Research Activities, October 2012: Agency News and Notes: AHRQ safety project reduces bloodstream infections by 40 percent

Agency News and Notes

AHRQ safety project reduces bloodstream infections by 40 percent

A unique nationwide patient safety project funded by the Agency for Healthcare Research and Quality (AHRQ) reduced the rate of central line-associated bloodstream infections (CLABSIs) in intensive care units by 40 percent, according to the Agency's preliminary findings of the largest national effort to combat CLABSIs to date. The project used the Comprehensive Unit-based Safety Program (CUSP) to achieve its landmark results—preventing more than 2,000 CLABSIs, saving more than 500 lives, and avoiding more than $34 million in health care costs.
The Agency and key project partners from the American Hospital Association (AHA) and Johns Hopkins Medicine discussed these dramatic findings at the AHRQ annual conference in September in Bethesda, Maryland, and introduced the CUSP toolkit that helped hospitals accomplish this marked reduction.
"CUSP shows us that with the right tools and resources, safety problems like these deadly infections can be prevented," said AHRQ Director Carolyn M. Clancy, M.D. "This project gives us a framework for taking research to scale in practical ways that help front-line clinicians provide the safest care possible for their patients."
CLABSIs are one type of healthcare-associated infection (HAI). HAIs are infections that affect patients while they are receiving treatment for another condition in a health care setting. HAIs are a common complication of hospital care, affecting one in 20 patients in hospitals at any point in time.
The national project involved hospital teams at more than 1,100 adult intensive care units in 44 states over a 4-year period. Preliminary findings indicate that hospitals participating in this project reduced the rate of CLABSIs nationally from 1.903 infections per 1,000 central line days to 1.137 infections per 1,000 line days, an overall reduction of 40 percent.
The CUSP is a customizable program that helps hospital units address the foundation of how clinical teams care for patients. It combines clinical best practices with an understanding of the science of safety, improved safety culture, and an increased focus on teamwork. Based on the experiences gained in this successful project, the CUSP toolkit helps doctors, nurses, and other members of the clinical team understand how to identify safety problems. It also gives them the tools to tackle these problems that threaten the safety of their patients. It includes teaching tools and resources to support implementation at the unit level.
The first broad-scale application of CUSP was in Michigan, under the leadership of the Michigan Health & Hospital Association, where it was used to significantly reduce CLABSIs in that State. Following that success, CUSP was expanded to 10 States and then nationally through an AHRQ contract to the Health Research & Educational Trust, the research arm of the AHA. "This partnership between the Federal government and hospitals provides clear evidence that we can protect patients from these deadly infections," said AHA President and CEO Richard J. Umbdenstock. "Hospitals remain committed to curtailing CLABSIs and enhancing safety in all clinical settings. Tools such as CUSP go a long way toward accomplishing that goal."
CUSP was created by a team led by Peter J. Pronovost, M.D., Ph.D., senior vice president for patient safety and quality at Johns Hopkins Medicine. "It is gratifying that this method has become such a powerful engine for improving the quality and safety of care nationwide," said Dr. Pronovost. "It is a really simple concept; trust the wisdom of your front-line clinicians." In addition, CUSP also builds on important work led by the Centers for Disease Control and Prevention and its evidence-based recommendations on treating infections. Together with HHS' National Action Plan to Prevent Healthcare Associated Infections (http://www.hhs.gov/ash/initiatives/hai/index.html) and the Partnership for Patients (http://www.healthcare.gov/compare/partnership-for-patients), AHRQ's efforts are a part of a coordinated approach drawing on the strengths and expertise across HHS.
Details about AHRQ's national CUSP project are available at http://www.ahrq.gov/qual/hais.htm. AHRQ's CUSP toolkit is available at http://www.ahrq.gov/cusptoolkit.

Healthcare-Associated Infection (HAI)

Healthcare-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a healthcare setting. HAIs can be acquired anywhere healthcare is delivered, including inpatient acute care hospitals, outpatient settings such as ambulatory surgical centers and end-stage renal disease facilities, and long-term care facilities such as nursing homes and rehabilitation centers. HAIs may be caused by any infectious agent, including bacteria, fungi, and viruses, as well as other less common types of pathogens.
These infections are associated with a variety of risk factors, including:

Use of indwelling medical devices such as bloodstream, endotracheal, and urinary catheters
Surgical procedures
Injections
Contamination of the healthcare environment
Transmission of communicable diseases between patients and healthcare workers
Overuse or improper use of antibiotics

Magnitude of the Problem
HAIs are a significant cause of morbidity and mortality. At any given time, about 1 in every 20 inpatients has an infection related to hospital care. These infections cost the U.S. healthcare system billions of dollars each year and lead to the loss of tens of thousands of lives. In addition, HAIs can have devastating emotional, financial and medical consequences.
A majority of hospital-acquired HAIs include:

Urinary tract infections
Surgical site infections
Bloodstream infections
Pneumonia

