Evidence on emerging therapeutics and the treatment of COVID-19 and its complications has been incomplete, often contradictory, and rapidly changing. The brisk development of effective strategies aimed at identifying, isolating, and treating this disease requires an equally fluid response. At Dell Seton Medical Center, a safety-net hospital that serves Austin in central Texas, our hospitalists have led the formation of numerous collaborative work groups to address the appropriate triage, management, and operational processes during the COVID-19 evolving pandemic.
We created a hospitalist-led COVID Therapeutics and Informatics Committee composed of specialists (infectious disease, pulmonary and critical care, hematology/oncology, neurology), pharmacy, nursing leadership, and the hospital chief medical officer). This committee was formed to evaluate and reach consensus regarding therapeutic interventions in order to ensure appropriate and timely evidence-based treatment. The goal was to limit practice variation and create a shared mental model to deliver consistent value-based care without increasing complexity. We discuss how evidence was evaluated in an interprofessional setting, focusing on not just the quality of data, but its application in an environment of uncertainty and resource scarcity.
We review the use of electronic communication platforms to facilitate direct and rapid communication among interprofessional providers and hospital leadership. We also discuss the development of creative workarounds to build protocols into the electronic medical record to implement new therapeutic interventions in real time.
This approach allows the rapid establishment and adoption of therapeutic protocols based on expert and consensus opinion in the absence of comprehensive national guidelines. This model may also be adopted for other complex disease states that require coordinated interprofessional interventions and frequent revisions to the standard of care.
1. Protocols improve care by creating a shared framework for approaching complex diseases and open communication within teams to personalize care.
2. Rapidly appraising evidence requires equipoise, thoughtful interpretation of retrospective data, and applying that specifically to a hospital’s local context.
3. Guidelines are best utilized when they are built into clinical care through Standardized Order Sets and disseminated in multiple modalities that reach their audience just in time.
4. The perfect can’t be the enemy of the good.
Protocolized care in progress: Rapid appraisal of evidence and standardization of practice in a pandemic
Live Q&A: Tuesday, Aug. 11, 1:00-2:00 p.m.
Dr. Brode and Dr. Busch are assistant professors in the department of internal medicine at Dell Medical School, University of Texas, Austin.