Quality improvement and rapid PDSA cycles to maintain routine surveillance of pulmonary pathogens during the COVID-19 pandemic in a pediatric cystic fibrosis clinic.

This was a quality improvement project, not a clinical trial; there was no control group, randomisation, or blinding, and inferential statistics were not used. It took place during the pandemic, so the results may not apply when in-person care is available. Only 66 of 120 mailed cultures were returned, so many home collections were not completed. After reminders were added, only 9 cultures were completed, too few to judge whether reminders worked. The paper did not report whether patients met the guideline of four sputum cultures a year. The quality of home-collected sputum samples and processing by outside laboratories was uncertain. A small but uncounted number of mailed equipment expired before families returned cultures. Other ongoing quality improvement projects about telehealth access and family communication may have influenced culture completion. Patient travel costs and most nursing time were not measured; only initial RN time to identify non-affiliated sites was estimated at five to ten hours.

This work was supported in part by an award from the Cystic Fibrosis Foundation. The authors declared no conflicts of interest. CF center grant funding covered postal costs and was occasionally used for quality improvement activities.

Do not conclude that curbside or mailed cultures improved cystic fibrosis outcomes. The paper reports culture counts, costs, and four patients who required treatment, but it had no comparison group and no inferential statistical analysis.