Pilot Implementation of a multi-faceted COVID-19 response at the department of paediatrics, QECH
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Date
2020-09-16
Authors
Journal Title
Journal ISSN
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Publisher
Kamuzu University of Health Sciences
Abstract
Type of Study
This is a mixed-methods pilot implementation study
Problem
COVID-19 is the current major disease of concern globally. The guidance developed by the World
Health Organisation (WHO) to help in the implementation of infection prevention and case
management of COVID-19 must be locally relevant for it to be effective in Malawi. This study will
apply the RE-AIM framework to assess key process and implementation outcomes of the QECH
Paediatric COVID-19 response.
The QECH Paediatric departmental response to COVID-19 has three elements (i) the implementation
of WHO guidance on infection prevention, rationale use of PPE and case management of children
with suspected COVID-19 disease (ii) ongoing monitoring and evaluation of in-patient case load, case
fatality rate and quality of care and (iii) the development of strategies to minimise in-patient length of
stay. Underpinning these three elements are ongoing communication strategies, logistics support and
real-time data utilisation through audit-feedback.
The aim of this study is to describe the implementation of this response and to pilot strategies for (i)
real time data utilisation and (ii) reduction of in-patient length of stay to mitigate against both the direct
and indirect effects of COVID-19.
Specific Objectives
I. To evaluate the implementation of COVID-19 specific guidance (infection prevention,
environmental cleaning and the rationale use of PPE) and how it changes over the course of
the epidemic.
II. To evaluate the pilot implementation of a data dashboard and associated learning system on
(i) compliance with COVID-19 guidance and (ii) in-patient quality of care.
III. To describe the effect of the COVID-19 epidemic on the in-patient caseload, case fatality rate
and in-patient quality of care compared to baseline.
IV. To determine the optimal strategies for minimising in-patient length of stay in our department
with the aim of reducing unnecessary patient exposure to COVID-19.
IV.V. To generate pilot effectiveness data on the utility of a “learning system” to support the COVID-
19 response at the QECH paediatric department.
Methods:
All elements of the COVID-19 response (the intervention) will be described at baseline using the
TiDieR checklist. The implementation of this response will be assessed using a modified RE-AIM
framework, supplemented with qualitative enquiry based on the Consolidated Framework for
Implementation Research. A key element of the intervention is real time data utilisation via
implementation of a data dashboard. The dashboard will be updated weekly. The aim of the
dashboard is to provide a “learning” system to inform ongoing COVID-19 specific activities and
maintain in-patient quality of care through identification of key indicators requiring improvement on a
weekly basis which will be entered into a PDSA cycle. The efficacy of the dashboard will be defined
as a 20% improvement in the chosen indicator over the following month. A key safety element in the
COVID response is minimising unnecessary length of stay (LOS) for in-patients. We will pilot two
strategies to reduce inpatient LOS; (i) IV-PO switch antibiotic ward rounds and a (ii) care pathway for
complex patients. These interventions will be developed through (i) audit of existing practices
including 6 months of retrospective data review and (ii) participatory work-shops with clinicians and nurses in the department. Pilot efficacy of these interventions will be assessed by comparing length of
stay and changes in antibiotic prescribing days in the department. The interventions will be refined
through feedback from key users and developed for future formal process evaluation.
Description
Keywords
Research Subject Categories::MEDICINE