SUSP Program Launched to Cut Surgical Site Infections

The CUSP model combines knowledge from both clinical science and social science. The first step is to educate staff on the science of patient safety – most importantly, communicating the idea that "the vast majority of preventable complications don’t belong to an individual surgeon or an individual nurse," but occur within the organization of the health care system, Dr. Berenholtz said.

The project leaders then ask the staff to complete an anonymous, two-question assessment that gauges their experience of how complications develop and what might be done to prevent them. Next, a unit-based improvement team is assigned an executive partner from the Armstrong Institute who meets with the team at least monthly to help prioritize improvement efforts and lead them through any bureaucratic hurdles they may face at their hospitals. Goals are set and agreed upon.

The team then tries to learn from "defects" within the process, and identifies ways to prevent mistakes, especially among the surgeons, nurses, anesthesiologists, and technicians who work in the OR. Finally, tools such as checklists are used to foster teamwork and improvement. SUSP leaders will ask improvement teams to use "briefings" and "debriefings" to learn from mistakes and move forward.

There’s plenty of motivation for hospitals to want to reduce SSIs. The Centers for Medicare and Medicaid Services, as part of the Surgical Care Improvement Project (SCIP), requires public reporting of surgical quality measures, including SSIs.

For instance, hospitals are supposed to report whether patients are given the right antibiotic at the right time. But the measure doesn’t tell anyone whether the patient’s outcome actually improved, noted Dr. Berenholtz. The SUSP goes beyond those SCIP measures to determine which factors at the local level might lead to SSIs at that particular facility, and to identify what intervention works at that particular location.

"It’s clear that there is no single fix for surgical site infections in colorectal surgery," said Dr. Wick, who has worked on content for the SUSP and has helped to present it to interested facilities.

"There are best practices, but not a clear-cut bundle; so for each hospital, whatever they implement will be a little different," she said, adding that the SUSP allows each facility to tailor interventions and improvements to its particular environment.

The AHRQ is funding the 4-year SUSP initiative. Initially, the focus will be on colorectal surgery, but the program will expand to other surgical specialties with the aim of preventing harm from complications such as pneumonia, pulmonary embolisms, and deep vein thrombosis, said Dr. Berenholtz, who is also with the department of surgery and the department of anesthesia and critical care medicine at Johns Hopkins.

The first cohort of hospitals to participate in the SUSP will be in Tennessee, Colorado, and Florida, with a second cohort slated to begin in September. It is not clear exactly how many hospitals will be involved; SUSP organizers are waiting to receive all final letters of commitment, Dr. Berenholtz said. The aim is to reach as many hospitals as possible; there is no upper limit on participants.

An electronic health record is not required for participation, but hospitals need to be able to collect data on the incidence of SSIs.

The organizers are primarily going through the CMS-funded Hospital Engagement Networks (HENs). These are state, local, and regional networks that began forming in December 2011 and will work to develop learning collaboratives for hospitals, as well as provide patient safety initiatives such as the SUSP.

At the end of the 4 years, it is hoped that the HENs will continue to find ways to reduce complications and improve patient safety, Dr. Berenholtz said.

"We hope it ends up that hundreds – if not thousands – of lives will be saved," he said.

Dr. Berenholtz disclosed that he receives grant funding from the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Robert Wood Johnson Foundation, and that he has received speaking honoraria from various hospitals related to patient safety and quality. Dr. Wick and her coauthors reported no conflicts.