While her responsibilities shifted, O’Donnell still had to oversee visits from accreditation agencies and regulators. She said she grew as a leader delegating some of the responsibilities for these visits to others and growing comfortable in leaning on her colleagues.

“We were raised as quality professionals, especially when it comes to regulatory visits, to be that point person, and we became very adept at doing that,” O’Donnell said. “But it changed so much with COVID-19—it took a while for me to realize that no one person could do everything. I was part of a team.”

But as hospitals’ quality teams became more important, the staff’s usual work took a hit. Central line-associated bloodstream infections in US hospitals had decreased by over 30% in the five years before the pandemic. In the second quarter of 2020, these infections increased by 28%.

Officials at Novant Health and CarePoint Health said they saw varying degrees of regression in several quality measures. At Boise, Idaho-based St. Luke’s Health System, catheter-associated urinary tract infectionspatient falls and mortality rates increased. COVID-19 factored into the quality metrics due to patient acuity and changes to care.

Patients overall were sicker and less able to get up to use the bathroom, which meant nurses had to place more catheters, and for longer periods of time—setting the stage for more catheter-associated urinary tract infections.

St. Luke’s had to rely heavily on travel nurses, who weren’t trained in the system’s specific procedures in cleaning and maintaining catheters, and how long they should be left in. COVID-19 patients had to be isolated in individual rooms, with fewer checks from nurses to minimize exposure.

“We realized that even when you have to make such dramatic and frequent changes to workflows and staff, you can’t forget the basics because they will come back to haunt you,” said Dr. Bart Hill, St. Luke’s vice president and chief quality officer.