Informing Emergency Care for COVID-19 patients: The COVED Quality Improvement Project Protocol

There is an urgency to support Australian ED clinicians with real-time tools as the COVID-19 pandemic evolves. The COVID-19 Emergency Department (COVED) Quality Improvement Project will provide flexible and responsive clinical tools to determine the predictors of key ED-relevant clinical outcomes.

The number of patients with COVID-19 (SARS-CoV-2) presenting to Australian Emergency Departments (EDs) is expected to increase dramatically. While there are many perspectives regarding international management of the pandemic there is a scarcity of published data specific to the ED context.

As COVID-19 threatens to overwhelm healthcare resources, it is imperative that ED clinicians have tools to identify patients at high risk for adverse outcomes. Predictive models for patient-level outcomes, based on real-time data, could help improve clinical care and ED processes. The COVID-19 Emergency Department (COVED) Quality Improvement Project has been initiated to meet this objective.

The COVED Quality Improvement Project

COVED is a prospective cohort study. The initial and current project site is the Alfred Hospital, Melbourne; it is intended that other Australian EDs will participate to form a network of sentinel sites. The Alfred Hospital is a tertiary, adult, Level 1 trauma centre with an ED census of approximately 70,000.

All adult patients that present to the ED and meet COVID-19 testing criteria, based on contemporary case definitions at the time of presentation, are included. The primary outcome of interest being measured is the patient’s result using the recommended initial test for detecting COVID-19 infection. This test is currently the COVID-19 Polymerase Chain Reaction (PCR) test, using the nasopharyngeal sample taken during the index ED presentation. Secondary outcomes include hospital admission, ICU admission, mechanical ventilation, the number of ventilator free days, hospital length of stay and death during hospital admission.

The variables for which data is being collected (covering inclusion criteria, potential predictors, clinical management and outcome measures) are mostly consistent with the variables in the larger COVID-19 case report form generated by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC).  The COVED list of variables is flexible to change as new data emerges regarding outcome predictors and treatment strategies. Up to date versions of the data dictionary and case report form are available below. This will facilitate standardisation of variables across participating sites.

This agile quality improvement project will inform real-time improvements in ED care. By determining the clinical predictors of patient-centred outcomes for patients with COVID-19, the study will enable a dynamic approach to systems design, resource allocation and clinical management during the pandemic. The COVED protocol is novel, with a methodology designed to meet the extreme and accelerating nature of the pandemic. Other sites interested in participating in the project are encouraged to contact the study investigators.


Title

Informing Emergency Care for COVID-19 patients: The COVID-19 Emergency Department (COVED) Quality Improvement Project Protocol

Links

COVED Podcast 1: “COVED-0”

COVED Podcast 2: “COVED-1”

Authors

O’Reilly GM MBBS MPH MBiostat FACEM PhD (1,2,3)
Mitchell RD MBBS (Hons) BMedSc (Hons) MPH&TM GradCertDisRefHlth FACEM (1,2)
Noonan MP MBChB (Hons) BPhty (Hons) MMEd FACEM (1)
Hiller R MBBS (1)
Mitra B MBBS MHSM FACEM PhD (1,2,3)
Brichko L MBBS (Hons) MHM DCH AFRACMA FACEM (1,2)
Luckhoff C MBChB FACEM (1)
Paton A MBChB FACEM CHIA (1,4)
Smit DV MBChB FACEM (1,2)
Santamaria MJ MBBS FACEM CHIA (1)
Cameron PA MBBS FACEM MD (1,2)

Affiliations

  1. Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
  2. School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
  3. National Trauma and Research Institute, Alfred Health, Melbourne, Australia
  4. Adult Retrieval Victoria, Ambulance Victoria, Melbourne, Australia