Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative.

Publication date: Jul 01, 2025

Primary care has been essential in ensuring the continuity of health services for patients with COVID-19 and other conditions. We aimed to increase the adoption of evidence-based interventions to identify clinical deterioration in adult patients with confirmed or suspected respiratory COVID-19 at the primary care level. We implemented specific interventions in nine Primary Healthcare Centres (PHCC) through a quality improvement collaborative (QIC) with an interrupted time-series design. Interventions included triage for acute respiratory symptoms, the National Early Warning Score 2 (NEWS2) scale, portable oximeters for selected patients and the provincial telehealth system. Additional components involved leadership commitment, teamwork tools, reminders, audits, feedback and direct observation. A mixed-method evaluation was conducted, with two learning sessions and three action periods to test and implement selected change ideas. Six PHHCs completed the study. Over 48 weeks, data from 877 patients were gathered, 356 in the baseline period (BP) and 477 in the implementation period (IP). Eight hundred and sixty-two medical consultations were reported, 367 for BP and 495 for IP. More COVID-19-confirmed diagnoses were observed in the IP group (1. 9% vs 15%, p

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