Julius Cuong Pham

Johns Hopkins University, Baltimore, Maryland, United States

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Publications (65)378.12 Total impact

  • Gregory E Skipper, Julius Cuong Pham, Peter J Pronovost
    Annals of internal medicine 04/2015; 162(8):598. DOI:10.7326/L15-0078-2 · 16.10 Impact Factor
  • 03/2015; 7(1):128-130. DOI:10.4300/JGME-D-14-00754.1
  • Julius Cuong Pham, Greg Skipper, Peter J Pronovost
    Biocontrol Science and Technology 12/2014; 14(12):37-8. DOI:10.1080/15265161.2014.969544 · 0.73 Impact Factor
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    ABSTRACT: Background Central line–associated bloodstream infection (CLABSI) remains one of the most common and deadly hospital acquired infections in the United States. Creating a culture of safety is an important part of healthcare–associated infection improvement efforts; however, few studies have robustly examined the role of safety climate in patient safety outcomes. We applied a pattern-based approach to measuring safety climate to investigate the relationship between intensive care unit (ICU) patient safety climate profiles and CLABSI rates. Methods Secondary analyses of data collected from 237 adult ICUs participating in the On the CUSP: Stop BSI project. Unit-level baseline scores on the Hospital Survey on Patient Safety, a survey designed to assess patient safety climate, and CLABSI rates, were investigated. Three climate profile characteristics were examined: profile elevation, variability, and shape. Results Zero-inflated Poisson analyses suggested an association between the relative incidence of CLABSI and safety climate profile shape. K-means cluster analysis revealed 5 climate profile shapes. ICUs with conflicting climates and nonpunitive climates had a significantly higher CLABSI risk compared with ICUs with generative leadership climates. Conclusions Relative CLABSI risk was related to safety climate profile shape. None of the climate profile shapes was related to the odds of reporting zero CLABSI. Our findings support using pattern-based methods for examining safety climate rather than examining the relationships between each narrow dimension of safety climate and broader safety outcomes like CLABSI.
    American Journal of Infection Control 10/2014; 42(10):S203–S208. DOI:10.1016/j.ajic.2014.05.020 · 2.33 Impact Factor
  • Julius Cuong Pham, Peter J Pronovost
    Annals of internal medicine 09/2014; DOI:10.7326/M14-2167 · 16.10 Impact Factor
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    ABSTRACT: Background. Several studies demonstrating that central line-associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections. Methods. We conducted a collaborative cohort study to evaluate the impact of the national "On the CUSP: Stop BSI" program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented. Results. A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16-18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50-0.65) at 16-18 months after implementation. Conclusion. Coincident with the implementation of the national "On the CUSP: Stop BSI" program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.
    Infection Control and Hospital Epidemiology 01/2014; 35(1):56-62. DOI:10.1086/674384 · 3.94 Impact Factor
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    Julius Cuong Pham, Thierry Girard, Peter J Pronovost
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    ABSTRACT: Incident Reporting Systems (IRS) are and will continue to be an important influence on improving patient safety. They can provide valuable insights into how and why patients can be harmed at the organizational level. However, they are not the panacea that many believe them to be. They have several limitations that should be considered. Most of these limitations stem from inherent biases of voluntary reporting systems. These limitations include: i) IRS can't be used to measure safety (error rates); ii) IRS can't be used to compare organizations; iii) IRS can't be used to measure changes over time; iv) IRS generate too many reports; v) IRS often don't generate in-depth analyses or result in strong interventions to reduce risk; vi) IRS are associated with costs. IRS do offer significant value; their value is found in the following: i) IRS can be used to identify local system hazards; ii) IRS can be used to aggregate experiences for uncommon conditions; iii) IRS can be used to share lessons within and across organizations; iv) IRS can be used to increase patient safety culture. Moving forward, several strategies are suggested to maximize their value: i) make reporting easier; ii) make reporting meaningful to the reporter; iii) make the measure of success system changes, rather than events reported; iv) prioritize which events to report and investigate, report and investigate them well; v) convene with diverse stakeholders to enhance the value of IRS. Significance for public healthIncident Reporting Systems (IRS) are and will continue to be an important influence on improving patient safety. However, they are not the panacea that many believe them to be. They have several limitations that should be considered when utilizing them or interpreting their output: i) IRS can't be used to measure safety (error rates); ii) IRS can't be used to compare organizations; iii) IRS can't be used to measure changes over time; iv) IRS generate too many reports; v) IRS often don't generate in-depth analyses or result in strong interventions to reduce risk; vi) IRS are associated with costs. Moving forward, several strategies are suggested to maximize their value: i) make reporting easier; ii) make reporting meaningful to the reporter; iii) make the measure of success system changes, rather than events reported; iv) prioritize which events to report and investigate, do it well; v) convene with diverse stakeholders to enhance their value.
