Wisconsin Critical Access Hospital Sees Big Results with AHRQ’s CUSP, RED and TeamSTEPPS®

Amery Hospital & Clinic, a 25-bed acute care critical access hospital in rural Wisconsin, used AHRQ’s Comprehensive Unit-based Safety Program (CUSP) to reduce surgical site infections (SSIs) to just 3 percent in October 2014 from 33.3 percent in January 2011.

AHRQ tools have impacted Amery in other ways, as well. The facility used CUSP to slash other preventable errors, employed the Agency’s Re-Engineered Discharge (RED) toolkit to reduce 30-day readmissions by nearly 30 percent, and, in early 2014, implemented the TeamSTEPPS® patient safety training program to bring more structure to Amery’s quality improvement efforts.

Prior to using the AHRQ tools, "Amery did not track SSIs or have a quality improvement plan," said Joanne Jackson, Amery’s human resources and quality improvement administrator. "We now have annual improvement goals that 8 to 10 interdisciplinary teams work on—abstracting data, performing root cause analysis, and developing and implementing effective interventions for improved patient health outcomes."

CUSP, an evidence-based strategic framework for safety improvement, was the first AHRQ tool Amery used. CUSP integrates communication, teamwork, and leadership engagement to create and support a culture of patient safety that can prevent patient harms.

When Amery first introduced CUSP and measured SSI rates in 2011, the combined SSI rate for surgery patients was 33 percent; SSI rates for total joint procedures were 10 percent. In 2014, SSI rates for both types were zero.

CUSP also has helped Amery:

• Maintain a zero rate of catheter-associated urinary tract infections through late 2014.
• Cut medication error rates from 1 in 2,100 doses in January 2010 to a 12-month average of 1 in 20,400 doses as of December 2014.

Amery’s improved safety performance has helped attract more surgeons—including an ophthalmologist and otolaryngologist—to perform additional types of surgeries at the hospital. More importantly, "Amery has developed a culture of accountability" with CUSP, Ms. Jackson reported.

For example, the first item on every agenda for hospital board of directors’ meetings is about the quality of patient care and the patient experience. Before CUSP, such issues were never discussed by the board, noted Ms. Jackson.

"The tools and concepts that the hospital has incorporated from CUSP brought us from minimal non-core rote reporting in 2010 to a continuous, focused, quality performance evaluation in 11 initiative areas," Ms. Jackson explained. "These resources were very important in building our entire quality improvement strategic plan."

CUSP checklists and "Staff Safety Assessment" have been particularly helpful, reported Ms. Jackson. The "Staff Safety Assessment," which is a part of the "Engage the Senior Executive" component of CUSP, motivated hospital leaders to address SSI rates that approached 25 percent in some instances.

In addition, Amery staff have used AHRQ’s RED toolkit to reduce hospital readmissions. The toolkit helps hospitals re-engineer their patient discharge processes to help patients prepare for life at home after hospitalization. Avery’s designated discharge advocates help patients understand their medications and schedule follow-up appointments with primary care physicians.

"We implemented RED toolkit items to improve patient readiness for discharge over the past 30 months," said Ms. Jackson. The toolkit helped Amery "decrease all-cause readmission rates to an average of 5.58 percent through September 2014 from 8.6 percent in August of 2012—a 35 percent improvement."

Amery implemented TeamSTEPPS in the spring of 2014. With TeamSTEPPS, "we have improved the structure for our eight quality initiative teams in promoting the right people on the right teams to achieve the right results," said Ms. Jackson.