Increasing Rates of Prone Positioning in Acute Care Patients with COVID-19

Area of Science:

• Critical Care Medicine
• Pulmonary Medicine
• Quality Improvement Science

Background:

• Prone positioning is known to improve outcomes in intubated patients with acute respiratory distress syndrome.
• Its use in nonintubated COVID-19 patients on general hospital floors is limited by significant operational and patient-related challenges.
• The study aimed to enhance the application of prone positioning for acute care COVID-19 patients.

Purpose of the Study:

• To increase the frequency of prone positioning among nonintubated, acute care patients diagnosed with COVID-19.
• To overcome identified barriers to implementing prone positioning on general hospital wards.

Main Methods:

• A retrospective analysis was performed on adult patients with COVID-19 respiratory failure admitted to acute care floors.
• A quality improvement initiative involved four key interventions: education, operational optimization, a dedicated prone positioning team, and EHR enhancements.
• Run charts tracked prone positioning frequency, and oxygen saturation was compared pre- and post-intervention for patients managed by physical therapy.

Main Results:

• The frequency of prone positioning among eligible patients increased significantly after the initiative's implementation, peaking at 46.4% weekly.
• A dedicated physical therapy team positioned 24.4% of patients who received prone positioning.
• Prone positioning by the physical therapy team led to a significant improvement in mean oxygen saturation from 91% to 95.2%.

Conclusions:

• A multidisciplinary quality improvement initiative effectively increased the frequency of prone positioning for acute care COVID-19 patients.
• The initiative successfully addressed barriers related to knowledge, equipment, training, and information technology.
• Implementing prone positioning on acute care floors can improve oxygenation in COVID-19 patients, suggesting its value beyond the intensive care unit.