COVID-19 Guidelines Changing Faster than the Virus: Implications of a Clinical Decision Support App

Saperstein, Yair; Ong, Stephanie L.; Al-Bermani, Tarik; Park, Joongheum; Saperstein, Yiela; Olayinka, J.; Jaiman, Anjali; Winer, Andrew; Salifu, Moro O.; McFarlane, Samy I.

doi:10.15344/2456-8007/2020/148

Cited by 12 publications

(12 citation statements)

References 11 publications

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“…This issue is pertinent in the case of novel conditions like COVID-19, where best practice changes frequently as more management options are discovered. 7 Overall, our results suggest there was greater understanding about the importance of anti-S antibody requesting over the 4-month intervention period. Our findings agree with research that has suggested a mixture of educational sessions and visual reminders increase application of guidelines in clinical practice.…”

Section: Discussionmentioning

confidence: 66%

“…This issue is pertinent in the case of novel conditions like COVID-19, where best practice changes frequently as more management options are discovered. 7 …”

Section: Discussionmentioning

confidence: 99%

“…As a novel disease, COVID-19 guidelines are constantly changing, resulting in poor practical implementation. 7 In September 2021, UK COVID-19 management guidelines stated that all patients hospitalised for acute COVID-19 illness should be considered for Ronapreve, and therefore should receive an anti-S test. 8 Ideally, testing should be done on admission to allow earlier administration of Ronapreve (if indicated).…”

Section: Introductionmentioning

confidence: 99%

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Increasing anti-S antibody testing: a quality improvement initiative with evolving COVID-19 guidelines

et al. 2022

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BackgroundCOVID-19 management guidelines are constantly evolving, making them difficult to implement practically. Ronapreve was a neutralising monoclonal antibody introduced into UK COVID-19 guidelines in 2021. It reduces mortality in seronegative patients infected with non-omicron variants. Antibody testing on admission is therefore vital in ensuring patients could be considered for Ronapreve as inpatients.Local problemWe found that on our COVID-19 ward, 31.4% of patients were not having anti-S tests despite fulfilling the other criteria to be eligible for Ronapreve. This was identified as an important target to improve; by not requesting anti-S tests, we were forgoing the opportunity to use an intervention that could improve outcomes.MethodsWe analysed patient records for patients with COVID-19 admitted to our ward over 4 months to observe if awareness of the need to request anti-S increased through conducting plan–do–study–act (PDSA) cycles.InterventionsOur first intervention was an multidisciplinary team (MDT) discussion at our departmental audit meeting highlighting our baseline findings and the importance of anti-S requesting. Our second intervention was to hang printed posters in both the doctors’ room and the ward as a visual reminder to staff. Our final intervention was trust-wide communications of updated local COVID-19 guidance that included instructions for anti-S requesting on admission.ResultsOur baseline data showed that only 68.6% of patients with symptomatic COVID-19 were having anti-S antibody tests requested. This increased to 95.0% following our three interventions. There was also a reduction in the amount of anti-S requests being ‘added on’, from 57.1% to 15.8%.ConclusionsCOVID-19 guidelines are constantly evolving and require interventions that can be quickly and easily implemented to improve adherence. Sustained reminders through different approaches allowed a continued increase in requesting. This agrees with research that suggests a mixture of educational sessions and visual reminders of guidelines increase their application in clinical practice.

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Section: Discussionmentioning

confidence: 66%

“…This issue is pertinent in the case of novel conditions like COVID-19, where best practice changes frequently as more management options are discovered. 7 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increasing anti-S antibody testing: a quality improvement initiative with evolving COVID-19 guidelines

et al. 2022

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“…Most CDS developed to date focus on single decision points and less on comprehensive disease-specific decision support spanning the duration of hospitalization. As a solution, we suggest creating a multifaceted CDSS that addresses care across the spectrum of a disease; this has also been suggested in the literature but has not been extensively studied [ 56 , 57 ]. A CDSS that incorporates all phases of care, from admission orders and imaging to discharge and follow-up, could be built to avoid redundancy as well.…”

Section: Discussionmentioning

confidence: 99%

Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses

Jones¹,

Banks²,

Melton³

et al. 2022

JMIR Hum Factors

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Background Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance. Objective This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology. Methods A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map. Results A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently. Conclusions End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption.

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“…Some effective public health measures, prevention strategies, and therapeutics options are now available, but international, national, and subnational policies do not always follow shared guidelines, creating confusion and mistrust among the general population [3][4][5]. This issue is partially determined by a gap between data collection, scientific evidence, their validation, and the creation/modification of the guidelines [6]. The forced cohabitation with SARS-CoV-2 has made it even clearer that there is great importance in making validated and updated scientific information available to policy makers, healthcare professionals, and the public as quickly as possible.…”

Section: Introductionmentioning

confidence: 99%

Semi-Automatic Systematic Literature Reviews and Information Extraction of COVID-19 Scientific Evidence: Description and Preliminary Results of the COKE Project

et al. 2022

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The COVID-19 pandemic highlighted the importance of validated and updated scientific information to help policy makers, healthcare professionals, and the public. The speed in disseminating reliable information and the subsequent guidelines and policy implementation are also essential to save as many lives as possible. Trustworthy guidelines should be based on a systematic evidence review which uses reproducible analytical methods to collect secondary data and analyse them. However, the guidelines’ drafting process is time consuming and requires a great deal of resources. This paper aims to highlight the importance of accelerating and streamlining the extraction and synthesis of scientific evidence, specifically within the systematic review process. To do so, this paper describes the COKE (COVID-19 Knowledge Extraction framework for next generation discovery science) Project, which involves the use of machine reading and deep learning to design and implement a semi-automated system that supports and enhances the systematic literature review and guideline drafting processes. Specifically, we propose a framework for aiding in the literature selection and navigation process that employs natural language processing and clustering techniques for selecting and organizing the literature for human consultation, according to PICO (Population/Problem, Intervention, Comparison, and Outcome) elements. We show some preliminary results of the automatic classification of sentences on a dataset of abstracts related to COVID-19.

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COVID-19 Guidelines Changing Faster than the Virus: Implications of a Clinical Decision Support App

Cited by 12 publications

References 11 publications

Increasing anti-S antibody testing: a quality improvement initiative with evolving COVID-19 guidelines

Increasing anti-S antibody testing: a quality improvement initiative with evolving COVID-19 guidelines

Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses

Semi-Automatic Systematic Literature Reviews and Information Extraction of COVID-19 Scientific Evidence: Description and Preliminary Results of the COKE Project

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