Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Abstract

Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation a novel comprehensive perioperative checklist for care of the COVID-19 parturient.Methods: Implementation of a novel workflow for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time.Conclusion: We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.

Implementation considerations for delivering inpatient COVID rehabilitation: A qualitative study

“…These included: conflicting opinions on best IPAC practices (outer setting), limited flow of information from senior leaders to frontline staff (inner setting), reduced access to rehabilitation equipment and understanding of how to provide high quality rehabilitative care in this context (intervention characteristics), willingness and self‐efficacy among frontline staff (individual characteristics), lack of opportunity to trial the intervention on a small scale and reverse or change course if warranted (intervention characteristics); and lack of time to reflect on and assess effectiveness (process). While these barriers are similar to those discussed in other studies implementing health interventions during COVID, 15,31–33 this was the first study to explore these challenges in a rehabilitation context and adds to the growing literature exploring rehabilitation in COVID care.…”

“…The major strength of this study was the ability to rapidly evaluate the implementation of a COVID zone at the onset of the pandemic, using a robust theoretical framework 13 . Importantly, our findings add to the growing body of literature exploring the challenges implementing health interventions during a crisis like the COVID pandemic 15–17,30–32 . However, this study did not explore the implementation of specific rehabilitation therapies for patients recovering from COVID and additional research is needed to understand both the types of therapies and how best to implement them in this adapted context for patients recovering from acute infections as well as long COVID 1,8,10,41–43 …”

Re-Imagining the Data Collection and Analysis Research Process by Proposing a Rapid Qualitative Data Collection and Analytic Roadmap Applied to the Dynamic Context of Precision Medicine

“…The CFIR approach has been criticised when applied recently to a precision medicine context for being time-intensive and potentially delaying the identification of findings (Best et al, 2021). In line with this criticism, the CFIR approach indicates some recent attempts by CFIR’s creators and other authors to speed up the qualitative data collection and deductive analytic process for contexts with rapid change (Gale et al, 2019; Nevedal et al, 2021; Zucco et al, 2021).…”

“…Sentiment Analysis is a candidate for resolving that deficit in a rapid way. In line with this paradigm shift, our implementation science study proposes the need for rapid qualitative analysis of the deductive CFIR approach (Gale et al, 2019; Nevedal et al, 2021; Zucco et al, 2021) through the use of Sentiment Analysis. Sentiment Analysis (Pang & Lee, 2008; Pinto et al, 2018) identifies and categorises opinions to determine whether participants’ attitudes toward a particular topic (intervention or product, etc.)…”