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100 Living COVID Guidelines Updates: Where To Now

Now that we have seen how powerful this type of industry-wide collaboration can be, it is an increasingly attractive option to take this approach and apply it to other important clinical areas

The National COVID-19 Clinical Evidence Taskforce was formed in March 2020 to provide Australian clinicians caring for people with COVID-19 with consistent, up-to-date and evidence-based guidance.

The taskforce consists of 34 organizations representing all healthcare professionals involved in the care of patients with COVID-19. We have seven panels of clinical and consumer experts covering the full spectrum of diseases, including primary and chronic care, pediatrics, pregnancy, care for the elderly, and acute and critical care. Our panels include more than 200 leading clinical experts from a variety of disciplines and from every state and setting, providing nationally consistent guidance and decision support.

The guidelines and associated decision support tools are widely used and have become standard de facto Standard of care across Australia, regularly cited by the Commonwealth Department of Health and jurisdictions, and with over a million page views and 500,000 users.

The significant volume of publications on COVID-19 over the past two years has meant daily global searches for new research and often weekly updates to the guidelines. It was a challenging and world-leading endeavor. In this piece we reflect on what we have learned so far.

What we learned

Two and a half years ago, as a health community, we knew nothing about COVID-19 – how it spreads or how to prevent transmission, no vaccines and no treatments. Things have come a long way.

Life guidelines are doable and valuable

As a taskforce, we have learned that it is possible to quickly and rigorously find, assess, and summarize evidence to guide clinical decision-making (here and here). In the 2.5 years since the taskforce was established, the guidelines have grown to over 180 recommendations covering the full spectrum of COVID-19 care and have been updated more than 100 times.

While live guideline methods were being tried before the pandemic (the Australian guidelines for living stroke are a notable, world-first example), COVID-19 provided a stress test for these nascent approaches, taking frequent updating to a whole new level of frequency.

Our experience also shows that living guidelines are used and are very helpful. While there was initial discussion of how clinicians might feel uncomfortable with guidelines being updated so frequently, it is now clear that clinicians really value guidelines that they know are up-to-date, available whenever they need them need, and are equipped with accompanying decision-making aids.

A broad coalition of organizations is effective and possible

There is no question that one of the greatest strengths of this work has been the broad coalition of healthcare professionals that came together to form the Taskforce. The 100 percent consensus approach between these groups has resulted in clinicians, regardless of their discipline or specialization, all receiving the same evidence-based advice. The reduction in duplication and the greater consistency of the guidelines have been valuable. Speaking with one voice has also really boosted the strength of that voice, as some correspondents have noted with some chagrin – “when you’re all saying the same thing, it’s pretty hard to argue”. Our members also appreciate the opportunity to learn cooperatively with and from one another in an interdisciplinary and cross-professional manner.

Our clinical and consumer staff are fantastic

The taskforce’s work was made possible by the unpaid contributions of hundreds of clinicians, often at weekly panel meetings. We estimate that we have benefited from more than 25,000 hours of her time in addition to her clinical and academic workload at a time of great need. The creation of the guidelines simply would not have been possible without her immense depth and breadth of practical clinical expertise and exceptional generosity.

And as the pandemic continues, one of the happy outcomes has been the peer support – both clinical and social – across the boards and our leadership groups. Being able to question, compare and contrast clinical practice in such a time of uncertainty has benefited not only the guidelines but also our individual clinical experts.

We were also amazed at the contributions from consumers, many of whom have had COVID-19 themselves or cared for loved ones with COVID-19. The generous, authentic input from the Taskforce consumer panel is important, rich and greatly appreciated.

Where next?

With new variants and new treatments constantly emerging, the work of the National COVID-19 Clinical Evidence Taskforce to continually update the guidance is needed for the foreseeable future. We hope that research will soon be available to evaluate treatments for long COVID and also to compare the effectiveness of current treatments to provide important evidence for decisions about which of the current treatments are most likely to be effective for patients.

Now that it has been shown that it is possible to have up-to-date, evidence-based clinical guidelines for COVID-19, it may become less palatable that guidelines in other areas of clinical uncertainty may only be updated every 3-5 years. Now that we have seen how powerful industry-wide collaboration of this type can be, it is an increasingly attractive option to take this approach and apply it to other clinical areas important to the sector.

Associate Professor Steve McGloughlin is Executive Director of the National COVID-19 Clinical Evidence Taskforce and Director of Intensive Care at Alfred Health.

Professor Caroline Homer AO is a Leading Midwifery Researcher and Co-Program Director for Maternal, Child and Adolescent Health at the Burnet Institute.

Associate Professor Julian Elliott is an Infectious Diseases Physician at Alfred Hospital and Lead for Evidence at Cochrane and a Senior Research Fellow at Cochrane Australia, Monash University.

Associate Professor Tari Turner is Director of the National COVID-19 Clinical Evidence Taskforce and Associate Professor (Research) at Cochrane Australia, Monash University.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policies of the AMA, the MJA or InSight+ unless otherwise stated.

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