Development of a quality assurance tool for intensive care units in Lebanon during the COVID-19 pandemic

Abstract

Background During the COVID-19 pandemic, low- and middle-income countries have rapidly scaled up intensive care unit (ICU) capacities. Doing this without monitoring the quality of care pose risks to patient safety and may negatively affect patient outcomes. While monitoring quality of care is routine in high income countries, it is not systematically implemented in most low- and middle-income countries. In this resource scarce context there is a paucity of feasibly implementable tools to monitor quality of ICU care. Lebanon is an upper middle-income country that during the autumn and winter of 2020-21 has had increasing demands for ICU beds for COVID-19. The World Health Organisation has supported the Ministry of Public Health to increase ICU beds at public hospitals by 300% but no readily available tool to monitor the quality of ICU care was available. The aim of this study was to describe the process of rapidly developing and implementing a tool to monitor quality of ICU care at public hospitals in Lebanon. Methods In the midst of the escalating pandemic, we applied a systematic approach to develop a realistically implementable quality assurance tool. We conducted a literature review, held expert meetings, and did a pilot study to select among identified quality indicators for ICU care that were feasible to collect during a one-hour ICU visit. In addition, a limited set of the identified indicators that were quantifiable were specifically selected for a scoring protocol to allow comparison over time as well as between ICUs. Results A total of 44 quality indicators, that, using different methods, could be collected by an external person, were selected for the quality of care tool. Out of these 33 were included for scoring. When tested, the scores showed large difference between hospitals with low versus high resources, indicating considerable variation in quality of care. Conclusion The proposed tool is a promising way to systematically assess and monitor quality of care in ICUs in the absence of more advanced and resource demanding systems. It is currently in use in Lebanon. The proposed tool may help identifying quality gaps to be targeted and can monitor progress. More studies to validate the tool is needed.

Assessing quality of critical care during an ongoing health emergency—a novel approach to evaluate quality of care at Lebanese public ICUs during COVID-19

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