HHS ASPR COVID-19 ECHO Clinical Rounds: Navigating a New Disease as a Community
In the midst of a new disease pandemic, how do frontline clinicians provide best-practice care when the science is still emerging?
U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response (HHS ASPR) COVID-19 ECHO Clinical Rounds addresses that challenge every week, with 500 to 1,000 physicians, nurses, emergency medical service (EMS) providers and other health professionals from across the country and around the world who connect via videoconference to learn about a range of clinical issues surrounding care of patients with COVID-19.
Launched in March, COVID-19 Clinical Rounds is an extraordinary collaboration of the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services (HHS), the ECHO Institute at the University of New Mexico and 25 professional societies, academic medical organizations and government agencies. The idea was to create a peer-to-peer learning platform for frontline clinicians to discuss their challenges and successes dealing with COVID-19, navigating the unknowns of the disease together.
“This is about following what’s happening in the moment and helping clinicians deal with what’s in front of them right now — whether it’s COVID-19 and ventilators or COVID-19 and kids or COVID-19 and hurricanes or protests,” said Richard Hunt, M.D., senior medical advisor of ASPR’s National Health Care Preparedness Program and program director of COVID-19 Clinical Rounds.
What comes out of the sessions is not intended as official policy recommendations or guidance. Instead, the COVID-19 Clinical Rounds provides a platform for clinicians to hear from peers who have been on the frontlines of the coronavirus pandemic and to share their experiences, perspectives, opinions and resources.
A Different Kind of Platform for Sharing Knowledge Peer to Peer
“In a hospital or academic setting, there’s a range of ways to share clinical knowledge — for example, at the patient’s bedside, talking with a resident or nurse about what works and what doesn’t,” Hunt said. “Or you can attend grand rounds and hear a presentation that was prepared six months ago.”
COVID-19 Clinical Rounds is something in between. It supports three regular weekly programs: one on critical care, including lifesaving treatment and clinical operations; another on emergency department patient care and clinical operations; and a third on EMS patient care and operations. Each learning session features brief presentations by guest clinicians and reactions by experts from relevant professional organizations.
Session moderators also use online polling to dig into participants’ opinions and experiences. Results of polling are shared with HHS’ Coronavirus Healthcare Resilience Task Force and in real time with participants. All COVID-19 Clinical Rounds are archived by Project ECHO, providing easy accessibility for clinicians who are unable to participate in real time.
But the Q&A space and chat box are where the real action is. That’s where participants share their questions, comments and experiences — and it’s where most of the discussion time is spent.
The first critical care session logged over 1,500 questions collected at registration. “That really spoke to the need for clinicians to think through this disease together,” Hunt said. “Suddenly, there’s this disease developing that we’re all trying to understand. Meanwhile, clinicians have to make decisions when there is no science.”
‘Clearing Out the Noise’ versus the ‘Real Deal’
As of early September, the sessions have included more than 45,000 cumulative participants across all 50 states and more than 30 countries. “People continue to show up,” Hunt said. “I think they see this as a way of clearing out the noise. They’re convinced that what they’re hearing here is the real deal, and that’s why they keep coming back.”
The secret, he believes, is the quality of the presenters. Hunt said he recruits them by following the virus. For example, early on in the program in late March, when he was searching for critical care presenters, he zeroed in on New York City, the epicenter of the outbreak in the United States at the time. “Wherever the hotspots are, that’s where I look for presenters.”
Experience is Hunt’s top criterion. He wants clinicians from the front lines of the pandemic, regardless of their speaking experience. It turns out, he said, that they are “extraordinary speakers, because they want to share their experiences.”
Interacting with Real-World Practice
There’s no question that the COVID-19 Clinical Rounds are informing real-world practice — and being informed by it as well. For example, critically ill patients with most serious respiratory infections require aggressive intubation and mechanical ventilation. Early on, it was assumed the same held true for critically ill COVID-19 patients. However, one of the first Clinical Rounds critical care presentations revealed that patients could be managed with non-invasive ventilatory support. In another session, a presenter discussed how proning patients could improve oxygenation — long before publication of this practice.
Importantly, experiences with COVID-19 evolve — and so does the knowledge. That’s why Hunt often invites presenters to return with updates about their experiences. For example, an emergency department director described in early April how the department embedded mental health support for doctors, nurses and other staff. Four weeks later, the presenter returned to report that the strategy had failed; now they were trying a “buddy system” for support. And if that didn’t work, they would try something else.
“The idea is to keep adapting until you get it right,” Hunt said. “That applies to many aspects of this disease.”
It’s also important to keep in mind that experiences are not the same as evidence, and that experiences with COVID-19 are diverse and vary according to where a clinician is located and other factors. But the Clinical Rounds participants have reported great value in learning from one another’s experiences. Some have said that they have even made specific changes in practice in response to what they’ve heard during the ECHO sessions.
“This is an iterative process of learning and adapting,” Hunt said. “What we’re doing has the potential both to advance and support medical care during this pandemic — and ones to come.”
