Physician-Patient Relationship

How doctors are taking patient safety over the CUSP to quality


What once was a process limited to intensive care in hospitals now is moving into the ambulatory setting. A patient safety model proven to eliminate dangerous and costly infections is being piloted as a way to heighten the quality of care in physician practices. 

Acute care facilities have applied the Comprehensive Unit-Based Safety Program (CUSP), developed by the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, with outstanding results.

In a free CUSP training toolkit from the Agency for Healthcare Research and Quality, one physician talks about the unexpected outcomes the 2,000 physicians and other personnel in his health system achieved after implementing this program.

“It has been 810 days since our last central line associated bloodstream infection in the ICU at Memorial and 1,025 days at Dorchester General,” said Michael Tooke, MD, the Chief Medical Officer of Shore Health Medical System in Easton, Md. Rates of other common infections, such as ventilator-associated pneumonia and catheter-associated urinary tract infections, were similarly slashed.

“I really want to emphasize the profound impact that is at the heart of the success of CUSP, and that is the shift in our thinking that it was actually possible to eliminate something that we came to view as inevitable,” Dr. Tooke said.

Partnering with the Johns Hopkins team that originally developed CUSP, the AMA is adapting the CUSP model’s five-step process and creating a prototype for its use in ambulatory physician practices, where managing chronic conditions, rather than treating acute episodes, is the norm. 

A pilot program of the AMA’s Improving Health Outcomes initiative is underway to apply the CUSP model so physicians and their practice staff monitor and treat hypertension. 

The CUSP principles include an understanding of the science of safety, an improved safety culture, and an increased focus on teamwork and communication. Observational research has shown that CUSP improves patient outcomes when combined with a checklist of clinical best practices. 

The prototype will be refined throughout this yearlong pilot to develop a program that ultimately will include best practices, supporting materials and tools, and models for building clinical-community linkages.