AHRQ Funds FOCUS Learning Collaborative

December 7, 2010 – Richmond, VA – The Agency for Healthcare Research and Quality (AHRQ) awarded a three year research grant of $4 million to the FOCUS initiative to improve teamwork to prevent infections in cardiac operations. This research is a joint collaboration of the Society of Cardiovascular Anesthesiologists (SCA) Foundation and the Quality and Safety Research Group (QSRG) at the Johns Hopkins School of Medicine.

Cardiac surgery is a high-risk procedure performed by a multidisciplinary team using complex tools and technologies. Efforts to improve patient safety and reduce human error for cardiac surgical patients have been ongoing for more than a decade, yet the literature provides little guidance regarding best practices for hazard identification and interventions to effectively reduce risk.

This three year study, led by Dr. Peter Pronovost, M.D., PhD, director of QSRG, uses the Comprehensive Unit Based Safety Program (CUSP) to improve teamwork and safety culture and technical interventions to prevent healthcare associated infections (surgical site infections, central line association bloodstream infections, and ventilator associated pneumonia).

“This study will examine whether a collaborative program to reduce infections and improve teamwork is more effective than the traditional passive method of sharing outcome data. This can positively impact cardiac surgery,” says Bruce Spiess, M.D., chair of the FOCUS initiative. Pronovost believes “For too long efforts to improve safety have been independent rather than interdependent, competitive rather than cooperative, and focused on efforts rather than results. In this project we will change this, working together, guided by science, informed by practice, we can reduce patient harm.”

Seventeen sites throughout the United States will participate in this study. The sites and primary investigators are:

Baystate Medical Center Springfield, MA

Anath Kashikar, M.D.

Bethesda North Hospital Cincinnati, OH

Elizabeth Burgess, M.D.

Duke University Durham, NC

Alina Nicora, M.D.

Lehigh Valley Hospital Allentown, PA

Nanette Schwann, M.D.

Liberty Hospital Liberty, MO

Mark Beltran, M.D.

Medical University of South Carolina Charleston, SC

James Abernathy, M.D.

New York University New York, NY

Marc Kanchuger, M.D.

San Francisco Veterans Affairs Medical Center San Francisco, CA

Martin London, M.D.

Shands Hospital at the University of Florida Gainesville, FL

Gregory Janelle, M.D.

Stanford University Stanford, CA

Christina Mora Mangano, M.D.

St. John’s Mercy St. Louis, MO

Christopher Young, M.D.

St. Lukes-Roosevelt Hospital Center New York NY

Zak Hillel, M.D.

University of Maryland Medical Center Baltimore, MD

Alina Grigore, M.D.

University of Miami/Jackson Memorial Hospital Miami, FL

Michael Barron, MD
University of Michigan Ann Arbor, MI

Wei Lau, M.D.

University of Pittsburgh Medical Center Presbyterian Hospital Pittsburgh, PA

Erin Sullivan, M.D.

University of Texas Southwestern Dallas, TX

Philip Greilich, M.D.

The FOCUS initiative is a multi-year, multi-center initiative, designed to examine the physical and cultural environment of the cardiac surgery operating rooms, and will seek to define processes by which the cardiovascular operative teams can reduce the occurrence of human error. Although every individual involved in cardiovascular operative patient care is dedicated to patient safety, the processes and communication patterns that exist frequently are inadequate to achieve the goal of absolute patient safety.

FOCUS takes pride in bringing together the key stakeholders in the operative cardiovascular surgery arena to not only study human error/patient safety but to take on the larger mission of changing patient care for the better. The FOCUS leadership has met with official representatives from four other academic societies: American Society of Extracorporeal Technology (AmSECT), Association of Operating Room Nurses (AORN), National Center for Human Factors Engineering in Healthcare (Medical HFE), the Society of Thoracic Surgeons (STS), and official collaboration of each society with the FOCUS project is currently being discussed.

The first step in the FOCUS initiative was an in-depth observation of the physical, interpersonal, and cultural environment in the cardiovascular operating rooms. The SCA Foundation funded the QSRG research team to conduct that baseline study. The results of that research helped inform the design of the new AHRQ funded grant.

The SCA Foundation, founded in October of 2007, is the philanthropic arm of the Society of Cardiovascular Anesthesiologists. The SCA Foundation advances cardiovascular patient safety and supports the continuous improvement of the cardiovascular anesthesiology profession.

The Society of Cardiovascular Anesthesiologists is an international organization of over 7,000 cardiac, thoracic, and vascular anesthesiologists that promotes excellence in clinical care, education, and research. Formed in 1977 to promote the specialty of cardiovascular anesthesia, it has grown rapidly with the expansion of cardiac, vascular and thoracic surgery. Over the past 30 years, the SCA has led the way in the training and certification of intra-operative echocardiographers, development of credentials for cardiovascular anesthesiology training (fellowship), and has collaborated with the wider medical community in setting guidelines for patient care.

Dr. Pronovost’s special interest is applying research methods that improve quality of health care and safety. In 2008, Dr. Pronovost was awarded a MacArthur Fellows Program grant. He is facilitating World Health Organization efforts to implement patient safety programs in several countries and is leading AHRQ funded efforts to replicate the Michigan program in every state in the U.S, the District of Columbia, and Puerto Rico.

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