SHM Converge Scientific Abstract ePoster Gallery-Implementation of Evidence-Based Medicine During the Covid-19 Pandemic: Lessons Learned From a National Survey of Academic Medical Centers

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This national survey examined how quickly academic medical centers (AMCs) translated emerging COVID-19 evidence into institutional practice during late 2020 and early 2021. Members of the Hospital Medicine Reengineering Network were asked to compare their local COVID-19 treatment recommendations with contemporaneous randomized trial results and national guidelines from NIH, IDSA, and ASH.<br /><br />Out of 83 sites, 52 responded, and 51 had internal COVID-19 guidance. These recommendations were usually created by multidisciplinary teams that included infectious diseases, hospital medicine, infection control, and critical care specialists. Guidance was commonly disseminated through email, institutional websites, and incorporated into electronic health record order sets and note templates.<br /><br />Overall, translation of evidence into practice was very rapid when trial data and guidelines were aligned. Dexamethasone was adopted by 94–100% of sites for patients needing 4–6L oxygen within 6–8 months of RECOVERY showing survival benefit. Baricitinib adoption was also high, reflecting the speed at which new evidence was incorporated once guideline updates appeared. However, there were notable gaps: only 80% of institutions recommended against dexamethasone in patients with SpO2 94%, despite evidence suggesting possible harm.<br /><br />The study also found a tendency toward overtreatment. Many sites recommended remdesivir for mechanically ventilated patients and dexamethasone for patients requiring only 1–2L oxygen, even when evidence was weak or negative. At the same time, AMCs showed innovation in areas where evidence was limited, such as awake proning, selective remdesivir use in early disease, and subgroup-based therapeutic anticoagulation.<br /><br />The authors conclude that AMCs can rapidly standardize care during a crisis, but they should also improve avoidance of unnecessary treatment and build systems to evaluate and deimplement practices as evidence changes.

Asset Subtitle

Alan Kubey

Meta Tag

Author List Alan Kubey, Amy Chang Berger, Andrew D. Auerbach, Ethan F. Kuperman, Katie E. Raffel, Kirsten Nieto, Kristen Kipps, Michael Brode, Noa Simchoni

Category Research

Concept COVID-19 Treatment Guideline

Concept Institutional Recommendation

Concept Evidence-to-Practice Translation

Concept Academic Medical Center

Concept Randomized Controlled Trial

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University and Mayo Clinic

Presenting Author Alan Kubey

Track Translating Research into Practice

Keywords

COVID-19

academic medical centers

evidence translation

clinical guidelines

randomized trials

dexamethasone

baricitinib

remdesivir

institutional practice

therapeutic anticoagulation

COVID-19 Treatment Guideline

Institutional Recommendation

Evidence-to-Practice Translation

Academic Medical Center

Randomized Controlled Trial