A New Approach to Developing Clinical Guidelines During a Crisis

Like many U.S. hospitals, Brigham and Women’s Hospital was engulfed in what would quickly become the global COVID-19 pandemic in late February 2020. The scale and speed of the pandemic were unprecedented for clinicians, with constantly evolving knowledge, data and resources that complicated patient care.

As COVID-19 patients began flooding the ICU in early March 2020, Brigham leadership knew its physicians and care teams couldn’t wait the months it typically takes for new hospital guidelines to be developed. They needed immediate access to the best data and evidence available at that moment.

To address this need, the hospital established a team of physicians from 15 disciplines to develop a COVID-19 clinical resource that would be accessible, searchable and adaptable. It also needed to be available to clinicians outside of the hospital. Their efforts resulted in, the world’s first and most comprehensive searchable website for step-by-step COVID-19 clinical guidelines.

A Physician-Scientist Perspective

Many of the Brigham experts contributing to had experience leading clinical trials of COVID-19 therapies that have shaped current treatment practices. One team member, Edy Yong Kim, MD, PhD, associate physician in the Division of Pulmonary Care and Critical Care Medicine, was in charge of the interdisciplinary team working on the COVID-19 protocols and now serves as managing editor and content director for

As a physician-scientist running an immunology lab, Dr. Kim brings a unique perspective to the task. “In the research lab, I am accustomed to evaluating imperfect data and making judgment calls instead of basing decisions on guidance developed over years or even decades of international consensus,” he said. “That perspective served me well as I pivoted from my research duties to clinical care and guideline development duties during the height of the pandemic.”

Dr. Kim found himself working with colleagues in infectious disease, cardiology, hematology, gastroenterology and OBGYN along with allied fields such as pharmacy, nursing and physical therapy to create within a few short weeks what typically takes months to develop. The protocols quickly grew to cover all aspects of COVID-19 care, from diagnostic tests to critical care. Each section of the protocols pairs a literature review with detailed protocols.

In December 2020, partnered with the University of California, San Francisco’s (UCSF’s) Institute for Global Health Sciences and Partners in Health (PIH) to create v2.0. This updated resource includes content relevant to all practice settings and presents information in an easy-to-use way for learning and practice.

“While I certainly appreciate the role of basic science, I very much enjoy working on projects like this one, which has a clear path to tangible patient benefits,” Dr. Kim said. “It has also been rewarding to collaborate with colleagues in other departments and allied health fields on this project. Everyone involved has been a true team player.”

Modern Guidelines for a Modern Pandemic

Dr. Kim praised the contributions of founder and initial editor-in-chief C. Lee Cohen, MD, MBA, who drove the development of the guideline infrastructure (published in Cell Rep Med) during her pulmonary fellowship at the Brigham. The infrastructure uses a collaborative writing application (CWA) to facilitate an expedited review process and a web platform that deploys content directly from the CWA to minimize any delays. All content is mobile-friendly, making it easy to access it directly at the patient’s bedside.

“Most hospital guidelines are stored as a PDF document on a shared drive and printed out when needed,” Dr. Kim said. “It was clear this approach wouldn’t work in a fast-paced COVID-19 ward, where every second counts as care teams try to keep up with rapidly evolving data.”

By the end of 2021, the open-access guidelines had grown from its initial 40 pages to more than 800 pages. It has been accessed more than 2 million times by users across more than 150 countries. To ensure the guidelines reflect the latest knowledge, a multidisciplinary committee meets every other week to incorporate new information from clinical experience, user feedback and newly published literature.

According to Dr. Kim, multiple local and national governments, hospitals and clinics have used the site as a key resource for their own clinical guideline development. Many engaged users, he said, are clinicians at smaller institutions, particularly those who do not have the capacity to have their own COVID-19 task forces.

“In creating this living, mobile-friendly resource for broad public use, the Brigham is leading by example,” he said. “We’re now brainstorming how to apply the lessons we learned in developing to other areas of clinical care.”

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