    12/2013; 2(3):e27. DOI:10.4081/jphr.2013.e27
  • Julius Cuong Pham, Peter J Pronovost, Gregory E Skipper
    JAMA The Journal of the American Medical Association 10/2013; 310(13):1403-1404. DOI:10.1001/jama.2013.277978 · 30.39 Impact Factor
  • Asad Latif, Peter J Pronovost, Julius C Pham
    Critical care medicine 09/2013; 41(9):e235-e236. DOI:10.1097/CCM.0b013e3182963ff1 · 6.15 Impact Factor
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    ABSTRACT: Our retrospective analysis of the Michigan Keystone intensive care unit (ICU) collaborative demonstrated that adult ICUs could achieve and sustain a zero rate of ventilator-associated pneumonia (VAP) for a considerable number of ventilator and calendar months. Moreover, the results highlight the importance of adjustment for ventilator-days before comparing VAP-free time among ICUs.
    Infection Control and Hospital Epidemiology 07/2013; 34(7):740-3. DOI:10.1086/670989 · 3.94 Impact Factor
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    ABSTRACT: As a safety net for the health care system, quality and safety performance in emergency medicine (EM) is important for policy makers, insurers, researchers, health care providers, and patients. Developing performance indicators that are relevant, valid, feasible, and easy to measure has proven difficult. To monitor progress, patient safety should be measured objectively. Although conceptual frameworks and error taxonomies have been proposed, a practical scorecard for measuring patient safety over time in EM has been lacking. This article proposes a framework that measures safety through 4 major domains: (1) how often patients are harmed, (2) how often appropriate interventions are delivered, (3) how well errors in the system are identified and corrected, and (4) emergency department (ED) safety culture. Examples of specific measures for each of these domains are provided, but the EM community should reach consensus on what measures are important for the ED environment and patients.
    American Journal of Medical Quality 05/2013; DOI:10.1177/1062860613489846 · 1.78 Impact Factor
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    ABSTRACT: The objective was to compare the characteristics of medication errors reported to 2 national error reporting systems by conducting a cross-sectional analysis of errors reported from adult intensive care units to the UK National Reporting and Learning System and the US MedMarx system. Outcome measures were error types, severity of patient harm, stage of medication process, and involved medications. The authors analyzed 2837 UK error reports and 56 368 US reports. Differences were observed between UK and US errors for wrong dose (44% vs 29%), omitted dose (8.6% vs 27%), and stage of medication process (prescribing: 14% vs 49%; administration: 71% vs 42%). Moderate/severe harm or death was reported in 4.9% of UK versus 3.4% of US errors. Gentamicin was cited in 7.4% of the UK versus 0.7% of the US reports (odds ratio = 9.25). There were differences in the types of errors reported and the medications most often involved. These differences warrant further examination.
    American Journal of Medical Quality 05/2013; 29(1). DOI:10.1177/1062860613482964 · 1.78 Impact Factor
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    ABSTRACT: A complete understanding of the financial impact of patient safety interventions must consider the economic incentives of both payers and providers within the current fee-for-service payment model. This study evaluated the impact of a central line-associated bloodstream infection (CLABSI) initiative on costs, reimbursements, and margins for 1 Hawaii hospital and its payers. Intensive care unit patients (January 2009-December 2011) who developed a CLABSI were compared to matched controls. Mean hospital cost, reimbursement, and margin was $222 692 versus $80 144 (P = .01), $259 433 versus $72 543 (P < .01), and $54 906 versus $6506 (P < .01), respectively. Although hospitals and payers reduce costs by preventing CLABSIs, hospitals also would decrease their margins, which creates a perverse incentive to have more line infections. An optimal reimbursement system must reward hospitals and payers for preventing harm rather than treating illness. This study highlights the critical role that health care payers have as patient safety advocates, financial sponsors, and facilitators.
    American Journal of Medical Quality 05/2013; 29(1). DOI:10.1177/1062860613486173 · 1.78 Impact Factor
  • Julius Cuong Pham, Peter J Pronovost, Gregory E Skipper
    JAMA The Journal of the American Medical Association 04/2013; 309(20):1-2. DOI:10.1001/jama.2013.4635 · 30.39 Impact Factor
  • Julius Cuong Pham, Kevin D Frick, Peter J Pronovost
