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Tri-City Medical Center, a 388-bed hospital in Oceanside, California, reduced central line-associated bloodstream infections (CLABSIs) by 33 percent and improved the on-time delivery of insulin to patients by 55 percent after changing patient care practices based on strategies from AHRQ’s Comprehensive Unit-based Safety Program (CUSP).

CUSP helps medical teams make patient care safer by combining improved teamwork, clinical best practices, and the science of safety. CUSP is used in the hospital’s telemetry, medical/surgical, and intensive care units.

“We used the CUSP strategies of identifying ways to further improve patient safety by getting feedback directly from our frontline workers and then learning from those defects,” said Ingrid Stuiver, Ph.D., Tri-City Medical Center’s director of clinical research. “We asked our frontline staff ‘How will patients most likely be harmed? How can we prevent this from happening?’ and conducted a workflow analysis in each of our hospital units.”

A root-cause analysis revealed that the central-line connectors needed to be checked or cleaned more frequently and consistently. So the Tri-City team implemented a procedural change that now involves daily color-coding in the patient’s chart to show whether the line was checked, cleaned, or replaced, Dr. Stuiver explained.

“This new process reduced CLABSIs by 33 percent from 2012 to 2017. Our baseline is now near zero and well below the national average,” she said.

Tri-City used those same CUSP strategies to improve on-time administration of insulin to patients and reduce medication errors. Tri-City leaders surveyed telemetry nurses and found that distractions such as phone calls and patients pressing call buttons occurred frequently during the first 2 hours of the morning nursing shift, when patient assessments and medication delivery are critical, Dr. Stuiver explained.

“Using CUSP as our framework, we engaged frontline staff to improve patient safety, accuracy, and workflow,” she said. “The staff redesigned processes so that RNs and acute care technicians had a 2-hour period of ‘protected time’ that they could totally devote to patient care. The only exceptions are urgent care situations that might arise.”

To promote awareness of protected time, the hospital printed business cards that explained the new procedure to patients and their families. Given the improvement in insulin delivery rates and a 46 percent reduction in reports of stress by staff, Tri-City leaders hope the concept of protected time will catch on.

“Our hospital’s leadership is continuously focused on improving patient safety,” Dr. Stuiver said. “They listened to the feedback of our frontline medical staff and took action based on what they heard. CUSP has produced a major change in attitude here, and that has led to a much stronger culture for patient safety.”