Our mission at Firstline is to bring people and knowledge together. With that in mind, we created our Community Content Library, to support knowledge sharing between ID specialists and expedite that flow of knowledge to providers quickly. The Community library includes thousands of vetted guidelines from hundreds of hospitals to use as a resource when developing your own guidelines, so that you can copy and adapt what works from other organizations. We recently spoke with Travis Kremmin (TK), Infectious Disease Clinical Specialist, AdventHealth Kansas City and Dr. Jennifer Macmillan (JM), Chair of Antimicrobial Advisory Committee, Muskoka Algonquin Healthcare, to learn more about their experiences about using the library and how it has changed their practice.
Tell us about your roles in Antimicrobial Stewardship.
TK: At my hospital I serve as the co-lead of the Antimicrobial Stewardship Program and also as an ID pharmacist rounding with the ID team at AdventHealth Kansas City.
JM: I have been the Chair or Co-chair of the Antimicrobial Stewardship Committee at my hospital, Muskoka Algonquin Healthcare (MAHC) since 2016. I was a member of this committee for a few years prior to taking on the Chair duties. I am a general surgeon at my hospital, with no specific training in antimicrobial stewardship, but I do have a passion for learning and for quality improvement.
What are the benefits of using Firstline’s Community Content Library?
TK: There are many great ID minds using the Firstline platform. The new Library lets me ‘pick the brains’ of these ID specialists on a certain topic quickly and easily without actually having to get in touch with them. Having access to their guidelines lets me understand their thought process. It helps me to see the flow of their information and easily adapt to my hospital. All this means I’m not reinventing the wheel.
JM: Using the library gave our team ideas on how to structure guidelines, how to incorporate things like risk stratification scores, and ideas for guidelines that we don’t currently have at my hospital.
What did your process for guideline creation look like before using the Firstline library?
TK: Before the library, we basically gathered all our information we wanted to present, then would go to a white board and try to draw out the best way for our information to flow. One of the hardest parts of starting a guideline from scratch, is to get the right flow of information (or what our ASP feels is the right flow). We debate if it would require too many clicks or not enough, too much information on one page or too little, etc.
JM: We were providing our hospital’s ordersets to Firstline and having their operations team morph them into the guideline format for the app. This wasn’t optimal, as there is a lot in the ordersets that really didn’t need to be in Firstline. Our intent with Firstline use is really primarily for antimicrobial treatment recommendations, and this was being drowned out by the other repetitive orderset content. As well, my hospital doesn’t have ordersets for that many clinical conditions. By reviewing the guidelines of other hospitals in the library, it generated ideas for our team as to what additional content our Antimicrobial Advisory Committee wanted to feature in Firstline.
Dr. Macmillan, you recently launched your hospital ASP guidelines in Firstline. How were you able to use our new Community Library as you were gearing up to launch?
JM: We were fortunate to have access to the library for 1-2 months prior to our launch, so this really helped with the creation of new guidelines.
For each guideline we were preparing to launch at MAHC, I perused the format and content of the relevant guidelines of other hospitals, particularly Canadian hospitals, and those somewhat geographically close to our location. I selected what I liked from each of these guidelines and copied it into ours, adapting the antimicrobial recommendations to those endorsed by our local committee.
How do you think your workflow will change as you use the Community Library?
JM: It’s very helpful to have the Community Library always available so if I feel inspired to start generating a new guideline, perhaps based on a recent clinical encounter where I found myself looking elsewhere for antimicrobial best practices, I’m not starting from scratch. There’s already at least one template out there to start editing and tweaking.
How many guidelines did you copy and how convenient was the process like for you?
JM: I don’t think we copied any guideline directly, but I certainly consulted the guidelines of other hospitals and adopted components of these for much of the content we used. The process was pretty convenient. It was easy to copy the entire guideline and have it ready for me to peruse/copy/edit as I went about building our guidelines. It helped to have 2 screens to work from (dual monitors) so I could be reviewing another hospital’s guideline on one screen, and creating/adding to our MAHC guideline on the other.
"Using Firstline’s library improves patient care even locally for me, as time is a limited resource and the less time I spend on these guidelines means more time I get with direct patient care activities." - Travis Kremmin
How has the process changed since you started using the Community Content Library?
TK: Viewing other hospital guidelines to see their flow of information saves us a lot of time. Additionally, looking at the Library we can see if we missed sections of content or have too much content.
JM: We now have Firstline guidelines for additional clinical conditions beyond those for which our hospital has ordersets. For example, we have created an Invasive Group A Streptococcal Infection guideline, a Staphylococcus aureus bacteremia guideline, and a Surgical Prophylaxis in Cesarean Delivery guideline, all borne out of ideas from other hospitals.
