The Comprehensive Unit-based Safety Program (CUSP) was developed by safety and quality researchers at the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the Agency for Healthcare Research and Quality (AHRQ).

CUSP was developed to improve patient safety by providing tools and support for caregivers that can help them identify and address hazards, using these five steps:

  • Educate staff in the science of safety;
  • Identify issues;
  • Engage executive leaders;
  • Learn from problems;
  • Develop tools for teamwork.

Johns Hopkins reports the program has been used to address patient falls, hospital-acquired infections (HAIs), medication administration errors, and specimen labeling errors, in addition to teamwork and communication issues. One project, called On the CUSP: Stop BSI, reduced central line-associated bloodstream infections (CLABSI) in 44 states by 40%. The project saved an estimated 500 lives. (For more information on that project, see the journal report online at:

The CUSP approach was piloted in more than 100 intensive care units in Michigan and showed promise for reducing HAIs. AHRQ cites these benefits from the CUSP program:

  • Engaging frontline clinicians and leadership;
  • Educating staff on the science of safety;
  • Assessing the safety culture, including infection control policies;
  • Creating regional consortia of stakeholders;
  • Offering coaching, consultation, and technical assistance;
  • Providing peer support;
  • Creating educational materials, tools, and webinars;
  • Collecting data and feedback to monitor performance;
  • Engaging patients and families.

“CUSP is different from other change models because it combines behavioral elements — an emphasis on safety culture, teamwork, and communication — with clinical elements — the checklist of proven practices — to create a powerful tool for promoting the adoption of evidence-based practices to prevent HAIs,” AHRQ states. (More information is available at:

AHRQ cites these successful experiences with CUSP:

  • 41% reduction in CLABSI in more than 1,000 intensive care units;
  • 30% reduction in catheter-associated urinary tract infections (CAUTIs) in more than 700 hospital non-intensive care units;
  • 54% reduction in CAUTI in more than 400 nursing homes;
  • 25-40% reduction in surgical site infections.

Johns Hopkins offers extensive resources for CUSP online at: More information from AHRQ about CUSP is available online at: