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. 2024 Jan 2;19(1):e0296294.
doi: 10.1371/journal.pone.0296294. eCollection 2024.

Implementation and impact of rapid SARS-CoV-2 point of care test on patient flow in the frailty pathway; A quality improvement approach

Ijeoma Okoliegbe  1   2 , Louise Brodie  3 , Alistair Cowie  3 , Brandon Tan  3 , Suzanne Clements  3 , Zoe Muir  3 , Noha El Sakka  1   2
Affiliations

Implementation and impact of rapid SARS-CoV-2 point of care test on patient flow in the frailty pathway; A quality improvement approach

Ijeoma Okoliegbe et al. PLoS One. .

Abstract

To maintain patient flow during the COVID-19 pandemic, rapid and accurate decisions for the safe triage of geriatrics patients was essential as turnaround times for laboratory testing was ineffective at supporting rapid clinical decision-making for transfer of care. Thus, to mitigate and inform these clinical decisions, a quality improvement collaborative project with the geriatrics and virology department was conducted at the Frailty Assessment Unit (FAU) at Aberdeen Royal Infirmary. The goal was to facilitate patient triage during transfer of care with the introduction of Point of Care testing (POCT). The interventions which resulted in significant improvements were based on the fishbone problem solving approach and the driver diagram with change ideas informing the five Plan, Do, Study and Act (PDSA) cycles. The QI intervention was crucial in supporting clinical staff decision making during transfers for 95% of patients who had been clinically judged as asymptomatic for COVID-19 infection. High staff engagement was observed with 83% of staff suggesting the process map was easy to follow and 92% of clinical staff agreed it contained sufficient information to support the testing process. With POCT introduction, the proportion of patients who were transferred with an early POCT result increased by 20% in the Rosewell House group and by 65% in the community Hospitals group, once governance arrangements were in place. Finally, the considerable uptake of POCT by the ward consequently led to a decrease of up to 86% in the number of samples sent to the laboratory for rapid SARS-CoV-2 testing. The quality improvement project provided a rapid and reliable SARS-CoV-2 triage tool and was effectively integrated into the geriatrics triage algorithm to facilitate patient placement and flow.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. A fishbone diagram illustrating the major obstacles to early SARS-CoV-2 test results in the frailty ward.
Fig 2
Fig 2. Driver diagram and change ideas implemented during the quality improvement intervention.
Fig 3
Fig 3. Plan, Do, Study and Act cycles carried out during the quality improvement intervention.
Fig 4
Fig 4. Qualitative analysis of staff views on the process map and POCT equipment.
Fig 5
Fig 5. Monthly proportion of patients transferred to a) Rosewell House and b) Community Hospitals with an early Abbott ID Now SARS-CoV-2 results.
Overall median was used to calculate the baseline was described by Clarke et al 2009 [11].
Fig 6
Fig 6. Time-series describing the monthly proportion of patients with rapid swabs during the quality improvement project.
Overall median was used to calculate the baseline was described by Clarke et al 2009 [11].
See this image and copyright information in PMC

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