Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative

Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative

Background Primary care has been essential in ensuring the continuity of health services for patients with COVID-19 and other conditions. We aimed to increase the adoption of evidence-based interventions to identify clinical deterioration in adult patients with confirmed or suspected respiratory COV...

Full description

Saved in:
Bibliographic Details
Main Authors: Javier Roberti, Ezequiel García Elorrio, Inés Suarez-Anzorena, Ana Paula Rodriguez, Luz Gibbons, Juan Pedro Alonso, Viviana Rodriguez, Valentina Lombardo, Facundo Jorro Barón, Marina Guglielmino, Emilse Vitar, Andrea Falaschi, Lía Bosio, Erica Negri, María Belén Peralta-Roca, María Victoria Bermejillo, Josefina Rizzo, Priscilla Maire, Luz Chávez, Agostina Pérez, Sonia Quintana, Marcela Oliva, Celeste Dulong, Pedro Carlos Silva, Cintia Evangelina Mérida, Andrea Silvina Farfarana, María Elizabeth Pérez, Oscar Paulino Luján, Marcela Cristina Carrión, Gabriela Scarano, Agustina Garbuio, Emilio Gentil, Nicolás Juárez, Gabriela Femenía, Evelyn Pechieu, Andrea Villalba, Carolina Guarnieri, Rubén Darío Hernández, Daniela Romano, Alberto Recabarren, Yamila Castro, Luis Biliato, Juan Gatica, Laura Villegas
Format: Article
Language:English
Published: BMJ Publishing Group 2025-07-01
Series:BMJ Open Quality
Online Access:https://bmjopenquality.bmj.com/content/14/3/e003390.full
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Primary care has been essential in ensuring the continuity of health services for patients with COVID-19 and other conditions. We aimed to increase the adoption of evidence-based interventions to identify clinical deterioration in adult patients with confirmed or suspected respiratory COVID-19 at the primary care level.Methods We implemented specific interventions in nine Primary Healthcare Centres (PHCC) through a quality improvement collaborative (QIC) with an interrupted time-series design. Interventions included triage for acute respiratory symptoms, the National Early Warning Score 2 (NEWS2) scale, portable oximeters for selected patients and the provincial telehealth system. Additional components involved leadership commitment, teamwork tools, reminders, audits, feedback and direct observation. A mixed-method evaluation was conducted, with two learning sessions and three action periods to test and implement selected change ideas.Results Six PHHCs completed the study. Over 48 weeks, data from 877 patients were gathered, 356 in the baseline period (BP) and 477 in the implementation period (IP). Eight hundred and sixty-two medical consultations were reported, 367 for BP and 495 for IP. More COVID-19-confirmed diagnoses were observed in the IP group (1.9% vs 15%, p<0.001).The bundle was implemented in 0% and 28.4% of patients in the BP and IP groups, respectively. On evaluating the individual components of the bundle, we discovered enhancements in the utilisation of triage, application of NEWS2 and utilisation of oximeters when appropriate. A decrease in the number of follow-up calls was observed at the end of the implementation.Patients rated the quality of care as positive in 66% of the cases in the BP and 76% in the IP group (p=0.023).Conclusion We successfully implemented a triage algorithm based on the NEWS2 score to identify respiratory deterioration in adult patients in primary care through a QIC. This intervention was perceived as an improvement in the quality of care by the patients.
ISSN:2399-6641

Similar Items