Call to Action
There is growing consensus that our ultimate goal should be the elimination of HAIs. To coordinate and maximize the efficiency of prevention efforts, a senior-level Federal Steering Committee for the Prevention of Healthcare-Associated Infections was established in 2008. Members include clinicians, scientists, and public health leaders who are high-ranking officials from the U.S. Department of Health and Human Services(HHS), U.S. Department of Defense, U.S. Department of Labor, and U.S. Department of Veterans Affairs. The Steering Committee marshaled the extensive and diverse resources across the federal government, formed public and private partnerships, and initiated discussions that identified new approaches to HAI prevention and collaborations.
In 2009, the HHS Assistant Secretary for Health created the Office of Healthcare Quality (OHQ) to support and carry out the Steering Committee’s mandate to improve healthcare quality by preventing and eventually eliminating HAIs. The Steering Committee developed the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination. At a meeting held in late 2010, subject matter experts (SMEs) met to discuss strategies to accelerate the progress towards national infection reduction goals. Since the 2010 meeting, several other large national meetings, as well as specific stakeholder meetings have taken place to build upon the strategies discussed at the 2010 meeting.
As the HAI Action Plan is a living document, the Steering Committee released a new iteration of the HAI Action Plan (open for public comment from April-June 2012) that incorporates new research and information. The updated iteration will be released fall 2012.
Collaboration
In April 2011, HHS announced another way it is committed to patient safety:-Partnership for Patients (PfP). It is a new public-private partnership to make hospital care safer, more reliable, and less costly by:

Keeping hospital patients from getting injured or sicker. By the end of 2013, to decrease instances of patients acquiring preventable conditions while in hospitals by 40 percent compared to 2010.
Helping patients heal without complication. By the end of 2013, to decrease preventable complications during a transition from one care setting to another, so that the number of patients who must be re-admitted to the hospital would be reduced by 20 percent compared to 2010.

Partnership for Patients: Better Care, Lower Costs

Doctors, nurses and other health care providers in America work incredibly hard to deliver the best care possible to their patients. Unfortunately, an alarming number of patients are harmed by medical mistakes in the health care system and far too many die prematurely as a result.

Introducing the Partnership for Patients with Sorrel King
Patient safety advocate Sorrel King talks about the Partnership for Patients and the loss of her child due to medical errors.

The Obama Administration has launched the Partnership for Patients: Better Care, Lower Costs, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership for Patients brings together leaders of major hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable, and less costly.
The two goals of this new partnership are to:

Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.
Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

Achieving these goals will save lives and prevent injuries to millions of Americans, and has the potential to save up to $35 billion across the health care system, including up to $10 billion in Medicare savings, over the next three years. Over the next ten years, it could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings. This will help put our nation on the path toward a more sustainable health care system.

Building on Local and National Work

In 1999, the landmark Institute of Medicine study, “To Err is Human,” estimated that as many as 98,000 Americans die every year from preventable medical errors. Despite many successful efforts, this statistic has not improved much in the following decade. And many more patients get injured or sicker from preventable adverse events after being admitted to a hospital.
After more than a decade of work to understand and address these problems, promising examples of better practices exist, but patients too often are still injured in the course of receiving care. There is much more work to be done to prevent unnecessary harm to patients.

At any given time, about one in every 20 patients has an infection related to their hospital care.
On average, one in seven Medicare beneficiaries is harmed in the course of their care, costing the government an estimated $4.4 billion every year.
Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days – that’s approximately 2.6 million seniors at a cost of over $26 billion every year.

Hospital Engagement Networks

Hospitals across the country will have new resources and support to make health care safer and less costly by targeting and reducing the millions of preventable injuries and complications from healthcare acquired conditions. $218 million was awarded to 26 state, regional, national, or hospital system organizations to be Hospital Engagement Networks. As Hospital Engagement Networks, these organizations will help identify solutions already working to reduce health care acquired conditions, and work to spread them to other hospitals and health care providers.
Hospital Engagement Networks will work to develop learning collaboratives for hospitals and provide a wide array of initiatives and activities to improve patient safety. They will be required to conduct intensive training programs to teach and support hospitals in making patient care safer, provide technical assistance to hospitals so that hospitals can achieve quality measurement goals, and establish and implement a system to track and monitor hospital progress in meeting quality improvement goals.
In addition to the Hospital Engagement Networks, $10 million has been awarded to three organizations to create a curriculum in patient safety for the Hospital Engagement Networks, engage Medicare, Medicaid and Children’s Health Insurance Program beneficiaries, their families and caregivers and others in specific activities supporting the aims of the Partnership for Patients, and evaluate the impact and effectiveness of the Partnership for Patients.
Learn more about the efforts of the Partnership for Patients to make care safer.

Improving Care Transitions

One of the ways the Partnership for Patients can achieve its goal of reducing preventable hospital readmissions is to focus on reducing complications during transitions from one care setting to another, particularly for patients with multiple chronic conditions. Safe, effective, and efficient care transitions require thoughtful collaboration among health care providers, hospitals, nursing homes and other facilities, social service providers, patient caregivers, and patients themselves.
In April 2011, Center for Medicare and Medicaid Services announced the opportunity for Community-based Organizations to apply for the Community-based Care Transitions Program (CCTP), which was authorized by Section 3026 of the Affordable Care Act. This extraordinary program allows a community of healthcare and social services providers to design and propose a Medicare fee for services benefit to receive payment for care transitions – tailored to the unique needs of the community.
Learn more about Care Transitions and the $500 Million in funding for the Community-based Care Transitions Program (CCTP)
Posted on: April 12, 2011