from the editor
Hospitals Were Unexpectedly Nimble in Translating Evidence During the Pandemic
It is interesting to learn that it can take as long as a decade or more for hospitals to implement an intervention after the first evidence shows a benefit in patients . This time lag is driven by the difficulty of building consensus among different medical disciplines , and barriers in communication within healthcare facilities . A new study co-led by Jefferson Health and UCSF demonstrates how hospitals overcame some of these barriers and rapidly adapted patient care . With data collected from academic medical centers across the U . S ., the research highlights key strategies that can help facilities respond to crises and ongoing threats .
“ The translation of evidence to practice in medicine is notoriously slow ,” says Alan Kubey , MD , a specialist in hospital medicine at Jefferson Health and Mayo Clinic and the co-lead of the study . “ Given the singular focus on COVID-19 , we were interested to see how nimble hospitals were able to shift care based on rapidly changing , and sometimes conflicting , evidence .”
The findings are borne out of the Hospital Medicine Re-engineering Network ( HOMERuN ), a collaborative of hospitalists and researchers at leading medical centers nationwide . The researchers surveyed members of the HOMERuN network between December 2020 and February 2021 . In total , 52 hospitals responded . They found that there was consistency in the interventions hospitals used based on available clinical evidence and national guidelines ; the most striking example was the near universal adoption ( 94-100 percent of survey responders ) of dexamethasone for patients requiring at least four liters of supplementary oxygen ; it took only six to eight months to adopt this treatment after a randomized clinical trial demonstrated a survival benefit . The researchers credit this translation of evidence in part to rapid information sharing among hospitals and intense focus of multidisciplinary COVID-19 treatment guideline committees .
To ensure rigor in interpreting evidence , 94 percent of survey respondents created multi-disciplinary teams that included infectious disease , hospital medicine , pulmonary critical
care , pharmacy and emergency medicine . These varied perspectives were critical in generating comprehensive COVID-19 guidelines and protocols .
The researchers also discovered that most of the hospitals they surveyed used multiple modes to disseminate their guidelines . In addition to email blasts and institutional websites , hospitals integrated guidelines into order sets , which are a list of directives and appropriate treatments , and 65 percent of respondents used accompanying note templates that guided providers through their diagnostic plan .
“ These order sets and note templates became a one-stop shop of concise information ,” says Kubey . “ It helped nudge the practitioner toward evidence-based strategies , like the correct dose of dexamethasone , remdesivir timing , respiratory support , etc . and enabled quick decision making at the bedside .”
While there was consistency in these effective practices across hospitals , the researchers also found a common pattern of treatment over no treatment , particularly when there were conflicting guidelines or evidence . “ It ’ s a reflection of practitioners ’ bias to do something rather than nothing , when in fact a treatment could be doing more harm than good ,” Kubey says . “ It ’ s an important lesson in handling uncertainty , encouraging medical teams to be critical in considering the available evidence , and developing guidelines that leave less room for interpretation .”
The researchers hope to learn how the convergence in strategies translated into patient outcomes in the responding hospitals . They also want this study to encourage dialogue among healthcare leaders , and national governing bodies regarding how best to translate evidence to bedside .
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Reference : Amy Chang Berger , Noa Simchoni , Andrew Auerbach , W . Michael Brode , Ethan Kuperman , Kattie Raffel , Alan Kubey for the HOMERuN COVID-19 Collaborative Group , “ Implementation of Clinical Practice Guidelines for Hospitalized Patients With COVID-19 in Academic Medical Centers ,” DOI : 10.1001 / jamanetworkopen . 2022.5657 , JAMA Network Open , 2022