Since the beginning of the current pandemic, COVID-19 has infiltrated all aspects of biomedicine. As the associations between mortality risk and chronic illness became evident, the field of hematology has played a front-line role in combating this global public health emergency, with a particular focus on patients with hematologic malignancies, immunodeficiencies, and sickle cell disease (SCD). Hematologists have been key in elucidating the pathophysiology of the microthromboses that occur with infection of the SARS-CoV-2 virus while determining the most effective anticoagulation regimens, in unraveling the mechanisms of the Multisystem Inflammatory Syndrome in Children, and in characterizing the development of neutralizing antibodies. 1–4 Accordingly, improving COVID-19 diagnostic testing – performance, capacity, availability, accessibility – has become a major collective goal of the biomedical community with hematologists heavily involved at the forefront of these efforts.
To achieve this goal, on April 24, 2020, Congress appropriated $1.5 billion for the National Institutes of Health (NIH) to support SARS-CoV-2 development and expansion of testing. Within days, the NIH launched the Rapid Acceleration of Diagnostics (RADx) Tech initiative to develop innovative technologies and speed them to market, with the goals of 1) deploying millions of COVID-19 tests per week by December 2020 and 2) enabling Americans to return safely to school and work.5 The ambitious agenda of RADx Tech, as the name indicates, includes clinical evaluation, manufacturing scale up, and widespread deployment of tests to detect the presence of SARS-CoV-2 virus.
Acute myeloid leukaemia (AML) is a medical emergency often presenting with hyperleucocytosis, coagulopathy and pulmonary infiltration necessitating emergent initiation of therapy. AML with concomitant severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection presents a unique challenge given the lack of evidence‐based guidelines or historical experience. While cohort studies have shown early serological responses to SARS‐CoV‐2 in healthy adults, 1 , 2 little is known about the serological responses to infection in patients with AML and the impact of chemotherapy on this response. In the present study, we detail the clinical presentations, treatments, serological and virological responses, and outcomes of two adolescents who presented with AML and concurrent coronavirus disease 2019 (COVID‐19).
Background: Clinical practice guidelines (CPGs) and associated order sets can help standardize patient care and lead to higher-value patient care. However, difficult access and poor usability of these order sets can result in lower use rates and reduce the CPGs’ impact on clinical outcomes. At our institution, we identified multiple CPGs for general pediatrics admissions where the appropriate order set was used in <50% of eligible encounters, leading to decreased adoption of CPG recommendations. Objective: We aimed to determine how integrating disease-specific order groups into a common general admission order set influences adoption of CPG-specific order bundles for patients meeting CPG inclusion criteria admitted to the general pediatrics service. Methods: We integrated order bundles for asthma, heavy menstrual bleeding, musculoskeletal infection, migraine, and pneumonia into a common general pediatrics order set. We compared pre- and postimplementation order bundle use rates for eligible encounters at both an intervention and nonintervention site for integrated CPGs. We also assessed order bundle adoption for nonintegrated CPGs, including bronchiolitis, acute gastroenteritis, and croup. In a post hoc analysis of encounters without order bundle use, we compared the pre- and postintervention frequency of diagnostic uncertainty at the time of admission. Results: CPG order bundle use rates for incorporated CPGs increased by +9.8% (from 629/856, 73.5% to 405/486, 83.3%) at the intervention site and by +5.1% (896/1351, 66.3% to 509/713, 71.4%) at the nonintervention site. Order bundle adoption for nonintegrated CPGs decreased from 84% (536/638) to 68.5% (148/216), driven primarily by decreases in bronchiolitis order bundle adoption in the setting of the COVID-19 pandemic. Diagnostic uncertainty was more common in admissions without CPG order bundle use after implementation (28/227, 12.3% vs 19/81, 23.4%). Conclusions: The integration of CPG-specific order bundles into a general admission order set improved overall CPG adoption. However, integrating only some CPGs may reduce adoption of order bundles for excluded CPGs. Diagnostic uncertainty at the time of admission is likely an underrecognized barrier to guideline adherence that is not addressed by an integrated admission order set.
Objectives of this study were to (1) describe barriers to using clinical practice guideline (CPG) admission order sets in a pediatric hospital and (2) determine if integrating CPG order bundles into a general admission order set increases adoption of CPG-recommended orders compared to standalone CPG order sets. We identified CPG-eligible encounters and surveyed admitting physicians to understand reasons for not using the associated CPG order set. We then integrated CPG order bundles into a general admission order set and evaluated effectiveness through summative usability testing in a simulated environment. The most common reasons for the nonuse of CPG order sets were lack of awareness or forgetting about the CPG order set. In usability testing, CPG order bundle use increased from 27.8% to 66.6% while antibiotic ordering errors decreased from 62.9% to 18.5% with the new design. Integrating CPG-related order bundles into a general admission order set improves CPG order set use in simulation by addressing the most common barriers to CPG adoption.