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Management research to provide operational advice on improving quality, reducing costs and eliminating disparities.

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On the CUSP: Stop BSI

Until recently, central line-associated bloodstream infections (CLABSI) were seen as an inevitable cost of doing business. Now the success of the On the CUSP: Stop BSI project has proven that these deadly infections can be eliminated.

Through support from the Agency for Healthcare Research and Quality, HRET led On the CUSP: Stop BSI in partnership with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Keystone Center for Patient Safety and Quality of the Michigan Health & Hospital Association.

Hospital units participating in On the CUSP: Stop BSI:

  • Reduced CLABSI rates by 40 percent
  • Saved more than 500 lives
  • Avoided approximately $34 million in excess health care costs

The goals of this groundbreaking project were to reduce the mean rate of CLABSI nationwide to less than one infection per 1,000 catheter days, to improve safety culture, and to partner with CDC to support the measurement and timely feedback of CLABSI and other health care-associated infection (HAI) data.

The project was based on the highly successful Keystone project that was carried out in over 100 intensive care units in Michigan. On the CUSP: Stop BSI provided educational and technical support to states and their hospitals for implementation of the Comprehensive Unit-based Safety Program (CUSP) and an evidence-based protocol to eliminate CLABSI. The Comprehensive Unit-based Safety Program (CUSP) transforms care and patient safety at the unit level by improving culture. Implementation of the CUSP model has been found to make reductions in HAIs sustainable over time and provides a foundation for other types of technical safety improvements.

As part of the On the CUSP: Stop BSI project, HRET developed the CUSP Toolkit, a modular resource that guides clinicians in implementing the CUSP culture change model. The CUSP Toolkit allows care teams to improve patient safety by addressing the ways in which physicians, nurses, and other clinical team members work together. CUSP builds capacity to address safety issues by combining clinical best practices and the science of safety. Each of the nine toolkit modules includes slide presentations, videos, facilitator notes, and CUSP tools that support change at the unit level. To download the CUSP Toolkit, visit

Visit to see the press release about On the CUSP: Stop BSI and the CUSP Toolkit.

For more information,visit

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