Median time to initiate COVID-19 treatment among hospitalized patients decreased from 12 hours to seven hours following a quality improvement initiative, while guideline-concordant treatment remained high, according to research presented at IDWeek 2026.
The quasi-experimental, pre-post quality improvement study was conducted from December 2024 through June 2025 across four health care systems. Robert L. Gottlieb, MD, of Baylor University Medical Center in Dallas, and colleagues conducted baseline and follow-up audits involving 150 hospitalized adults in each phase. Eligible patients were at least 18 years old and had positive SARS-CoV-2 antigen or molecular tests. Most patients had mild-to-moderate COVID-19 and were at high risk for progression to severe disease.
In baseline surveys completed by 63 health care professionals, difficulty classifying COVID-19 illness severity (48%) and gaps in guideline knowledge (41%) were the most frequently cited barriers to timely care and treatment decisions.
The initial audit-feedback sessions included 90 health care professionals who reviewed baseline findings, received point-of-care resources and developed action plans addressing institutional barriers. Follow-up workshops involving 20 professionals occurred two to five months later, with surveys administered before and after each set of sessions. Follow-up patient chart audits and health care professional surveys were used to evaluate practice changes.
Treatment timing and prescribing patterns
In addition to the reduction in median time to COVID-19 treatment initiation, guideline-concordant treatment was documented in 97% of patients before the intervention and 95% afterward.
Remdesivir monotherapy was the most frequently prescribed treatment, increasing from 65% before the intervention to 69% afterward. Nirmatrelvir/ritonavir monotherapy decreased from 21% before to 18% afterward. Prescribing of remdesivir plus corticosteroids increased from 7% to 10%, while prescribing of remdesivir, corticosteroids and an immunomodulatory agent decreased from 3% to 2%.
Educational outcomes
According to the researchers, the audit-feedback and follow-up sessions significantly improved health care professionals' knowledge, competence and confidence.
In the audit-feedback sessions, the proportion of participants who correctly identified that remdesivir could be used regardless of renal impairment, including dialysis, increased from 27% before the session to 46% afterward. In a clinical scenario involving a 54-year-old woman with chronic kidney disease, the proportion of participants correctly recommending remdesivir increased from 38% to 66%. The proportion reporting moderate to high confidence in differentiating COVID-19 therapies based on safety and efficacy increased from 67% to 94%.
During follow-up sessions, the proportion correctly recommending remdesivir for a patient with end-stage kidney disease receiving dialysis increased from 25% before the session to100% afterward. High confidence in overcoming barriers to starting treatment as early as possible increased from 35% to 100%, while high confidence in addressing challenges related to illness severity classification increased from 50% to 100%.
Institutional changes and follow-up
Action plans most frequently prioritized increasing awareness of treatment guidelines (71%) and updating institutional protocols (36%). At follow-up, these were also the most frequently reported successfully implemented actions, at 40% and 30%, respectively.
Among 27 health care professionals completing follow-up surveys, 70% reported improved hospital performance in identifying risk factors, selecting therapies and initiating treatment promptly. Participants reported that the resources primarily supported discussions of best practices (37%) and treatment decision-making (30%).
“This QI initiative drove real-world practice changes, significantly reducing the median time to COVID-19 treatment initiation,” the researchers wrote. “By updating protocols and addressing barriers in severity classification, audit-feedback interventions optimized the timely delivery of guideline-concordant care.”
Dr. Gottlieb reported consulting relationships with AbbVie, Alnylam Pharmaceuticals, AstraZeneca, Eli Lilly and Company, Gilead, Johnson & Johnson and Roche; speaking or promotional education relationships with Alnylam Pharmaceuticals and Pfizer; research support from Gilead; and stock or bond holdings in Lexicon Pharmaceuticals. Six other authors reported no financial relationships. No disclosure was listed for Jeffrey D. Carter, PhD.