Sanjay Saint, M.D., M.P.H.

Sanjay Saint
Professor
Medical SchoolInternal MedicineHospital Medicine
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Biography

Dr. Saint’s research focuses on enhancing patient safety by preventing healthcare-associated complications, with a special focus on catheter-related infection, translating research findings into practice, and medical decision-making. He is the Chief of Medicine at the VA Ann Arbor Healthcare System and the Director of the Ann Arbor VA Medical Center/University of Michigan Patient Safety Enhancement Program (PSEP). The mission of PSEP is to improve the quality of patient care by conducting research that prevents adverse patient outcomes that stem from the processes of healthcare. Dr. Saint is the lead author of Preventing Hospital Infections: Real-World Problems, Realistic Solutions (Oxford University Press), and has also presented a TEDxUofM talk entitled “Improving Healthcare: Straight from the Heart.” 

  • M.D., University of California, Los Angeles
  • M.P.H., University of Washington
  • B.A., Political Science, University of California, Irvine
  • B.S., Biology, University of California, Irvine

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What are you thinking about?

Our team focuses on how to prevent hospital-acquired conditions such as health care-associated infection (also called “nosocomial” infection). One of the most common nosocomial infections in the U.S. is catheter-associated urinary tract infection (CAUTI), which affects patients in essentially all venues: the intensive care unit, the medical-surgical floor, the skilled nursing facility, and in the long-term care setting. We are currently working with the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the research arm of the American Hospital Association, and several professional societies on a 50-state collaborative to prevent CAUTI. We reported the results from over 600 hospitals in the New England Journal of Medicine (Saint et al., N Engl J Med, June 2016), which show that CAUTI rates decreased by 32 percent on medical-surgical units along with a significant decrease in catheter use. This effort has now spread to nearly 1000 U.S. hospitals. 

Why is this interesting to you?

Preventing CAUTI provides insight into implementation within hospitals. We know that implementing evidence-based practices can be challenging; however, using CAUTI as a clinical model allows us to better understand the inner workings of a hospital. If hospitals struggle with preventing CAUTI, it may point to problems related to nurse-physician communication, prioritization of initiatives, or leadership and followership issues. We suspect that these same elements may also impact how a hospital tackles other endemic health care-associated conditions, such as pressure sores and falls.

What are the practical implications for healthcare?

The goal of most U.S. hospitals is to achieve the triple aim - better health, higher quality, and lower costs. We would like to help hospitals achieve this by providing them with a tool they can use for self-assessing their CAUTI programs. During the past decade, our team has received funding support from the Department of Veterans Affairs, the National Institutes of Health, the CDC, and AHRQ to better understand why some hospitals are more successful than others in preventing nosocomial infections. We have also collaborated with the World Health Organization. This work includes conducting site visits of more than 50 hospitals across the country, as well as working with hospitals in Italy, Switzerland, and Japan.

From these interviews, we found that a handful of critical issues seemed to arise irrespective of a hospital’s location or size. While some were technical issues (collecting data and assessing catheter necessity), many were related to common barriers to effective CAUTI prevention (e.g., lack of a physician champion, nursing resistance, poor leadership support). Understanding that while useful, in-person visits are both time-consuming and resource-intensive, we began work on a self-administered list of questions - the CAUTI Guide to Patient Safety, or “GPS” - that could be completed by key informants to help guide their hospital’s approach to CAUTI prevention. Several state hospital associations and numerous hospitals have been using the “CAUTI GPS” to guide their CAUTI prevention activities. To further our mission of enhancing patient safety, we have also developed materials such as a book published by Oxford University Press entitled Preventing Hospital Infections: Real-World Problems, Realistic Solutions, and a TEDxUofM entitled, “Improving Healthcare: Straight from the Heart.”

 

 

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