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

Abstract

Background: Primary care has been essential inensuring the continuity of health services for patientswith COVID-19and other conditions. We aimed toincrease the adoption of evidence-basedinterventionsto identify clinical deterioration in adult patients withconfirmed or suspected respiratory COVID-19at theprimary care level.Methods: We implemented specific interventions in ninePrimary Healthcare Centres (PHCC) through a qualityimprovement collaborative (QIC) with an interruptedtime-seriesdesign. Interventions included triage foracute respiratory symptoms, the National Early WarningScore 2 (NEWS2) scale, portable oximeters for selectedpatients and the provincial telehealth system. Additionalcomponents involved leadership commitment, teamworktools, reminders, audits, feedback and direct observation.A mixed-methodevaluation was conducted, with twolearning sessions and three action periods to test andimplement selected change ideas.Results: Six PHHCs completed the study. Over 48 weeks,data from 877 patients were gathered, 356 in the baselineperiod (BP) and 477 in the implementation period (IP).Eight hundred and sixty-twomedical consultations werereported, 367 for BP and 495 for IP. More COVID-19-confirmeddiagnoses were observed in the IP group (1.9%vs 15%, p<0.001).The bundle was implemented in 0% and 28.4% ofpatients in the BP and IP groups, respectively. Onevaluating the individual components of the bundle, wediscovered enhancements in the utilisation of triage,application of NEWS2 and utilisation of oximeters whenappropriate. A decrease in the number of follow-upcallswas observed at the end of the implementation.Patients rated the quality of care as positive in 66% of thecases in the BP and 76% in the IP group (p=0.023).Conclusion: We successfully implemented a triagealgorithm based on the NEWS2 score to identifyrespiratory deterioration in adult patients in primary carethrough a QIC. This intervention was perceived as animprovement in the quality of care by the patients.