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. 2024 Jun 3;13(2):e002618.
doi: 10.1136/bmjoq-2023-002618.

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

Cecilia Inés Loudet  1   2 , Facundo Jorro Barón  3 , Rosa Reina  4 , María Del Pilar Arias López  4 , Silvia Liliana Alegría  5 , Cecilia Del Valle Barrios  6 , Rodolfo Buffa  7 , María Laura Cabana  8 , Eleonora Roxana Cunto  9 , Simón Fernández Nievas  3 , Mariel Ayelén García  10 , Luz Gibbons  3 , Gabriela Izzo  11 , María Natalia Llanos  12 , Claudia Meregalli  4 , José Joaquín Mira  13 , María Elena Ratto  4 , Mariano Luis Rivet  14 , Javier Roberti  3   15 , Ana María Silvestri  16 , Analía Tévez  17 , Leonardo Joaquín Uranga  18 , Graciela Zakalik  19 , Viviana Rodríguez  3 ; 5C Study Group; Ezequiel García-Elorrio  3
Collaborators, Affiliations

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

Cecilia Inés Loudet et al. BMJ Open Qual. .

Abstract

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: 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: 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: 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: 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.

Keywords: Burnout, Professional; COVID-19; Collaborative, breakthrough groups; Critical care; Quality improvement.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) PPE global compliance control chart. The mean, lower control limit (LCL) and upper control limit (UCL) in BP (weeks 1–8) and IP (weeks 9–55). A significant improvement was noted from week 38 until the end of treatment (values above the mean). (B) Patient flow objective assessments on ICU morning round control charts. It is indicated mean, LCL and UCL in BP (weeks 1–8) and IP (weeks 9–55). A significant improvement was noted from week 41 until the end of the study (values above the mean). BP, baseline phase; ICU, intensive care unit; IP, intervention phase; PPE, personal protective equipment.
Figure 2
Figure 2
EASE test usage rate and EASE score compared with COVID-19 waves during the study period. EASE, SARS-CoV-2 Emotional Overload Scale.
See this image and copyright information in PMC

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