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    ABSTRACT: Reliable data are essential to ensuring that health care is delivered safely and appropriately. Yet the availability of reliable data on safety remains surprisingly poor, as does our knowledge of what it costs (and should cost) to generate such data. The authors suggest the following as priorities: (1) develop valid and reliable measures of the common causes of preventable deaths; (2) evaluate whether a global measure of safety is valid, feasible, and useful; (3) explore the incremental value of collecting data for each patient safety measure; (4) evaluate if/how patient safety reporting systems can be used to influence outcomes at all levels; (5) explore the value-and the unintended consequences-of creating a list of reportable events; (6) evaluate the infrastructure required to monitor patient safety; and (7) explore the validity and usefulness of measurements of patient safety climate.
    American Journal of Medical Quality 03/2013; 28(6). DOI:10.1177/1062860613479397 · 1.78 Impact Factor
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    ABSTRACT: Rapid-response systems (RRSs) are a popular intervention in U.S. hospitals and are supported by accreditors and quality improvement organizations. The purpose of this review is to evaluate the effectiveness and implementation of these systems in acute care settings. A literature search was performed between 1 January 2000 through 30 October 2012 using PubMed, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials. Studies published in any language evaluating outcome changes that occurred after implementing an RRS and differences between groups using and not using an RRS (effectiveness) or describing methods used by RRSs (implementation) were reviewed.A single reviewer (checked by a second reviewer) abstracted data and rated study quality and strength of evidence. Moderate-strength evidence from a high-quality meta-analysis of 18 studies and 26 lower-quality before-and-after studies published after that meta-analysis showed that RRSs are associated with reduced rates of cardiorespiratory arrest outside of the intensive care unit and reduced mortality. Eighteen studies examining facilitators of and barriers to implementation suggested that the rate of use of RRSs could be improved.
    Annals of internal medicine 03/2013; 158(5 Pt 2):417-25. DOI:10.7326/0003-4819-158-5-201303051-00009 · 16.10 Impact Factor
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    ABSTRACT: Hawaii joined the On the CUSP: Stop BSI national effort in the United States in 2009 (CUSP stands for Comprehensive Unit-based Safety Program). In the initial 18-month study evaluation, adult ICUs decreased central line-associated bloodstream infection (CLABSI) rates by 61%. The impact of a series of novel strategies/tools in reducing infections and sustaining the collaborative in ICUs and non-ICUs in Hawaii was assessed. This cohort collaborative consisted of 20 adult ICUs and 18 nonadult ICUs in 16 hospitals. Hawaii developed and implemented six tools between July 2010 and August 2011: a tool to investigate CLABSIs, a video to address cultural barriers, a standardized dressing change kit, a map of the cohort's journey, a 12-strategies leadership dashboard, and a geometric plot of consecutive infection-free days. The primary outcome measure was overall CLABSI rates (mean infections per 1,000 catheter-days). A comparison of baseline data from 28 ICUs with 12-quarter (36-month) postimplementation data indicated that the CLABSI rate decreased across the entire state: overall, 1.57 to 0.29 infections/1,000 catheter-days; adult ICUs, 1.49 to 0.25 infections/1,000 catheter-days; nonadult ICUs, 2.54 to 0.33 infections/1,000 catheter-days, non-ICUs (N= 14), 4.52 to 0.25 infections/1,000 catheter-days, and PICU/NICU (N = 4), 2.05 to 0.53 infections/1,000 catheter-days. Days between CLABSIs in the adult ICUs statewide increased from a median of 5 days in 2009 to 70 days in 2011. Hawaii successfully spread the program beyond adult ICUs and implemented a series of tools for maintenance and sustainment. Use of the tools shaped a culture around the continued belief that CLABSIs can be eradicated, and infections further reduced.
    Joint Commission journal on quality and patient safety / Joint Commission Resources 02/2013; 39(2):51-60.
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    ABSTRACT: OBJECTIVE:: To compare the distribution, causes, and consequences of medication errors in the ICU with those in non-ICU settings. DESIGN:: A cross-sectional study of all hospital ICU and non-ICU medication errors reported to the MEDMARX system between 1999 and 2005. Adjusted odds ratios are presented. SETTING:: Hospitals participating in the MEDMARX reporting system. