What is the Surgical Unit Safety Program (SUSP)?

SUSP is a project funded by the Agency for Healthcare Research and Quality (AHRQ) to measurably improve clinical outcomes, teamwork culture and patient safety in surgery. The project is designed to build on the success of previous programs (CUSP/CLABSI) by applying new methods and tools to effectively assist teams with quality improvement in the complex surgical environment.

What is TRIP?

TRIP is the acronym for Translating Research Into Practice, the Armstrong Institute’s model for increasing the reliable use of evidence-based therapies. Our model embeds an explicit model for knowledge translation in a collaborative model for broader dissemination of knowledge into practice.¹

What is CUSP?

CUSP is the acronym for the Comprehensive Unit-based Safety Program. CUSP was designed to improve safety culture and learn from mistakes by integrating safety practices into the daily work of a unit or clinical area. The implementation of CUSP is associated with improvements in patient safety, clinical outcomes and safety culture. CUSP has been applied in a number of clinical areas and quality improvement initiatives, most notably the Michigan Keystone ICU project^2,3 and the national On the CUSP: STOPHAI project.⁴

Who is leading SUSP?

The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality is the primary lead for this work and is accountable to AHRQ for program design, implementation and evaluation under terms of the contract. Subcontractors that add tremendously to the value of this project include Dr. Clifford Ko, (Director of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), and Professor of Surgery) from the University of California, Los Angeles and Dr. Charles Bosk, (Professor of Sociology and Medical Ethics) from the University of Pennsylvania. The Johns Hopkins team includes many of the leaders of the Michigan and national CLABSI projects and similar large-scale initiatives including Peter Pronovost, Sean Berenholtz and Marty Makary.

The Technical Expert Panel (TEP) for this work includes national and international leaders that have conducted critical work in this area. They will share their knowledge, experience and recommendations with the project team and AHRQ as we implement the program.  (See list of TEP members)

What are the specific goals of the project?

• To achieve significant reductions in rates of surgical site infections and surgical complications
• To achieve significant improvements in safety culture   

Who can join SUSP?

Participation in the program is available to any hospital in any state, as well as hospitals in the District of Columbia and Puerto Rico.  Hospitals may participate through their state hospital association, state patient safety agency, hospital engagement network (HEN) or other convening group.  We will work with individual hospitals that are NOT part of a larger coordinating group to explore how to facilitate their involvement. 

How will teams demonstrate improvement?

All teams will focus on:

• One outcome measure: SSI rate
• One process measure: use of check- list like methods to improve surgery safety (briefings/debriefings)
• Improving safety and teamwork culture

Over time, additional issue-based interventions will be provided that teams may choose to implement, including but not limited to activities to reduce mislabeled specimens, wrong sided surgery and retained foreign objects.

What do we need to do?

• Assemble a multidisciplinary team including frontline staff in the Preop, OR and Postop areas
• Participate in six weekly on-boarding calls
• Participate on monthly content calls
• Participate on monthly coaching calls
• Participate in annual face-to-face meetings
• Regularly meet as a team to implement interventions and monitor performance

What data will we need to collect? *

• Monthly surgical site infection data (numerator and denominator) each month for patients having colorectal and general surgery
• Quarterly project implementation data (structured interview and brief survey)
• Annual teamwork/culture data using the AHRQ Hospital Survey of Patient Safety (HSOPS)

*Where data are already collected/available (for example through ACS NSQIP or NHSN), we will work with your team to import already available data if you desire.

Will teams have ready access to data reports?

• Yes, all participating teams will have monthly SSI performance available through online, readily accessible reports, including comparison to blinded aggregate data from other sites. 
• HSOPs comparative reports will be available subsequent to each annual survey.
• Project implementation reports will be available at a site-specific level and in aggregate on a rolling basis.

When did the program begin, and when will it end?

SUSP was funded in September 2011 and is designed to end in August, 2015.  Each participating hospital/surgical services team is expected to participate for a minimum of 24 months.

When can hospitals join this program?

We plan to enroll participants two times per year. The first cohort of participants is being recruited in April 2012 with onboarding planned for late May and June and official launch of the work in July 2012. This initial cohort is targeted to hospitals enrolled in the ACS NSQIP program since those facilities have baseline data readily available. The cohort is NOT however, limited to NSQIP participants. 

The second 2012 cohort will launch in September 2012. We expect to launch cohorts in January and May of 2013 and January of 2014.

What are the benefits to hospitals and teams for participating in this program?

• Opportunity to be part of a national effort with shared learning
• Participate at the forefront of helping to learn how this model works at the local level
• Improve patient outcomes through cutting edge tools & resources
• Teams develop a heightened sense of purpose by working together to make things better, reinforcing the value in their work.
• Become a member of a surgical learning community and build relationships that will last longer than the project
• Provision of comparative feedback reports to track hospital progress;
• Opportunity for 10 teams (voluntary) to participate in on-site interviews and observations by an experienced team to discern barriers and facilitators to project implementation

Is there a fee to participate?

There is no fee to participate.

How do we learn more or enroll in the program?

To learn more or have us e-mail the packet, contact: Dr. Lisa Lubomski, lluboms1@jhmi.edu.

References

1. Pronovost P, Berenholtz S, and Needham D. Translating evidence into practice: a model for large-scale knowledge translation. BMJ 2008;337:963-965.

2. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related blood stream infections in the ICU. N Engl J Med. 2006 Dec 28;355(26):2725-32.

3. Pronovost PJ, Goeschel CA, Colantuoni E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: an observational study. BMJ. 2010 Feb 4;340:c309. doi: 10.1136/bmj.c309.

4. Eliminating CLABSI: A National Patient Safety Imperative. AHRQ Publication No: 11-0037-EF, April 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/onthecusprpt/