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EBMT 2020 Annual Meeting - Quality management during the COVID-19 pandemic

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Quality Management session QM2 - Tuesday 1 September, 13:00-14:00H, Auditorium 6

The second of the quality management sessions on the final day of this year’s EBMT special online congress features quality management professionals discussing the dramatic events that unfolded at their hospitals during the COVID-19 crisis, plus the results of a survey into the role of quality managers in stem cell transplants.

Dr Mara Magri, of the Haematology & Bone Marrow Transplant Unit at ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, will give the background of the COVID-19 story in Italy,  which was among the first countries outside of Asia to report cases of COVID-19, and by 22 June had reported 239,627 cases (34,657 deaths). Lombardy was the most severely affected region (93,111 cases, 16,573 deaths), particularly the province of Bergamo (14,171 deaths).

“The epidemic was unexpected, violent and prolonged; it was not comparable with any other natural event but was more like a trench warfare after a sustained attack,” she explains. “The influx of COVID-19 patients has been so overwhelming at our hospital that the previously available resources were exhausted in a matter of days. It immediately became clear that it was necessary to activate emergency responses, which resulted in a complete reorganisation of the entire hospital.”

Separate COVID-19 units were created in both the adult and paediatric internal medicine and surgery departments, in ICUs and the semi-intensive area, and the emergency room. By March 28, 498 of 779 beds were allocated to COVID-19 patients. Of these, 92 were admitted to the ICUs, and 12 to the sub-intensive critical area. Training was provided to all personnel in the hospital, with over 1500 people trained in one week. 

“As the worst part of the storm passed, an emergency plan was prepared with a quick clinical unit relocation and redeployment of the available staff for the possible next wave,” says Dr Magri. “In the meantime, a series of precautions have been put in place such as constant use of personal protective equipment for the clinical staff in case of contact with any patient, even if not clearly positive. We are also insisting on hand sanitisation and masks for all patients and visitors entering our hospital.

The impact that the coronavirus pandemic had on quality managers (QMs) working in transplant centres in the UK will be presented by Sarah Holtby, bone marrow transplant and cellular therapy lead for quality management, University Hospital Southampton NHS Foundation Trust, UK. She explains that during this time, many QMs were asked to work from home as the government locked down the country and only absolutely essential travel to work was allowed.

Her presentation will cover the QM activities and the challenges, changes, positives and learning that were experienced.  “In some centres the quality team were redeployed and the transplant and quality programme was basically suspended,” she explains. Yet in other centres vital transplant work continued and the quality management work actually increased in specific areas such as risk assessment and management, putting into practice the new guidelines from the UK’s National Institute of Health and Care Excellence (NICE), EBMT and BSBMT, implementation of more stringent infection control including patient and staff testing, and updates to standard operating practices and new contingencies.

Spain is another country hit particularly hard by COVID-19. “To understand why the COVID pandemic has hit Spain so badly, we have to consider that Spain has an old population, deeply rooted social customs that hinder social distancing, and a public health system that has suffered from a severe lack of funding,” explains Dr Christelle Ferrà, based at the Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain.

As in other countries, Spain increased its ICU beds, avoided non-essential hospital activity, and reduced people exposure and traffic in the hospital (patients, relatives and staff). Whenever a patient had fever and was isolated, they were treated in a separate ‘circuit’ especially established for patients with suspected or confirmed COVID-19.

“We adapted to the new situation through our quality management plan, prioritising patient safety,” explains Dr Ferrà. “A contingency plan and a general standard operating procedure for SARS CoV-2 prevention and management of patients receiving cellular therapy were created following national and international guidelines. The cellular therapy program was interrupted from early March to mid-April 2020. Quality reports were created, informed consent modified, and objectives and indicators from 2019 were dragged into 2020.”

Little by little, the cellular therapy program including stem cell transplant has been relaunched at the Hospital Germans Trias i Pujol, together with the quality management activities. An adapted quality management program was brought into operation to deal with the COVID-19 pandemic, based on the standards of JACIE (the committee of EBMT that develops and maintains global standards for the provision of quality medical and laboratory practice in cellular therapy).

Also in this session, Dr Renza Monteleone, EBMT Quality Managers Committee Chairperson, and based at Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, Calabria, Italy, will summarise the results of the survey Role of Quality Management Professionals (QM) in Stem Cell Transplant Programs”, launched in July 2019 by the JACIE Quality Managers Committee and EBMT.

This survey has been carried out to collect information about the profile, duties, background and responsibilities of quality managers working at stem cell transplant programs or one of the facilities involved (collection, processing, clinical). A total of 167 responses from 35 countries have been received; the collected information has been anonymised and will be used to conduct studies and publications on the role of quality manager.

During this session, Dr Monteleone will present the first data from the survey. As regards the education of QM, 36% have a Master’s degree, and in the 76% of cases the education is in health field; more than half (58%) had a formal training in QM and 62% in auditing.

The most important information obtained from the survey is that the role of quality manager is not yet recognised in all countries in the same manner,” explains Dr Monteleone. “In 77 % of cases the role of quality manager in the stem cell transplant program is not recognised as an official role inside the public national health system, and the quality manager is a professional with an external contract (often not permanent) or a with different primary responsibility (for example, health professionals or data manager) that is also in charge of quality.”