Implementation of Clinical Practice Guidelines for Hospitalized Patients With COVID-19 in Academic Medical Centers

Abstract

This survey study assesses the rate at which US academic medical centers have adopted evidenced-based guidelines for the management of COVID-19 into practice.

Figure 1.. Map of Hospitals Participating in the Hospital Medicine Reengineering Network

UC indicates University of California; UIHC, University of Iowa Hospitals and Clinics; UNC, University of North Carolina; UNM, University of New Mexico; UPMC, University of Pittsburgh Medical Center; UT, University of Texas; and VCU, Virginia Commonwealth University.

Figure 2.. Comparing Academic Medical Centers’ Institutional Recommendations to National Guidelines and Randomized Clinical Trial (RCT) Data

The percentage of sites recommending use of each clinical intervention for a given patient population, stratified by disease severity, is presented alongside simplified findings from notable RCTs (eAppendix in the Supplement) and guidelines available at the time of the survey from the National Institutes of Health (NIH), Infectious Diseases Society of America (IDSA), and American Society of Hematology (ASH). No published RCTs were available at the time of the survey for anticoagulation or proning. ACTIV-4 indicates Anti-thrombotics for Adults Hospitalized With COVID-19; ACTT, Adaptive COVID-19 Treatment Trial; ATTACC, Antithrombotic Therapy to Ameliorate Complications of COVID-19; HFNC, high-flow nasal cannula; NC, nasal cannula; NIPPV, noninvasive positive-pressure ventilation; PLACID, Convalescent Plasma in the Management of Moderate COVID-19 in Adults in India; PlasmAr, Convalescent Plasma and Placebo for the Treatment of COVID-19 Severe Pneumonia; RECOVERY, Randomized Evaluation of COVID-19 Therapy; REMAP-CAP, A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia; Spo₂, oxygen saturation as measured by pulse oximetry.