During the COVID-19 pandemic, ID professionals were inundated with new research and frequently changing recommendations. The medical field published over 100,000 articles about COVID-19 in 2020.1 Providers were overwhelmed both in the clinic and by the amount of research to wade through to find the latest and best evidence for COVID-19 management.
Fraser Health Authority, a network of hospitals in British Columbia, Canada, was the first organization on Firstline to create a COVID-19 guideline for their providers, just as the virus began to sweep across Canada. The Firstline Clinical Content team saw the immediate utility to Fraser Health’s providers and, with permission, offered to copy the guideline to other organizations on the Firstline platform. Within days, health organizations across Canada were distributing effective clinical guidance originating from Fraser Health, but adapted to each local context.
Dr. Justin Kosar, Stewardship Lead in Saskatchewan Health Authority reflecting on those days says, “Pre-screened material is the most underrated feature of Firstline by far.” ID professionals trust their peers because they know the information is validated, vetted, and synthesized.
"Pre-screened material is the most underrated feature of Firstline by far." - Dr. Justin Kosar
This was the genesis of the idea for the Firstline Community, a global network for professionals covering infectious diseases to share knowledge, reduce redundancy, and minimize misinformation. The two main pillars of the Firstline Community are the content library of guidelines and a discussion platform for knowledge exchange.
Content Library: Broadening the Exchange of Evidence-Based Guidance
Inspired by the success of sharing COVID guidance across different organizations, our team created a collaborative support for the Community to lean on – the Firstline Content Library, which enables ID experts to freely and easily access all the guidance available on Firstline. The Library contains over 3,000 peer-reviewed guidelines created by expert infectious disease specialists all over the world. Stewards can search and browse any topic and then select their favourite to copy to their own collection. They can make any necessary changes and add local recommendations to fit their needs.
Dr. Travis Kremmin, Infectious Disease Pharmacist from AdventHealth Kansas City says, “There are many great ID minds using the Firstline platform. The library lets me ‘pick the brains’ of these ID specialists on a certain topic quickly and easily”. He stresses the benefit: “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. The less time we all spend doing the same thing, creating content, the more time we can all dedicate to patient care and outcomes.”
As another example, Dr. Kelechi Eguzo, president of the Marjorie Bash Foundation, was working at Saskatchewan Health Authority when he first discovered Firstline. He wanted to bring the app to his home in Abia State, Nigeria to support local stewardship efforts. Using the library, Dr. Eguzo was able to copy guidance from other low to middle income countries, and Saskatchewan, the original location that inspired his project. Now, several guidelines from Dr. Eguzo’s versions are being copied into other projects in developing nations via the Firstline Library.
We have also seen organizations who joined Firstline with very few of their own guidelines use the Library to generate a whole repertoire of guidance. Dr. Jennifer Macmillan, Chair of Antimicrobial Advisory Committee at Muskoka Algonquin Healthcare shares, “Using the Firstline 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.”
Discussion Platform: Tackling Challenging Cases as a Community of Experts
The Firstline Library is a collaborative foundation that is enormously valuable to guidance creators as is. But when paired with the ability to discuss that guidance with peers, the benefit becomes so much greater.
Our team at Firstline realized that we work with incredible ID experts from all over the world every day, but outside of their own organizations, few are in regular contact with each other. We wanted to connect these minds and facilitate a network that expands the reach of an individual to a larger community. The Firstline Community’s discussion board is a purpose-built platform to do just that.
Via the Firstline Community, ID experts have come together to answer tough clinical questions that may not be readily available through research, such as dosing and treatment for special populations, or when to use novel treatment options for management of different infectious syndromes. The community also discusses common stewardship problems like asymptomatic bacteriuria and reducing unnecessary lab requisitions.
"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. Travis Kremmin
The best part of online communities is its ability to cross continents and oceans with ease. In Cape Coast, Ghana, many antimicrobial stewardship programs are in their infancy. A stewardship committee member was working on their antimicrobial utilization metrics for the first time. He shared his calculations with the Community and multiple members based in Canada came forward to help verify his work and give further suggestions on benchmarks and other quality improvement targets.
At the time of writing, the Firstline Community has over 750 members from all over the world and continues to grow and welcome new members every day.
Clinical Knowledge is Collaborative
The ID experts in the Firstline Community have made it clear that it is in sharing and collaboration that we will find our way forward. Firstline is committed to providing the tools and space to make it easy. Accurate, actionable knowledge is the best defense against infectious diseases - a dose of vaccine can be used by only one person, but all of humanity can benefit from the right knowledge. As Thomas Jefferson said, knowledge is like a candle that loses nothing when it lights another candle.
- Insights on using Firstline’s Community Content Library
- Application of Firstline in Abia State, Nigeria
- Join the Firstline Community
1) Else, H. How a torrent of COVID science changed research publishing. nature.com 2020, and Garba S, Ahmed A, Mai A, Makama G, Odigie V. Proliferations of Scientific Medical Journals: A Burden or A Blessing Oman Med J. 2010 Oct;25(4):311-4. doi: 10.5001/omj.2010.89. PMID: 22043365; PMCID: PMC3191655. ↩