Evidence map›Paper›PMID 38830729›Full record

ArticleBMJ open quality2024

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

Cecilia Inés Loudet, Facundo Jorro Barón, Rosa Reina, María Del Pilar Arias López, Silvia Liliana Alegría, Cecilia Del Valle Barrios, Rodolfo Buffa, María Laura Cabana, Eleonora Roxana Cunto, Simón Fernández Nievas and 16 more

Abstract read
In one paragraph

Article in BMJ open quality, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors.

Cecilia Inés LoudetSociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina cloudet@med.unlp.edu.ar.ORCID 0000-0002-1647-5110
Facundo Jorro BarónInstituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina.
Rosa ReinaSociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina.
María Del Pilar Arias LópezSociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina.
Silvia Liliana AlegríaHospital Provincial de Neuquén Dr Castro Rendón, Neuquén, Argentina.
Cecilia Del Valle BarriosHospital General de Agudos Dr Ignacio Pirovano, Ciudad Autónoma de Buenos Aires, Argentina.
Rodolfo BuffaHospital JB Iturraspe, Córdoba, Argentina.
María Laura CabanaHospital Dr Pablo Soria, Jujuy, Argentina.
Eleonora Roxana CuntoHospital de Infecciosas Dr Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
Simón Fernández NievasInstituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina.
Mariel Ayelén GarcíaHospital Dr Sanguinetti, Comodoro Rivadavia, Chubut, Argentina.
Luz GibbonsInstituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina.
Gabriela IzzoHospital Simplemente Evita, González Catán, Buenos Aires, Argentina.
María Natalia LlanosHospital de Clínicas Virgen de Fátima, La Rioja, Argentina.
Claudia MeregalliSociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina.
José Joaquín MiraDepartamento de Salud Alicante-Sant Joan, Sant Joan d'Alacant, Spain.
María Elena RattoSociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina.
Mariano Luis RivetHospital General de Agudos Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina.
Javier RobertiInstituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina.
Ana María SilvestriHospital J C Perrando, Resistencia, Chaco, Argentina.
Analía TévezHospital Balestrini, La Matanza, Buenos Aires, Argentina.
Leonardo Joaquín UrangaHospital Príncipe de Asturias, Córdoba, Argentina.
Graciela ZakalikHospital Luis Carlos Lagomaggiore, Mendoza, Argentina.
Viviana RodríguezInstituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina.
5C Study Group
Ezequiel García-ElorrioInstituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll.

objectiveThe 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).

methodsWe 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.

resultsWe 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.

conclusionA 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.

Indexed as

COVID-19Intensive Care UnitsQuality ImprovementSARS-CoV-2AdultArgentinaDelivery of Health CareFemaleHealth PersonnelHumansInterrupted Time Series AnalysisMaleMiddle AgedPandemicsPersonal Protective EquipmentPublic HealthBurnout, ProfessionalCollaborative, breakthrough groupsCOVID-19Critical careQuality improvement

Identifiers

PMID38830729
PMCPMC11149125

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.