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In the preliminary analysis of the VIRUS COVID-19 Registry of Discovery, the Critical Care Research Network, investigators discovered significant variations in mortality that were not readily explained by patient comorbidities, demographics, or severity of illness. It became evident that much of the disparity in outcomes was tied to variations in processes of care from one intensive care unit (ICU) to another. This realization inspired the creation of the STOP-VIRUS Learning Collaborative, which seeks to help participants rapidly evaluate and effectively implement best practice recommendations from the ever-evolving body of knowledge related to the care of critically ill patients with COVID-19.
“All things considered, process variations were not surprising early in the pandemic,” said Alexander S. Niven, MD, core faculty for the collaborative and consultant with the Division of Pulmonary and Critical Care Medicine at Mayo Clinic, Rochester, Minnesota. “SARS-CoV-2 was a brand new virus, and healthcare teams were forced to apply the information that was readily available in the face of an overwhelming surge in cases. The patient volume also forced hospital systems to bring in many staff who did not regularly practice in the ICU to provide care.” STOP-VIRUS leaders set out to address these variations and ensure a more effective response moving forward by creating a learning collaborative in a virtual setting. Sponsored by the Society of Critical Care Medicine (SCCM) and supported by the Centers for Disease Control and Prevention (CDC), STOP-VIRUS launched in April as a six-month program. Participation was open to all U.S. and U.S. territory hospitals currently participating in the VIRUS registry that had entered at least three to six months of data. Twelve hospitals are participating. Effectively managing very ill patients, including those with COVID-19, requires a standardized, systemic, and structured approach. Multiprofessional members from each STOP-VIRUS institution completed online modules using Mayo Clinic’s Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) program during the first 30 days of the collaborative. Launched in 2013, CERTAIN has proven effective at improving ICU processes and patient outcomes in a prospective quality improvement (QI) intervention at 34 ICUs across 15 countries. STOP-VIRUS participants were asked to follow the CERTAIN admission and rounding checklists and to employ patient- and family-shared decision-making tools and strategies to humanize the critical care environment and ensure consistent, patient-centered decision-making. They also were encouraged to begin using a COVID-specific ICU checklist and conduct a safety culture survey to better understand the teamwork and culture within the ICU. While outcomes are not expected until the end of the year, at three months many participants reported that they had shared information from the weekly STOP-VIRUS state-of-the-art summaries and discussions in leadership meetings. Several reported that they are actively working on a variety of QI projects related to the management of respiratory failure, prevention of nosocomial complications, and strengthening patient and family communication regarding goals of care based on data provided by the VIRUS Registry. STOP-VIRUS leaders are encouraging participants to report their own findings. “Previously people didn’t think this could be done virtually, but COVID forced us to think differently, and we’ve shown it can work,” said Yue Dong, MD, STOP-VIRUS core faculty and assistant professor of medicine at Mayo Clinic. “We’ve learned a lot from members of hospitals of various sizes and settings and from different members of the multidisciplinary team—we’ve been learning together. The Zoom-based videoconference plus online engagement with Blackboard and Twitter (blended learning) helps build the community we all seek to improve daily care for patients.” STOP-VIRUS focuses on providing high-quality education by creating a robust network within SCCM to summarize and deliver the best current understanding to participants. It also provides a learning community and framework to help centers establish and effectively implement QI practices. Because effective multidisciplinary care proved to be vital during the pandemic, applicants were asked to choose a nursing leader, physician leader, pharmacist, and respiratory therapist to participate in the weekly one-hour calls via Zoom. The calls feature subject matter experts delivering state-of the-art updates on one of six curriculum topic areas (based on a preprogram member needs assessment survey) and include a summary of the latest COVID-19 best practices and literature. Implementation experts offer advice on disseminating and implementing these best practices. The collaborative also often employs smaller breakout groups to maximize the opportunity to share experiences; the breakout groups then share their learnings and discussions with the larger group via Twitter with the #STOPVIRUScollab hashtag. Based on the preliminary findings of STOP-VIRUS, the six curriculum topics are:
Posted: 10/21/2021 | 0 comments
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