ChristianaCare Used AHRQ Resources to Reduce Blood Infections, Expedite Stroke Care

July 2020

ChristianaCare used AHRQ's Comprehensive Unit-based Safety Program (CUSP) to significantly reduce bloodstream infections and AHRQ's TeamSTEPPS program to expedite emergency care for stroke patients, cutting the time in half. ChristianaCare is a teaching health system with facilities in Delaware, Maryland, New Jersey, and Pennsylvania.

Patient infection rates dropped after ChristianaCare implemented CUSP strategies to promote improved teamwork, clinical best practices, and the science of safety. The number of central line-associated bloodstream infections in intensive care units (ICUs) decreased from 21 cases in 2011 to four cases in 2019.

"The CUSP initiative gave each ICU 'ownership' of its infection rates. Each ICU established a multi-disciplinary team—ranging from medical directors to clinicians to others, such as the cleaning staff—that focused on ways to reduce bloodstream infection rates. Over time, the results have been very positive," said Marci Drees, M.D., M.S., ChristianaCare's chief infection prevention officer and hospital epidemiologist.

ChristianaCare also used CUSP to decrease the use of central venous (blood-line) catheters in its ICUs by nearly half. Catheter days dropped from 12,627 days in 2011 to 6,574 days in 2019.

"The traditional thinking among staff had been that if you use catheter devices, then your patients are going to get infections. CUSP helped us change that way of thinking by tremendously improving the culture of safety. For example, our nurses are now empowered to stop a procedure they observe that might pose potential harm to the patient," Dr. Drees said.

"We were able to reduce infections systematically because our team members became more conscious about what's possible when adhering to the evidence-based practices of CUSP. We've now expanded CUSP to many of our hospital inpatient care units as well, she continued.

In another patient safety project, ChristianaCare used AHRQ's TeamSTEPPS tools in simulation training to expedite emergency treatment for stroke patients. TeamSTEPPS training and tools improved staff communication, which resulted in faster surgical care for stroke patients: critical surgical treatment time was cut to about 20 minutes, half of what it had been.

"The time from 'door to incision' decreased from over 40 minutes to less than 20 minutes consistently within a 2-year period, and we attribute that directly to the TeamSTEPPS teamwork and communication strategies in clinical care," said Susan Coffey-Zern, M.D., ChristianaCare's director of virtual education and simulation training.

"We use TeamSTEPPS in almost all of our team training simulations, including cardiac life support, Code Blue, and obstetric emergency response training," Dr. Coffey-Zern said, adding that ChristianaCare trains about 2,500 healthcare providers in TeamSTEPPS each year.

Developed jointly by AHRQ and the Department of Defense, TeamSTEPPS is an evidence-based system that aims to improve communication and teamwork skills among healthcare professionals, boosting patient safety and care.

To keep patient safety top of mind and regularly measure employees' perceptions of patient safety within the health system, ChristianaCare also uses AHRQ surveys on patient safety culture. The health system conducts the Hospital Survey on Patient Safety Culture and Medical Office Survey on Patient Safety Culture every 2 years.

"The AHRQ surveys allow us to gain a perception of our caregivers in relation to a culture of safety and understand opportunities to improve. We can gain a true understanding of what's going on within our health system," said Ann Principe, D.N.P., M.B.A., R.N., director in ChristianaCare's Office of Quality and Patient Safety.

Participation in the hospital survey by healthcare providers and staff increased from 57 percent in 2017 to 70 percent in 2019. Similarly, participation in the medical office survey rose from 57 percent in 2017 to 67 percent in 2019.

Principe attributed the increased survey participation to robust project management using AHRQ's patient safety survey user guide. The guide promotes strategies such as obtaining executive management buy-in, providing frequent survey result updates to employees, and stressing that the survey responses are confidential.

"We keep our caregivers (employees) and leadership informed of survey results using different methods. These include providing reports at all levels, group presentations, and internal tableau dashboards," she said.

"Our caregivers are engaged in patient safety activities and are interested in seeing the survey outcomes. This can influence future decisions on actions at the unit and system level. For the hospital survey, we've found that 'Teamwork Within the Units' is a composite for which we consistently see our highest scores demonstrating success, especially at the unit level," Principe said.