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: MEDMARX is an anonymous, self-reported, confidential, deidentified, internet-accessible medication error reporting program that allows hospitals to report, track, and share medication error data. There were 839,553 errors reported from 537 hospitals. ICUs accounted for 55,767 (6.6%) errors, of which 2,045 (3.7%) were considered harmful. Non-ICUs accounted for 783,800 (93.4%) errors, of which 14,471 (1.9%) were harmful. Errors most often originated in the administration phase (ICU 44% vs. non-ICU 33%; odds ratio 1.63 [1.43-1.86]). The most common error type was omission (ICU 26% vs. non-ICU 28%; odds ratio 1.00 [0.91-1.10]). Among harmful errors, dispensing devices (ICU 14% vs. non-ICU 7.1%; odds ratio 2.09 [1.69-2.59]) and calculation mistakes (ICU 9.8% vs. non-ICU 5.3%; odds ratio 1.82 [1.48-2.24]) were more commonly identified to be the cause in the ICU compared to the non-ICU setting. ICU errors were more likely to be associated with any harm (odds ratio 1.89 [1.62-2.17]), permanent harm (odds ratio 2.45 [1.17-5.13]), harm requiring life-sustaining intervention (odds ratio 2.91 [1.86-4.56]), or death (odds ratio 2.48 [1.18-5.19]). When an error did occur, patients and their caregivers were rarely informed (ICU 1.5% vs. non-ICU 2.1%; odds ratio 0.63 [0.48-0.84]) by the time of reporting. CONCLUSIONS:: More harmful errors are reported in ICU than non-ICU settings. Medication errors occur frequently in the administration phase in the ICU. When errors occur, patients and their caregivers are rarely informed. Consideration should be given to developing additional safeguards against ICU errors, particularly during drug administration, and eliminating barriers to error disclosures.
    Critical care medicine 12/2012; 41(2). DOI:10.1097/CCM.0b013e318274156a · 6.15 Impact Factor
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    ABSTRACT: As participation in marathon running has increased, there has also been concern regarding its safety. To determine if the increase in marathon participation from 2000 to 2009 has affected mortality and overall performance. Descriptive epidemiology study. We used publicly available racing and news databases to analyze the number of marathon races, finishing race times, and deaths from 2000 to 2009 in marathons in the United States. The total number of marathon finishers has increased over this decade from 299,018 in 2000 to 473,354 in 2009. The average overall marathon finishing time has remained unchanged from 2000 to 2009 (4:34:47 vs 4:35:28; P = .85). Of 3,718,336 total marathon participants over the 10-year study period, we identified 28 people (6 women and 22 men) who died during the marathon race and up to 24 hours after finishing. The overall, male, and female death rates for the 10-year period were 0.75 (95% confidence interval [CI], 0.38-1.13), 0.98 (95% CI, 0.48-1.36), and 0.41 (95% CI, 0.21-0.79) deaths per 100,000 finishers, respectively. There was no change in the death rate during this time period for overall, male, or female groups (P = .860, .533, and .238, respectively). The median age among deaths was 41.5 years (interquartile range, 25.5 years). Fifty percent (14/28) of deaths occurred in participants less than 45 years old. Myocardial infarction/atherosclerotic heart disease caused 93% (13/14) of deaths in those 45 years and older. A variety of conditions caused death in younger racers, the most common being cardiac arrest not otherwise specified (21%, n = 3). Participation in marathons has increased without any change in mortality or average overall performance from 2000 to 2009.
    The American Journal of Sports Medicine 05/2012; 40(7):1495-500. DOI:10.1177/0363546512444555 · 4.70 Impact Factor
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    ABSTRACT: The objective of this study is to determine the effects of environmental factors on physician situation awareness (SA) in an emergency department (ED) setting. An objective method of level 1 (i.e., perception) SA measurement and evaluation was developed and applied. Resident physician level 1 SA was measured using the Situational Awareness Global Assessment Technique (SAGAT). SAGAT question probes (i.e., sets of 10 questions) were generated randomly from a pool of questions and administered hourly. Questions were answered at a 7.4% false response rate. Environmental measures (i.e., patient information, physician information, temporal information, and workload) were collected concurrently. Mixed-effects modeling was used to determine the relationship between physician SA and environmental factors adjusting for potential correlation within physician observed, patients managed, and questions asked. Significant factors associated with decreases in SA include: patient hand-offs (Odds Ratio (OR): 1.67), resident physician in final year of training (OR: 0.49), and number of patients managed (OR: 1.17). Significant correlation within question was observed and adjusted for. Overall, this study demonstrates a novel approach toward diagnosing factors contributing to physician SA during patient care. SA studies in healthcare may provide evidence for interventions aimed at improving healthcare work environments and patient safety.
    04/2012; 2(2). DOI:10.1080/19488300.2012.684739

Publication Stats

1k Citations
378.12 Total Impact Points

Institutions

  • 2006–2014
    • Johns Hopkins University
      • • Department of Anesthesiology and Critical Care Medicine
      • • Department of Medicine
      • • Department of Emergency Medicine
      • • Department of Pediatrics
      Baltimore, Maryland, United States
  • 2013
    • Hawaii Medical Service Association
      Honolulu, Hawaii, United States
  • 2011
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2007–2011
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
  • 2010
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Health Policy and Management
      Baltimore, Maryland, United States
    • University of Iowa
      Iowa City, Iowa, United States
  • 2009
    • American Society of Health-System Pharmacists
      Maryland, United States