Supporting decisions on the Covid-19 frontline

As we slowly emerge from the Covid-19 crisis, Dr Amad Khan, neurosurgical registrar at University Hospital Southampton NHS Foundation Trust, shares what he believes doctors have learned about using technology-based support tools on the coronavirus frontline.

As doctors, we’re used to dealing with complex and unpredictable cases. It’s our daily reality. It’s what we’re trained for. But the Covid-19 pandemic has ramped this up, presenting us with extraordinarily challenging situations we’ve never faced before.

For many clinicians, it has meant working outside of our usual specialities. Hospitals adopted an ‘all hands-on-deck’ crisis footing as a way to manage and treat the unprecedented number of patients coming through their doors. This meant that surgeons like myself, anaesthetists and other unrelated specialists suddenly found themselves in an unfamiliar setting, treating an unknown disease.

There was little time available to arm ourselves with the knowledge we needed to tackle this pandemic. And for that matter, there was not very much authoritative information to be found.

Need for accurate information

In this kind of high-pressure, information-starved, emergency scenario, knowledge and accurate information became a scarce and valuable commodity – much like PPE.

To this end, I was grateful our trust had previously invested in Clinical Decision Support (CDS) technology.

In our case, we use UpToDate from Wolters Kluwer. Coincidentally, I was an advocate for the Trust to introduce this type of technology, having used it as a medical student at other hospitals. Based on my personal experience, I was very aware how useful this technology can be as a complementary tool. Being able to access the latest peer-reviewed evidence-based research and treatment recommendations on a smartphone or tablet at the point of care is a game-changer, especially when dealing with a virus like Covid-19 where best-practice recommendations are changing all the time.

The feedback from colleagues working on the Covid frontline is that CDS played an important and effective role in treating patients. As well as helping to manage patients’ symptoms, CDS also helps to reduce unnecessary testing – literally taking the guesswork out of the process. It’s sometimes tempting when faced with the unknown to request multiple tests to make sure we cover all eventualities to reach the right diagnosis. CDS can help to reduce the trial and error approach to testing. One of the ways technology does this is by suggesting tests you may not initially have considered, which can set you on the path to the right answer a lot more quickly.

Noticing the abnormal

In the context of the pandemic, we also hear it helped in understanding pathophysiology (abnormal changes in body functions caused by the disease processes), and provided important guidance on how to ventilate Covid patients, which is more complicated than with other diseases. Our teams also found it reassuring that the information they were using was peer-reviewed and evidence-based. It’s good to know you’re not taking decisions in isolation, and that the information is underpinned by a vast and sound base of expertise. The app’s Covid-19 topics have been viewed more than eight million times since the start of the crisis. This proves that other doctors in the same situation in thousands of hospitals across the world are receiving the same guidance. In a crisis, this can provide some peace of mind at time when you may be second-guessing yourself.

Need for evidence based resources

From our experience over the past few months, looking after Covid-19 patients has greatly increased our need for evidence-based resources to provide quick access to accurate information. This is especially true as information is evolving fast, with new and experimental drugs being trialled globally.

As all doctors will recognise and acknowledge, this is incredibly useful when you think about the barrage of new information and evidence we’re constantly exposed to and need to process. In a high-pressure setting like the one we’ve just been through, it’s impossible to stay ahead of the mountain of new information. To give you an idea of the volume, I hear, for example, there were 50 published studies on Covid-19 by the end of January, and 7,000 by end of April. These numbers will no doubt have another multiple by now.

Now that we’re in the recovery phase, it’s a good opportunity to reflect on the many different ways we’re tackling this crisis. What went right and what we could have done better. From my own point of view, I’m confident that knowledge technology played a valuable role, and that this important resource should be considered a key support tool if we need to prepare for a second wave.