May 7, 2021 – At the start of the COVID-19 pandemic, healthcare systems struggled to change patient care processes – in particular when it comes to strategies aimed at reducing the risk of hospital complications. A look at how a hospital applied its Learning Health System (LHS) framework to respond to an increase in nosocomial pressure injury (HAPI) linked to COVID-19 is presented in May / June Journal for Quality Health Care (JHQ), the peer-reviewed journal of National Association for Quality Health Care (NAHQ). The journal is published in the Lippincott portfolio by Wolters Kluwer.
“Given the significant challenges that pressure ulcers can pose to the inpatient, healthcare providers and executives face the task of HAPI risk mitigation that takes into account the unknowns of the COVID pandemic,” write Shea Polancich, PhD, RN, and colleagues at University of Alabama at Birmingham. Their experience shows how an LHS approach can help healthcare systems reduce the risk of HAPI and other preventable complications, with beneficial effects on patient care and reimbursement.
Using the LHS model has improved the delivery of care – even during a pandemic
Dr Polancich and colleagues examined electronic health record data from 772 patients who were discharged from their academic medical center from March to July 2020 to gain insight into the prevalence of HAPIs and the effectiveness of the efforts to HAPI improvement over 4 years of Model LHS. About 29% of the patients included in the scan were diagnosed with COVID-19.
After the start of the pandemic, HAPI numbers began to rise steadily: from 56 cases in March to a peak of 90 cases in May. Researchers believe the increase in HAPIs was linked to changes in organizational workflow and wound assessment processes in the early weeks of the pandemic. For example, to reduce exposure to COVID-19 and preserve personal protective equipment, the Wound, Ostomy and Continence (WOC) team used iPads outside patient rooms for a remote evaluation.
The limited ability to observe, touch, and directly treat patients may have resulted in less effective management of pressure ulcers. Restricted visits by family members or other caregivers – a large set of “eyes and ears” at the bedside – could also have contributed to the increase in PAHs.
As the nursing leadership team identified opportunities for improvement, the workflow and processes of care were quickly adapted. Forty-two percent of HAPI cases in COVID patients were potentially related to positioning or devices affecting the face, head, and neck – possibly related to lying COVID patients in a supine position in order to increase the aeration of the lungs. The problem was solved by using adhesive silicone bandages to relieve pressure points in the areas above the neck.
With changes in nursing practice and a gradual return to normal hospital operations, the number of HAPI cases began to decline in June, reaching a low of 51 events at the end of July. This corresponds to a 45% decrease in the total number of HAPIs.
About 37% of HAPIs linked to COVID-19 were stage 3 or above. Hospitals are not eligible to receive full reimbursement from the Centers for Medicare and Medicaid Services for advanced HAPIs – making pressure ulcers an important management goal.
“Fluctuations and variations in the number of HAPIs over the study period likely occurred due to organizational learning on how to manage patients with COVID 19,” the researchers write. By following the LHS model, their hospital was able to identify gaps in patient care in real time and apply the information learned to improve future care delivery. Dr Polancich and colleagues conclude: “This case study demonstrates the importance for health systems to be able to quickly assess and document a problem, to deploy resources to solve the problem, as well as to assess the effectiveness of an intervention. “
DOI: 10.1097 / JHQ.0000000000000301
About Journal for Healthcare Quality
the Journal for Quality Health Care (JHQ), a peer-reviewed journal, is an official publication of the National Association for Healthcare Quality. (NAHQ). JHQ is a professional forum that continually advances the practice of quality healthcare in diverse and changing environments, and is the premier choice for creative and scientific solutions in the pursuit of quality healthcare. The Journal publishes scientific papers that reach leaders across all healthcare circles, leveraging applied research and producing practical, timely and impactful evidence on healthcare system transformation.
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