Ricerc@Sapienza

The Coronavirus Disease (Covid-19) pandemic is rapidly spreading across the world,
representing an unparalleled challenge for health care systems. There are differences in the
estimated fatality rates, which cannot be explained easily. In Italy, the estimated case fatality rate
was 12.7% in mid-April, while Germany remained at 1.8%. Moreover, it is to be noted that different
areas of Italy have very different lethality rates. Due to the complexity of Covid-19 patient
management, it is of paramount importance to develop a well-defined clinical workflow in order to
avoid the inconsistent management of patients. The Integrated Care Pathway (ICP) represents a
multidisciplinary outline of anticipated care to support patient management in the Sant’Andrea
Hospital, Rome. The main objective of this pilot study was to develop a new ICP evaluated by care
indicators, in order to improve the COVID-19 patient management. The suggested ICP was
developed by a multi-professional team composed of different specialists and administrators
already involved in clinical and management processes. After a review of current internal practices
and published evidences, we identified (1) the activities performed during care delivery, (2) the
responsibilities for these activities, (3) hospital structural adaptation needs and potential improvements, and (4) ICP indicators. The process map formed the basis of the final ICP document;
160 COVID-19 inpatients were considered, and the effect of the ICP implementation was evaluated
over time during the exponential phase of the COVID-19 pandemic. In conclusion, a rapid adoption
of ICP and regular audits of quality indicators for the management of COVID-19 patients might be
important tools to improve the quality of care and outcomes.