American University of Beirut Medical Center (AUBMC) began 145 years ago in a small, rented building in Beirut. Over the years, milestones include the founding of the School of Nursing, the first of its kind in the Middle East, and the addition of a state-of-the-art medical centre with five Centres of Excellence, an elaborate outpatient facility, an emergency department, research laboratories, classrooms, and offices for academic staff.
Frontline caregivers across the world were challenged by the unprecedented demands of COVID-19. On top of those stresses, clinicians at AUBMC faced additional catastrophic events – a devastating explosion and a severe economic downturn — while still managing the unrelenting tide of the pandemic.
When it came to the COVID-19 pandemic, the major issue was needing to be updated about the latest evidence or the latest news.
“Even attending physicians and the biggest experts in such diseases needed to update data on a daily basis, because it is a dynamic field and things were changing quickly with no clear-cut answers,” explains Dr Firas Kreidieh, a Clinical Fellow in Hematology and Oncology, Department of Internal Medicine at AUBMC. The ‘UpToDate’ evidence-based clinical decision support solution from Wolters Kluwer played a large role in providing the latest evidence and answers to their questions.
With UpToDate, his team was able to practice evidence-based medicine efficiently and deliver the best patient care under normal and crisis situations. Care teams at AUBMC rose to the challenge, effectively caring for a massive influx of patients during the pandemic, local disaster, and an economic crisis.
Evidence impacting education
Dr Kreidieh’s history with UpToDate dates back to his third year in medical school when he began clinical experience.
“At that time, my major use of UpToDate was for disease background and medication information,” he recalls. “It’s on the wards when you start getting these clinical questions and when you really appreciate the importance of UpToDate to find the answers.”
Dr Kreidieh has served as Medical Chief Resident at the Internal Medicine Department at AUBMC, which started using UpToDate at the medical centre in 2007.
“UpToDate helps our residents and interns by synthesizing the evidence and providing them with what they need to know about a certain topic, enhancing clinical and research skills and increasing efficiency that’s reflected back positively in quality patient care,” he explains.
Speed to answers in a crisis
Dr Kreidieh, along with Dr Ali Taher, AUBMC Vice Dean and a Professor of Medicine at the Division of Hematology & Oncology – who also serves as Vice-Chair for Research at the Department of Internal Medicine and the Director of the Naef K. Basile Cancer Institute – couldn’t have anticipated how the AUBMC team would be tested in the year 2020.
UpToDate proved a worthy partner during the COVID-19 pandemic, Dr Kreidieh says. “Given that it is continually updated and available in one reference, UpToDate is and was extremely helpful,” he explains. “For example, a resident or intern who was on night duty and had lots of critical patients on the COVID unit to take care of, they could access UpToDate to get a fast, current, concise answer to a question. I strongly believe that UpToDate has enhanced our efficiency on the wards. Efficiency is an asset to promoting quality patient care, particularly in situations where time saves lives.”
Dr Taher adds: “UpToDate has revolutionized our workflow on the wards and enhanced our ability to further promote patient quality care, particularly during the COVID pandemic.”
While in the midst of the pandemic, the AUBMC team suddenly experienced a massive influx of trauma patients when the Beirut port exploded on August 4, 2020, injuring more than 6,000 people.
“I was in the infusion unit and felt the ground move, so I thought it was an earthquake,” Dr Kreidieh recalls. “Then there was a second very loud sound and so much smoke that I thought something happened within the AUBMC campus.”
The medical centre activated Code D, the disaster code, which Dr Kreidieh explains is seldom activated at the hospital unless a major catastrophe occurs. “A message is sent to all house staff that we really need help, and everybody, even those at home came into the hospital,” Dr Kreidieh says.
Dr Kreidieh was impressed and inspired to see his hospital pull together. “It was really an inspirational scene seeing all the medical teams, including surgery, oncology, internal medicine — all departments were really one hand. And I will never forget that night.”
Direct access to evidence at critical moments
UpToDate can be integrated with a health system’s electronic medical record (EMR) for direct access to clinical decision support without interrupting workflow. AUBMC has UpToDate links conveniently in its Epic EMR system, Dr Kreidieh explains, “so you can simply click on the link for UpToDate and access any data you would like right from the EMR.”
“The major use of UpToDate on the night of the explosion was searching drugs, antibiotics, and botulinum toxin,” says Dr Kreidieh. “The injuries were major, particularly in terms of blast injuries, so there were several antimicrobials that we needed to start patients on.”
Patients who were injured by flying glass from the explosion often required a botulinum injection. But, Dr Kreidieh explains, if the patient had already received a prior injection and/or had an infection, there are specific guidelines to be followed.
“UpToDate directly provides the guidelines, the table, and the algorithm for that. Not having to search the literature for those answers really saved time and helped us increase our efficiency when dealing with lots of patients and a shortage of house staff,” Dr Kreidieh says.
Dr Taher says: “UpToDate provides concise summary of topics relevant to us in medicine and can guide us to look at the references. It saves a lot of time. AUBMC has recently provided access to UpToDate even when outside the AUB campus.”
UpToDate has revolutionized our workflow on the wards and enhanced our ability to further promote patient quality care, particularly during the COVID pandemic.
Dr Kreidieh adds: “Thanks to UpToDate, our efficiency on the wards has increased markedly. When you actually have no time to search for answers to a certain question is when UpToDate really proves its value.”
Dr Taher concludes: “UpToDate has revolutionized our workflow on the wards and enhanced our ability to further promote patient quality care, particularly during the
COVID pandemic and the blast crisis.”
