Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
Hospital Interzonal General de Agudos General San Martín, La Plata, Buenos Aires, Argentina.
BMJ Open Qual. 2024 Jun 3;13(2):e002618. doi: 10.1136/bmjoq-2023-002618.
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.
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).
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.
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.
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.
在资源较少的环境中，对医疗保健服务的需求在 COVID-19 大流行期间过高，重症监护病房（ICU）承受了最大的损失。
目的是使 90%的患者就诊时都能正确使用个人防护设备（PPE），使 90%的患者都能达到患者流程目标（OPF）的要求，并为 90%的医护人员（HCW）提供情绪支持工具。
我们在阿根廷的 14 个 ICU 中进行了一项准实验研究，采用中断时间序列设计。我们随机选择了 2020 年 7 月至 2021 年 7 月期间入院的成年危重病患者和同期的活跃 HCW。我们实施了一项质量改进合作（QIC），包括一个基线阶段（BP）和一个干预阶段（IP）。QIC 包括学习课程、行动时期和改进周期（计划-做-研究-行动），这些都是由专家通过平台网络活动进行虚拟指导的。主要研究结果包括以下内容：正确使用 PPE，通过直接观察使用每日目标表遵守九项特定 OPF，以及使用基于网络的工具跟踪 HCW 的情绪健康状况。
我们收集了 7341 次 PPE 使用观察（BP 中有 977 次，IP 中有 6364 次），正确使用的比例从 58.4%提高到 71.9%（RR 1.2，95%CI 1.17-1.29，p<0.001）。我们观察了 7428 次患者就诊，以评估遵守 9 项 OPF 的情况（BP 中有 879 次，IP 中有 6549 次），遵守率从 53.9%提高到 67%（RR 1.24，95%CI 1.17-1.32，p<0.001）。结果表明，HCW 并没有像预期的那样使用自我心理健康评估的支持工具。
即使在大流行期间，质量改进合作也能有效地改善医疗流程和正确使用 PPE，这表明有可能在全国范围内扩大质量改进合作网络，以改善整体医疗服务的提供。情绪支持工具的接受程度有限，需要进一步分析。
