Implementation of a Virtual Interprofessional ICU Learning Collaborative: Successes, Challenges, and Initial Reactions From the Structured Team-Based Optimal Patient-Centered Care for Virus COVID-19 Collaborators

Abstract

Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes.

Objectives: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices.

Design setting and participants: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method for delivering evidence based critical care. Collaborators participated in weekly 1-hour videoconference sessions on high impact topics, monthly quality improvement (QI) coaching sessions, and received extensive additional resources for asynchronous learning.

Main outcomes and measures: Outcomes included learner engagement, satisfaction, and number of QI projects initiated by participating teams.

Results: Eleven of 13 initial sites participated in the Collaborative from March 2, 2021, to September 29, 2021. A total of 67 learners participated in the Collaborative, including 23 nurses, 22 physicians, 10 pharmacists, nine respiratory therapists, and three nonclinicians. Site attendance among the 11 sites in the 25 videoconference sessions ranged between 82% and 100%, with three sites providing at least one team member for 100% of sessions. The majority reported that topics matched their scope of practice (69%) and would highly recommend the program to colleagues (77%). A total of nine QI projects were initiated across three clinical domains and focused on improving adherence to established critical care practice bundles, reducing nosocomial complications, and strengthening patient- and family-centered care in the ICU. Major factors impacting successful Collaborative engagement included an engaged interprofessional team; an established culture of engagement; opportunities to benchmark performance and accelerate institutional innovation, networking, and acclaim; and ready access to data that could be leveraged for QI purposes.

Conclusions and relevance: Use of a virtual platform to establish a learning collaborative to accelerate the identification, dissemination, and implementation of critical care best practices for COVID-19 is feasible. Our experience offers important lessons for future collaborative efforts focused on improving ICU processes of care.

Keywords: COVID-19; critical care; learning collaborative; quality improvement; severe acute respiratory syndrome coronavirus 2.

Figure 1.

Each participating site who joined the Collaborative was required to identify an interprofessional team consisting of at least one nurse, pharmacist, respiratory therapist, and physician. Some sites had more than one individual in the disciplines represented. Additional nonclinical learners included research fellows and administrators. During each of the weekly Zoom sessions, a collaborative approach to learning was encouraged and facilitated through small group discussions in “breakout rooms.” SME = subject matter expert, STOP-VIRUS = Structured Team-based Optimal Patient-Centered Care for Virus COVID-19.

Figure 2.

Design and implementation of the Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 (STOP-VIRUS) curriculum was based on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury program. Following site enrollment and learning needs assessment, longitudinal asynchronous and synchronous collaborative learning identified and disseminated COVID-19 management best practices and facilitated multicenter ongoing quality improvement (QI) projects. We used engagement, participant reactions and completed quality improvement Plan-Do-Study-Act cycles to measure the outcomes of this intervention. SCCM = Society of Critical Care Medicine, VIRUS = Viral Infection and Respiratory illness Universal Study.