1. Impact of the Comprehensive Unit-based Safety Program (CUSP) on safety culture in a surgical inpatient unit.
- Author
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Timmel J, Kent PS, Holzmueller CG, Paine L, Schulick RD, and Pronovost PJ
- Subjects
- Baltimore, Hospitals, University standards, Humans, Interdisciplinary Communication, Job Satisfaction, Nursing Staff, Hospital organization & administration, Nursing Staff, Hospital standards, Organizational Case Studies, Organizational Culture, Organizational Innovation, Patient Care Team standards, Personnel Turnover, Quality Assurance, Health Care standards, Safety Management standards, Surgery Department, Hospital standards, Patient Care Team organization & administration, Quality Assurance, Health Care organization & administration, Safety Management organization & administration, Surgery Department, Hospital organization & administration
- Abstract
Background: A culture of teamwork and learning from mistakes are universally acknowledged as essential factors to improve patient safety. Both are part of the Comprehensive Unit-based Safety Program (CUSP), which improved safety in intensive care units but had not been evaluated in other inpatient settings., Methods: CUSP was implemented beginning in February 2008 on an 18-bed surgical floor at an academic medical center to improve patient safety, nurse/physician collaboration, and safety on the unit. This unit admits three to six patients per day from up to eight clinical services., Results: Staff implemented several interventions to reduce safety hazards and improve culture. Surgical patients admitted to one clinical service were cohorted on this unit to increase physician presence. A team-based goals sheet was implemented to improve communication and coordination of daily goals of care. Nurses were included on rounds to form an interdisciplinary team. Five of six culture domain scores demonstrated significant improvements from 2006 and 2007 to 2008. There was a 27% nurse turnover rate in 2006 and a 0% turnover rate in 2007 and 2008., Conclusions: Improvements were observed in safety climate, teamwork climate, and nurse turnover rates on a surgical inpatient unit after implementing a safety program. As part of the CUSP process, staff described safety hazards and then as a team designed and implemented several interventions. CUSP is sufficiently structured to provide a strategy for health care organizations to improve culture and learn from mistakes, yet is flexible enough for units to focus on risks that they perceive as most important, given their context. Broad use of this program throughout health systems could arguably produce substantial improvements in patient safety.
- Published
- 2010
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