3. What key advice did hospital medicine leaders want to share related to clinical practice standardization during the COVID-19 pandemic?

Best Practices

• • Standardize, standardize, standardize: Over and over again, respondents emphasized the importance of defining standardized protocols to guide care. Such protocols not only ensure consistent adherence to best practices but also boost efficiency and increase alignment across interdisciplinary teams and transitions of care.
  • Centralized, clear, concise, and consistent communication: Hand-in-hand with lesson 1, respondents stressed that clinical guidance must be clearly communicated and “as easy to access and follow as possible.”
  • Tapping the experts: In addition to maintaining an up-to-date “single source of truth” as mentioned above, many respondents cited multidisciplinary clinical care huddles, e.g., with ID and Critical Care/Pulmonology, as a useful mechanism to ensure consistency in care. Along similar lines, several sites mentioned that having a core group of COVID-19-experienced hospitalists also improved the acceptance and dissemination of standardized practices.

Pitfalls to Avoid

• • Non-evidence-based care: Many respondents warned against the routine use of interventions that are not supported by clinical outcomes, with several noting potential harm to patients from non-evidence-based use of anticoagulation, antibiotics, dexamethasone, convalescent plasma, and even frequent lab draws.
  • “Be careful of the curse of knowledge”: More communication is not necessarily better and can actually create confusion, especially when it is not clear, concise, and practical for the busy clinician (e.g., provide specific clinical scenarios for teaching rather than referencing the supplemental ACTT data).