Tennessee Medical Center Uses AHRQ Tools to Reduce Infections, Medical Errors

After using principles from AHRQ's Comprehensive Unit-based Safety Program (CUSP) to reduce pressure ulcers, NorthCrest Medical Center in Springfield, Tennessee, used CUSP practices to tackle 24 other patient safety problems ranging from catheter-associated urinary tract infections (CAUTI) to medication errors.

"We use CUSP exclusively to accomplish just about anything," said Randy Davis, M.B.A., NorthCrest's CEO. CUSP is an evidence-based method that helps clinical teams address safety issues by combining clinical best practices and the science of safety.

The 109-bed NorthCrest, which has a certified wound care center, struggled with pressure ulcers for several years before implementing CUSP principles in 2012 to address the problem. Administrators noted improvements within 3 weeks.

"That was a springboard and catalyst to using CUSP techniques with great success," Mr. Davis said.

The hospital then assembled a team focused on CAUTI. After experiencing 10 CAUTIs in 2012, NorthCrest reduced the number of such infections quickly and sustained those efforts after CUSP processes were introduced. In 2016, NorthCrest had only one case of CAUTI. AHRQ's Toolkit for Reducing CAUTI in Hospitals applies CUSP principles to help hospitals prevent CAUTI in patients and improve safety culture.

CUSP has been successful, added Angela Beard, R.N., M.S.N., vice president and chief nursing officer, because implementation has been led by nurses and other bedside staff, even though a physician and senior executive sponsor each CUSP team.

Beard said that the CUSP elements NorthCrest found useful were educating staff in the science of safety, identifying defects, engaging executive leaders, learning from defects, and implementing teamwork tools.

She explained, "We identified early in our program that educating the staff on safety was critical. The frontline staff are the people that identify problems and defects, so safety training was necessary to define our goals. Leaders' roles are to be sure the CUSP teams have what they need to accomplish their tasks, not to solve the problems. We also perform a root cause analysis on everything that causes patient harm to learn from our mistakes and to prevent similar errors or defects in our care."

NorthCrest has used CUSP methods to tackle a variety of issues, including central line-associated bloodstream infections and ventilator-associated pneumonia. The hospital has also adapted CUSP practices for other patient safety concerns such as falls, medication errors, and readmissions.

Beard noted, "One of the best CUSP principles we use is for leaders to report to the hospital's quality committee and be accountable for their CUSP teams."

The hospital experienced 194 medication errors in 2011. Thanks to CUSP, only 45 such errors occurred in 2015. Readmissions, meanwhile, fell from 303 in 2012 to 87 by the end of 2016.

NorthCrest's CUSP teams meet every 2 weeks to report their results. Successes are shared with members of the board and medical staff. When a CUSP team hits its improvement goal or verifies zero errors, it can stay active or shut down. If a CUSP team is retired and incidents creep up again, the team is reactivated.

Beyond the results, Ms. Beard noted the most helpful outcome of CUSP has been employee engagement that comes with CUSP. "We fundamentally changed the culture and philosophy of this organization," she said.