BMJ Open Quality (Jun 2024)

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

  • Gabriela Sanchez,
  • Javier Roberti,
  • Luz Gibbons,
  • Ezequiel García-Elorrio,
  • Viviana Rodriguez,
  • Viviana Chediack,
  • Maria del Pilar Arias López,
  • Cecilia Inés Loudet,
  • Facundo Jorro Barón,
  • Rosa Reina,
  • Silvia Liliana Alegría,
  • Cecilia del Valle Barrios,
  • Rodolfo Buffa,
  • María Laura Cabana,
  • Eleonora Roxana Cunto,
  • Simón Fernández Nievas,
  • Mariel Ayelén García,
  • Gabriela Izzo,
  • María Natalia Llanos,
  • Claudia Meregalli,
  • José Joaquín Mira,
  • María Elena Ratto,
  • Mariano Luis Rivet,
  • Ana María Silvestri,
  • Analía Tévez,
  • Leonardo Joaquín Uranga,
  • Graciela Zakalik,
  • Laura Paggi,
  • Jacqueline Vilca Becerra,
  • Ivanna Rodríguez,
  • José Gelmetti,
  • Agustina Paglia,
  • Magali Villacorta,
  • Fernando Luna,
  • Christian Vanini,
  • Alicia Sirino,
  • Carina Balasini,
  • Elizabeth Johanna Bastías Saez,
  • Mariela Viviana Fumale,
  • Leticia Fernanda Castillo,
  • Alejandra del Valle Rodríguez,
  • Andrea Elizabeth Vitale,
  • Yanina Luz Vernetti,
  • Eliseo Velásquez Chambi,
  • Aracelly Pérez Flores,
  • Itala Talamas Hurtado,
  • Marta Verduguez,
  • Verónica Bortoli,
  • Maximiliano Carmona,
  • Matías Caponi,
  • Melisa Chocobar,
  • Flavia Badilla,
  • Gisela Videla,
  • Cecilia Conil,
  • Analía Ileana Resguardo,
  • Silvia Susana González,
  • Elizabeth Rodríguez Muñoz,
  • Rosana Gregori,
  • José Antonio Almeida,
  • Cecilia Verónica Domínguez,
  • Olga Zulema Tejerina,
  • Susana Tejerina,
  • Cintya Tintilay,
  • Malena Lamas,
  • Dalma Gutiérrez,
  • Patricia Báez,
  • Valeria Aguiar,
  • Josefa Galán,
  • María Eugenia Gauna,
  • Daniela Olmos Kutscherauer,
  • Andrea Marcolini,
  • Fernando David Fernández,
  • Luis Fernando Castellano,
  • Silvia Edith Catalini,
  • Gladys Myriam Aramayo,
  • Luciano Inowlocki Calejman,
  • María Luz Torrico,
  • Liliana González,
  • Vilma Villavicencio,
  • Javier Julián Ortega,
  • Pablo Nicolás Taborda,
  • Martín Américo Moreno,
  • Silvina Maricel Moyano,
  • Sebastian Vacas,
  • Claudia del Valle Fernández,
  • Clemente Mamani,
  • Sabrina Guillén,
  • Karina Maciel,
  • Silvia Laura Fernández,
  • Gustavo Plotnikow,
  • Cecilia Florencia Pereyra,
  • Inés Suárez Anzorena,
  • Marianela Lescano,
  • Marina Guglielmino

DOI
https://doi.org/10.1136/bmjoq-2023-002618
Journal volume & issue
Vol. 13, no. 2

Abstract

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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.