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

BackgroundThe demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll.ObjectiveThe aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% c...

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Published in:	BMJ open quality Vol. 13; no. 2; p. e002618
Main Authors:	Loudet, Cecilia Inés, Jorro Barón, Facundo, Reina, Rosa, Arias López, María del Pilar, Alegría, Silvia Liliana, Barrios, Cecilia del Valle, Buffa, Rodolfo, Cabana, María Laura, Cunto, Eleonora Roxana, Fernández Nievas, Simón, García, Mariel Ayelén, Gibbons, Luz, Izzo, Gabriela, Llanos, María Natalia, Meregalli, Claudia, Joaquín Mira, José, Ratto, María Elena, Rivet, Mariano Luis, Roberti, Javier, Silvestri, Ana María, Tévez, Analía, Uranga, Leonardo Joaquín, Zakalik, Graciela, Rodríguez, Viviana, García-Elorrio, Ezequiel, Paggi, Laura, Becerra, Jacqueline Vilca, Rodríguez, Ivanna, Gelmetti, José, Paglia, Agustina, Villacorta, Magali, Luna, Fernando, Vanini, Christian, Sirino, Alicia, Balasini, Carina, Bastías Saez, Elizabeth Johanna, Fumale, Mariela Viviana, Castillo, Leticia Fernanda, Valle Rodríguez, Alejandra del, Vitale, Andrea Elizabeth, Vernetti, Yanina Luz, Chambi, Eliseo Velásquez, Flores, Aracelly Pérez, Hurtado, Itala Talamas, Verduguez, Marta, Bortoli, Verónica, Carmona, Maximiliano, Caponi, Matías, Chocobar, Melisa, Badilla, Flavia, Videla, Gisela, Conil, Cecilia, Chediack, Viviana, Resguardo, Analía Ileana, Susana González, Silvia, Muñoz, Elizabeth Rodríguez, Gregori, Rosana, Almeida, José Antonio, Domínguez, Cecilia Verónica, Tejerina, Olga Zulema, Tejerina, Susana, Tintilay, Cintya, Lamas, Malena, Gutiérrez, Dalma, Báez, Patricia, Aguiar, Valeria, Galán, Josefa, Gauna, María Eugenia, Kutscherauer, Daniela Olmos, Marcolini, Andrea, Fernández, Fernando David, Castellano, Luis Fernando, Catalini, Silvia Edith, Aramayo, Gladys Myriam, Calejman, Luciano Inowlocki, Torrico, María Luz, González, Liliana, Villavicencio, Vilma, Ortega, Javier Julián, Taborda, Pablo Nicolás, Moreno, Martín Américo, Moyano, Silvina Maricel, Vacas, Sebastian, Valle Fernández, Claudia del, Sánchez, Gabriela, Mamani, Clemente, Guillén, Sabrina, Maciel, Karina, Fernández, Silvia Laura, Plotnikow, Gustavo, Pereyra, Cecilia Florencia, Anzorena, Inés Suárez, Lescano, Marianela, Guglielmino, Marina
Format:	Journal Article
Language:	English
Published:	England British Medical Journal Publishing Group 03-06-2024 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Adult Argentina Burnout, Professional Collaboration Collaborative, breakthrough groups COVID-19 COVID-19 - epidemiology COVID-19 - prevention & control Critical care Delivery of Health Care - standards Disease transmission Feedback Female Health care Health Personnel - psychology Health Personnel - statistics & numerical data Hospitals Humans Intensive care Intensive Care Units - organization & administration Intensive Care Units - statistics & numerical data Interrupted Time Series Analysis - methods Intervention Low income groups Male Medical personnel Medical supplies Middle Aged Nurses Original Research Pandemics Pandemics - prevention & control Patient safety Personal protective equipment Personal Protective Equipment - statistics & numerical data Prevention Public health Public Health - methods Quality Improvement SARS-CoV-2 Teams Argentina COVID-19 Critical care Quality improvement Burnout, Professional Collaborative, breakthrough groups
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Summary:	BackgroundThe demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll.ObjectiveThe 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).MethodsWe 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.ResultsWe 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.ConclusionA 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2399-6641
DOI:	10.1136/bmjoq-2023-002618