Quality improvement collaborative for improving patient care delivery in Argentine public health sector intensive care units.

Humans Quality Improvement COVID-19 / prevention & control Argentina Intensive Care Units / organization & administration SARS-CoV-2 Male Female Personal Protective Equipment / statistics & numerical data Middle Aged Pandemics / prevention & control Delivery of Health Care / standards Adult Public Health / methods Health Personnel / statistics & numerical data Interrupted Time Series Analysis / methods

Burnout, Professional COVID-19 Collaborative, breakthrough groups Critical care Quality improvement

Journal

BMJ open quality

ISSN: 2399-6641

Titre abrégé: BMJ Open Qual

Pays: England

ID NLM: 101710381

Informations de publication

Date de publication:
03 Jun 2024

Historique:

received: 21 09 2023

accepted: 13 05 2024

medline: 4 6 2024

pubmed: 4 6 2024

entrez: 3 6 2024

Statut: epublish

Résumé

The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll. The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs). We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs. We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected. A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.

Sections du résumé

BACKGROUND BACKGROUND

The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll.

OBJECTIVE OBJECTIVE

The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs).

METHODS METHODS

We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs.

RESULTS RESULTS

We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected.

CONCLUSION CONCLUSIONS

A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.

Identifiants

DOI: 10.1136/bmjoq-2023-002618 PMID: 38830729

pubmed: 38830729

pii: bmjoq-2023-002618

doi: 10.1136/bmjoq-2023-002618

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Investigateurs

Laura Paggi (L)

Jacqueline Vilca Becerra (JV)

Ivanna Rodríguez (I)

José Gelmetti (J)

Agustina Paglia (A)

Magali Villacorta (M)

Fernando Luna (F)

Christian Vanini (C)

Alicia Sirino (A)

Carina Balasini (C)

Elizabeth Johanna Bastías Saez (EJ)

Mariela Viviana Fumale (MV)

Leticia Fernanda Castillo (LF)

Alejandra Del Valle Rodríguez (AD)

Andrea Elizabeth Vitale (AE)

Yanina Luz Vernetti (YL)

Eliseo Velásquez Chambi (EV)

Aracelly Pérez Flores (AP)

Itala Talamas Hurtado (IT)

Marta Verduguez (M)

Verónica Bortoli (V)

Maximiliano Carmona (M)

Matías Caponi (M)

Melisa Chocobar (M)

Flavia Badilla (F)

Gisela Videla (G)

Cecilia Conil (C)

Viviana Chediack (V)

Analía Ileana Resguardo (AI)

Silvia Susana González (S)

Elizabeth Rodríguez Muñoz (ER)

Rosana Gregori (R)

José Antonio Almeida (JA)

Cecilia Verónica Domínguez (CV)

Olga Zulema Tejerina (OZ)

Susana Tejerina (S)

Cintya Tintilay (C)

Malena Lamas (M)

Dalma Gutiérrez (D)

Patricia Báez (P)

Valeria Aguiar (V)

Josefa Galán (J)

María Eugenia Gauna (ME)

Daniela Olmos Kutscherauer (DO)

Andrea Marcolini (A)

Fernando David Fernández (FD)

Luis Fernando Castellano (LF)

Silvia Edith Catalini (SE)

Gladys Myriam Aramayo (GM)

Luciano Inowlocki Calejman (LI)

María Luz Torrico (ML)

Liliana González (L)

Vilma Villavicencio (V)

Javier Julián Ortega (JJ)

Pablo Nicolás Taborda (PN)

Martín Américo Moreno (MA)

Silvina Maricel Moyano (SM)

Sebastian Vacas (S)

Claudia Del Valle Fernández (CD)

Gabriela Sánchez (G)

Clemente Mamani (C)

Sabrina Guillén (S)

Karina Maciel (K)

Silvia Laura Fernández (SL)

Gustavo Plotnikow (G)

Cecilia Florencia Pereyra (CF)

Inés Suárez Anzorena (IS)

Marianela Lescano (M)

Marina Guglielmino (M)

Informations de copyright

Déclaration de conflit d'intérêts

Competing interests: None declared.