CUSP in combination with evidence-based clinical interventions has been proven to dramatically reduce CLABSI. It is a powerful, flexible model for safety improvement that is sustainable, and it is useful for preventing harm in multiple areas. CUSP is comprised of five basic steps:
- Educate staff in the science of safety
- Identify defects
- Engage executive leaders
- Learn from defects
- Implement teamwork tools
Dr. Peter Pronovost at Johns Hopkins in Baltimore, Maryland, developed CUSP with funding from AHRQ to prevent health care-associated infections in hospital intensive care units. In 2004, AHRQ funded a statewide demonstration in more than 125 Michigan ICUs to prevent deadly CLABSIs using CUSP combined with evidence-based technical interventions. AHRQ contracted with HRET in 2008 to implement CUSP nationally. HRET has worked with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Michigan Health & Hospital Association Keystone Center for Patient Safety and Quality to apply CUSP to other hospital units and safety problems nationwide.
More than 1,100 hospital teams in adult ICUs in 46 States and territories participated in the national implementation project. Using CUSP, these hospital teams have reduced the rate of CLABSI by 40 percent. So far, the reduction in the rate of CLABSIs in the project has prevented more than 2,000 CLABSIs, saved more than 500 lives and avoided more than $34 million in health care expenses. Though the CLABSI prevention bundle had been available to hospitals for some years, applying CUSP was the key ingredient in the project's success. CUSP is different from other change models because it makes its tools relevant to clinicians by putting them in the context of a hospital environment at a unit level. With the addition of CUSP tools, the technical intervention was readily accepted due to the culture change that CUSP promotes.
