Becker's Clinical Quality & Infection Control

18 QUALITY IMPROVEMENT & MEASUREMENT A gap in front-line staff training — and how Lifespan is closing it By Erica Carbajal "I f you see something, say something." It's a phrase familiar to front-line staff who hospitals and health systems in large part rely on to report safety risks and events, but in many cases, a key component is missing: Training. ose who work outside of healthcare quality may assume such training for front-line staff is common, though both anecdotal reports and survey data demonstrate otherwise. In a 2019 survey of healthcare quality leaders, only 33% of respondents said employees at their organization are trained and educated in quality work. "We say a lot about what should happen in healthcare, but we spend very little time telling people how to do that," Stephanie Mercado, president and CEO of the National Association of Healthcare Quality, told Becker's. is is the impetus that drove NAHQ to develop a quality training course for staff that walks through how to actually identify safety risks and events, what the expectations are aer an error or potential error is spotted, and the process improvement cycle to prevent future incidents. Every year, about 10,000 frontline employees at Providence, R.I.-based Lifespan are required to complete the training. "Whether someone is hired — they're new and you're onboarding them to the organization — or if [they] work at the bedside and have been working in patient care for a long time, there is a need to go back and remind people of what their connection is to a greater discipline," said Nidia Williams, PhD, vice president of quality and patient safety at Lifespan, where employees have long been required to complete annual training on compliance and risk management. "I don't think quality and safety is any different. I think there's an annual responsibility for everybody to brush up on their competencies regarding safety and certainly regarding quality," Dr. Wiliams, who is also a NAHQ board member, told Becker's. e training is structured to essentially demystify what should happen when an employee sees something that may pose a risk for or has caused a patient safety event, and then breaks down how to perform a root cause analysis and corrective action plan to fill in gaps that led to or posed a risk for an error. "ere's really not a lot of consistent standardized training in quality and in safety" to reduce variation and lay out expectations for front- line staff, Dr. Williams said. At Lifespan, the quality training has been in place for about three years and is now incorporated into the onboarding process for new employees. Lifespan has since seen a boost in the number of near-miss events reported by staff, which prompted the system to build a "good catch" program, where leaders on a monthly basis congratulate staff who point out an issue that could have led to a significant error but ultimately didn't. e effort enables the system to investigate safety issues and ensure failure areas are corrected. "You want to catch and learn about these system and process issues that could result in failure before they actually do, so having the near- miss events be entered with greater frequency really told us that the culture of safety was growing and developing," Dr. Williams said. Ultimately, the need for quality training stems from the fact that the healthcare workforce comes from diverse backgrounds in terms of education, Ms. Mercado and Dr. Williams explained. Each healthcare profession has its own set of competencies that different educational programs develop curriculum around. "is is appropriate when nuanced content is involved, and even to provide a competitive edge between academic programs," Ms. Mercado said. "However, this becomes problematic when we are attempting to prepare a workforce together post-graduation and they don't share common vocabulary, skills or behaviors related to universal topics like quality and safety." n Half of long COVID-19 patients don't improve after 1.5 years By Erica Carbajal M ore than 50% of patients experiencing long COVID-19 did not improve after 18 months, according to new study findings that included more than 800 patients. The research was published Oct. 31 in the International Journal of Infectious Diseases, and is based on an analysis of 806 patients referred to a long COVID-19 clinic in Denmark. Referred patients had persistent symptoms at least 12 weeks after the onset of COVID-19. Overall, 70% of patients were female, with a median age of 48. Researchers used the results of a symptom questionnaire to assess whether patients improved over a 1.5 year follow-up period. Patients were given standard health scores four times between enrollment and after 18 months of follow-up. Of the 429 patients they were able to follow up with at 1.5 years, 57% "failed to improve in long COVID-19 severity" regardless of the variant they were infected with, the findings showed. There was a significant drop in median scores from the symptom questionnaires 7 to 10 months after infection, before plateauing 12 to 18 months after infection. "We suggest the search for long COVID treatments focus on those severely affected patients to develop future new treatments, which we believe will be effective across all SARS-CoV-2 variants." n

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