Zec Simon, Zorko Garbajs Nika, Dong Yue, Gajic Ognjen, Kordik Christina, Harmon Lori, Bogojevic Marija, Singh Romil, Sun Yuqiang, Bansal Vikas, Vu Linh, Cawcutt Kelly, Litell John M, Redmond Sarah, Fitzpatrick Eleanor, Kooda Kirstin J, Biehl Michelle, Dangayach Neha S, Kaul Viren, Chae June M, Leppin Aaron, Siuba Mathew, Kashyap Rahul, Walkey Allan J, Niven Alexander S
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Department of Anesthesia, Pain Medicine and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA.
Crit Care Explor. 2023 Jun 5;5(6):e0922. doi: 10.1097/CCE.0000000000000922. eCollection 2023 Jun.
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.
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.
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.
Outcomes included learner engagement, satisfaction, and number of QI projects initiated by participating teams.
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.
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.
危重病医学学会最初的发现病毒感染与呼吸道疾病通用研究(VIRUS)登记分析表明,危重症护理流程的改进为改善危重症COVID-19患者的预后提供了最大的可改变机会。
创建基于团队的结构化以患者为中心的COVID-19重症监护病房最佳护理协作项目,以识别并加速实施基于最佳证据的COVID-19诊疗方法。
设计、背景与参与者:这个为期6个月的项目包括来自VIRUS登记站点的跨专业志愿者团队,他们接受了关于急性疾病和损伤早期识别与治疗清单及iNjury方法的在线培训,这是一种提供基于证据的危重症护理的结构化系统方法。合作者参加了关于高影响力主题的每周1小时视频会议、每月质量改进(QI)指导会议,并获得了大量用于异步学习的额外资源。
结局包括学习者的参与度、满意度以及参与团队发起的QI项目数量。
13个初始站点中的11个于2021年3月2日至2021年9月29日参与了该协作项目。共有67名学习者参与了该协作项目,包括23名护士、22名医生、10名药剂师、9名呼吸治疗师和3名非临床人员。11个站点在25次视频会议中的参会率在82%至100%之间,其中3个站点的至少一名团队成员参加了100%的会议。大多数人报告称主题与他们的执业范围相符(69%),并会向同事强烈推荐该项目(77%)。在三个临床领域共发起了9个QI项目,重点是提高对既定危重症护理实践套餐的依从性、减少医院获得性并发症以及加强重症监护病房以患者和家庭为中心的护理。影响协作成功参与的主要因素包括积极参与的跨专业团队;既定的参与文化;绩效基准化以及加速机构创新、建立联系和获得认可的机会;以及随时可获取可用于QI目的的数据。
使用虚拟平台建立学习协作项目以加速识别、传播和实施COVID-19危重症护理最佳实践是可行的。我们的经验为未来专注于改善重症监护病房护理流程的协作努力提供了重要经验教训。