Patient Safety and Quality

Reliability model improves hospital safety and eliminates bloodstream infections in the ICU

Peter J. Pronovost, M.D., Ph.D., and colleagues at Johns Hopkins University, supported in part by the Agency for Healthcare Research and Quality (HS14246), recently developed a model to improve the reliability of hospital patient safety. They pilot tested the model at the Johns Hopkins Hospital and in nearly 200 intensive care units (ICUs) in Michigan, New Jersey, and Rhode Island. Use of the reliability model at nearly 100 Michigan ICUs markedly reduced catheter-related bloodstream infections (CRBSIs). The proportion of all ICU months of observation with no CRBSIs increased from 59 percent at baseline to 80 percent, 7 to 9 months following implementation of the reliability model. This approach was also beneficial at eliminating CRBSIs across a range of ICU sizes.

The reliability model targets three important groups—senior leaders, team leaders, and frontline staff. Also, teams are given a manual of operations to facilitate change management for planned interventions—engage, educate, execute, and evaluate. The model focuses on identifying evidence-based interventions that improve patient outcomes, selecting interventions with the most impact on outcomes and converting them to behaviors, developing measures to evaluate reliability, measuring baseline performance, and ensuring that patients receive the evidence-based interventions.

In addition, a comprehensive unit-based safety program (CUSP) is used to improve culture and guide organizations in learning from mistakes. As part of CUSP, a senior executive adopts a work area and actively participates in safety efforts with staff. Staff in each work area are asked to learn from one defect per month, and department and hospital leaders are asked to learn from one defect per quarter using a structured tool. In addition, CUSP asks safety teams to implement tools, such as daily goals and morning briefings, to help improve the organizational safety culture.

For more details, see "Tracking progress in patient safety: An elusive target," by Dr. Pronovost, Marlene R. Miller, M.D., M.Sc., and Robert M. Wachter, M.D., in the August 9, 2006, Journal of the American Medical Association 296(6), pp. 696-699; and "Creating high reliability in health care organizations," by Dr. Pronovost, Sean M. Berenholtz, M.D., M.H.S., Christine A. Goeschel, R.N., M.P.A., M.P.S., and others, in the August 2006 HSR: Health Services Research 41(4), pp. 1599-1617.

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