Aurora Health Care Embraces AHRQ’s CUSP Method to Protect Patient Safety

Fourteen hospitals operated by Aurora Health Care in eastern Wisconsin reduced central line-associated bloodstream infections (CLABSI) in intensive care units by 65 percent after adopting patient safety strategies from AHRQ's Comprehensive Unit-based Safety Program (CUSP).

CUSP, an evidence-based method that helps clinical teams address safety issues by combining clinical best practices and the science of safety, was implemented at the Aurora facilities from 2011 to 2012.

"Keeping patients safe by preventing healthcare-associated infections is part of our patient safety program," said Deborah Bonin, a certified professional in healthcare quality and Aurora's patient experience manager. "CUSP is one resource in our toolkit to build our culture of safety."

Aurora implemented CUSP across its facilities after two of its hospitals produced noteworthy results.

"We had such success with CUSP in the intensive care units, that, starting in 2013, we expanded our efforts to reduce CLABSI across all units. System-wide, we have consistently achieved rates lower than the benchmark set by the CDC’s National Healthcare Safety Network," said Ms. Bonin. "We’ve been significantly below that."

Kathy Leonhardt, M.D., M.P.H., Aurora’s former vice president of clinical quality and currently a health care quality and patient safety consultant, said success with reducing CLABSI prompted Aurora leaders to apply CUSP concepts to other safety concerns, such as the reduction of catheter-associated urinary tract infections.

"Aurora has a system-wide awareness of safety," Dr. Leonhardt said. "We select projects like CUSP on a regular basis" to enhance and sustain patient protections. Aurora has taken important steps in this effort, including establishing a system-wide, multidisciplinary patient safety team, and implementing "Fair and Just Principles," which establishes a non-punitive response to errors.

Aurora uses other AHRQ tools, including the Agency’s TeamSTEPPs program, its Hospital Survey on Patient Safety Culture, and its Health Literacy Universal Precautions Toolkit. The tools have focused on four patient goals: improving the culture of safety; medication safety; infection prevention; and decreasing complications.

TeamSTEPPS, an evidence-based system developed by AHRQ and the Department of Defense, has been implemented across Aurora's ambulatory settings. The training program helps improve communication and teamwork skills among health care professionals. At Aurora, this has helped improve safety strategies, communication techniques, and teach-back with patients.

AHRQ's Hospital Survey on Patient Safety Culture, which helps hospitals assess staff perspectives on patient safety issues, medical errors, and event reporting, has been distributed by Aurora every two years since 2005.

"Aurora hospitals have improved their results over time,” Ms. Bonin said. "There have been improvements in the AHRQ survey dimensions, 'Overall Perception of Patient Safety’ and ‘Non-Punitive Response to Error,' which are two dimensions we have focused on the past several years."

After AHRQ’s survey identified "Communication with Patients" as an opportunity for improvement, an Aurora patient safety team developed a toolkit for effective communication. "We included elements from the AHRQ Health Literacy Universal Precautions Toolkit," said Ms. Bonin. "We also developed an online learning module for staff using information from the AHRQ toolkit."