Improving management of hospitalised patients with COVID-19: algorithms and tools for implementation and measurement

BMJ Open Qual. 2020 Nov;9(4):e001130. doi: 10.1136/bmjoq-2020-001130.

Abstract

Background: The COVID-19 pandemic represents an unprecedented challenge to healthcare systems and nations across the world. Particularly challenging are the lack of agreed-upon management guidelines and variations in practice. Our hospital is a large, secondary-care government hospital in Kuwait, which has increased its capacity by approximately 28% to manage the care of patients with COVID-19. The surge in capacity has necessitated the redeployment of staff who are not well-trained to manage such conditions. There was a great need to develop a tool to help redeployed staff in decision-making for patients with COVID-19, a tool which could also be used for training.

Methods: Based on the best available clinical knowledge and best practices, an eight member multidisciplinary group of clinical and quality experts undertook the development of a clinical algorithm-based toolkit to guide training and practice for the management of patients with COVID-19. The team followed Horabin and Lewis' seven-step approach in developing the algorithms and a five-step method in writing them. Moreover, we applied Rosenfeld et al's five points to each algorithm.

Results: A set of seven clinical algorithms and one illustrative layout diagram were developed. The algorithms were augmented with documentation forms, data-collection online forms and spreadsheets and an indicators' reference sheet to guide implementation and performance measurement. The final version underwent several revisions and amendments prior to approval.

Conclusions: A large volume of published literature on the topic of COVID-19 pandemic was translated into a user-friendly, algorithm-based toolkit for the management of patients with COVID-19. This toolkit can be used for training and decision-making to improve the quality of care provided to patients with COVID-19.

Keywords: clinical; clinical practice guidelines; critical care; decision support; performance measures; quality improvement.

MeSH terms

  • Algorithms*
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / therapy*
  • Delivery of Health Care / organization & administration*
  • Female
  • Health Plan Implementation / methods*
  • Humans
  • Kuwait / epidemiology
  • Male
  • Pandemics
  • Pneumonia, Viral / therapy*
  • SARS-CoV-2