Did you encounter any surprises while using the Community Library?
TK: No surprises that I can think of ….the process has worked smoothly from the get go and now I will not start creating any guideline, pathogen, or drug in the platform before first checking the library.
JM: I was surprised to see the breadth of content in the library.
Dr. Kremmin, it’s interesting that one of the guidelines you adapted originated at Multicare in Washington. Also, when AdventHealth Orlando recently implemented Firstline, they copied and adapted all of your antimicrobials. How does it feel to exchange this kind information with your peers?
TK: I think it’s awesome! The less time we all spend doing the same thing, creating content, the more time we can all dedicate to patient care and outcomes.
Dr. Macmillan, which institutions did you adapt from, what changes did you make and why?
JM: We mainly searched for content from hospitals within my province of Ontario. I found the content from Oak Valley Health (formerly Markham Stouffville Hospital), Joseph Brant Hospital, Sault Area Hospitals, and Saskatchewan Health Authority very useful. I also read some of the Firstline blogs to learn about the work of BC Women’s Hospital in promoting penicillin allergy assessment through Firstline, and am developing our guideline with their content and formatting in mind.
"As the Chair of the Antimicrobial Advisory Committee at my small hospital, where we do not have any Infectious Disease specialists or pharmacists with specialized training in antimicrobial stewardship, I have found the it extremely useful to have access to this warehouse of robust, current, and synthesized content." - Jennifer Macmillan
What insights and tips can you share with others in the ID community who haven’t yet tried this feature?
TK: I would encourage anyone to try the content library first, prior to creating any guidance from scratch. Even if you want to make your own new content, I’d still use the Library to look at the flow of information and adapt that flow to your content. It makes the whole process much easier.
JM: The Content Library is a great resource, particularly when your hospital is preparing to launch on Firstline and wants so you can create robust and broad-based content right from the get-go. It enables you to compare how similar content (i.e. community acquired pneumonia) can be organized in different ways within the app, so your committee can select the format that appeals to your group, but modify as you see fit. I found it best to work with two screens open. On one I had the guideline(s) I was perusing/copying from other hospitals. On the other, I had the guideline I was building for my hospital.
In the past, how often did you typically create new guidelines?
TK: After the first go around we tried to create or update a guideline quarterly as time allowed. Being able to use the community library feature will allow us to add guidelines more freely and frequently with ease of use.
What impact will this have for you on how you develop guidelines going forward?
JM: After I look in the Library to see what content other hospitals have included in a particular guideline that I’m planning to build, then I’ll decide if we want to include a broader or narrower scope (i.e. include recommendations for outpatient management, or only focus on inpatient). Likewise, I will compare different formats as to how to present the content, sometimes sending screenshots to other committee members or colleagues to see whether there’s a preference in terms of intuitiveness or practicality. Then we start the development of our own guideline, ensuring that it aligns with content from our ordersets.
"Firstline has really helped us promote best practices in antimicrobial prescribing across both hospital sites, and expand the content to be relevant to clinicians working in the outpatient setting as well."
- Jennifer Macmillan
How will using the Community Library ultimately improve patient care?
TK: The library improves patient care as it connects ASP minds on guidelines across regions and throughout the world. It lets us share information easily. Additionally it improves patient care even locally for me, as time is a limited resource and the less time I spend on these guidelines means more time I get with direct patient care activities.
JM: We have found that once we create a robust guideline, it actually prompts us to reassess our hospital’s orderset for that clinical condition. This has led to improvements in the quality of our ordersets. It makes so much sense for those of us who are trying to promote best practices around antimicrobial prescribing to share what we have worked on, and build on the work of others, so long as we can attribute this work appropriately.
As the Chair of the Antimicrobial Advisory Committee at my small hospital, where we do not have any Infectious Disease specialists or pharmacists with specialized training in antimicrobial stewardship, I have found it extremely useful to have access to this warehouse of robust, current, and synthesized content. Being able to launch our MAHC profile in Firstline with at least 8 well developed guidelines has hopefully generated trust and confidence in the quality of the recommendations coming from our Antimicrobial Advisory Committee. Sometimes the hardest part of creating a new guideline is picking a place to start. With templates from other hospitals easily accessible to our committee, adding new relevant content to the MAHC profile in Firstline can be accomplished quite quickly and efficiently. Firstline has really helped us promote best practices in antimicrobial prescribing across both hospital sites, and expand the content to be relevant to clinicians working in the outpatient setting as well.
Learn more about the results others have seen with Firstline.
Join Dr. Kremmin and Dr. Macmillan and contribute to the ID discussion on Firstline Community.