \sis-tuhm\A system is a construct or collection of different elements that together produce results not obtainable by the elements alone. The elements, or parts, can include people, hardware, software, facilities, policies, and documents; that is, all things required to produce systems-level results.
Armstrong Institute for Patient Safety and Quality16
Armstrong Institute for Patient Safety and Quality17
Armstrong Institute for Patient Safety and Quality18
Armstrong Institute for Patient Safety and Quality20
What Can you Do?
• Erase lines and collaborate– Safety and education aligning
• Ensure competency in certification • Develop robust MOC program
– Include learning from defects– Include clinical communities– Include peer to peer review
• Create moral framework for learning and accountability
Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley, JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:2014-2020.
Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, Thompson DA, Sinopoli D, Cosgrove S, Sexton JB, Marsteller JA, Hyzy RC, Welsh R, Posa P, Schumacher K, Needham D. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: Observational study. British Med J 2010;340:c309.
DePalo VA, McNicoll L, Cornell M, Rocha JM, Adams L, Pronovost PJ. The Rhode Island ICU Collaborative: A model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide. Qual Saf Health Care 2010;19:555-561.
Berenholtz SM, Pham JC, Thompson DA, Needham DM, Lubomski LH, Hyzy RC, Welsh R, Cosgrove SE, Sexton JB, Colantuoni E, Watson S, Goeschel CA, Pronovost PJ. An intervention to reduce ventilator-associated pneumonia in the ICU: Collaborative cohort study. Infect Control Hosp Epidemiol 2011, in press.
Sexton JB, Berenholtz SM, Goeschel CA, Watson S, Holzmueller CG, Thompson DA, Hyzy RC, Marsteller JA, Schumacher K, Pronovost PJ. Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Med Feb 2011.
Lipitz-Snyderman A, Steinwachs D, Needham DM, Colantuoni E, Morlock LL, Pronovost PJ. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: Retrospective comparative analysis. Brit Med J 2011;342:d219.
Pronovost, PJ, Marsteller JA, Goeschell CA. Preventing Bloodstream Infections: A Measurable National Success Story: Health Affairs 2011;20:628-634
Dixon-Woods, M, Bosk, C, Goeschel CA, Pronovost PJ. Explaining Michigan: Milbank Quarterly 2011
Selected References
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