Sharing real-world insights on COVID-19 in intensive care

UCLPartners delivered a programme of work on intensive care, working in partnership with the Intensive Care Society, National Emergency and Critical Care Network, North Thames ARC, the Rapid Research, Evaluation and Appraisal Lab based at UCL, Health Innovation Network and the AHSN Network.

The programme included:

1. Rapid syntheses of emerging frontline learning in intensive care units (ICUs) to support the Excel Nightingale Hospital and inform best practice locally, regionally and nationally
2. Gathering and disseminating learning from national and international knowledge sharing webinars organised by the Intensive Care Society
3. Creating a COVID-19 intensive care multi-disciplinary learning collaborative

Background and context

Clinicians needed to learn through experience how to most effectively manage respiratory failure and other complications associated with this novel disease. This clinical learning, as well as learning around operational aspects of delivering care in a pandemic, needed to be rapidly gathered and shared, both in our region and nationally.

To meet this need we drew together clinical, academic and quality improvement expertise and resources across our partnership and beyond to create a programme of work to rapidly gather, synthesise and share emerging insights on COVID-19 management.

Our approach

1. Rapid syntheses of emerging frontline learning in ICU to support the Excel Nightingale Hospital and beyond

We gathered and analysed external learning on COVID-19 in intensive care to feed into the real time health learning system at the Excel Nightingale Hospital. The aim was to use this data to improve clinical practice in as close to real time as is possible by presenting bite-sized clinically relevant feeds to the Nightingale clinical and management teams at their daily handover meetings.

Working with a team of the quantitative and qualitative researchers and clinical academics in our partner higher education institutions, we synthesised the latest insights emerging from frontline practice and published and grey literature, sharing these weekly.

Beyond Nightingale, there was also a need to share actionable information and insights with UCLPartners trusts and nationally across the NHS, as well as supporting international knowledge assimilation, in a way that complemented rather than replicated other efforts.

2. Disseminating learning from Intensive Care Society knowledge sharing sessions

We worked with the Intensive Care Society to capture and disseminate learning from regular facilitated virtual knowledge sharing sessions between UK and international clinicians with considerable experience of ICU management of COVID-19 infected patients.

3. COVID-19 intensive care collaborative

We established a virtual shared learning platform to facilitate multi-disciplinary, multi-specialty discussions across intensive care teams in London and to disseminate learning from work underway inter/nationally.

The virtual collaborative, hosted on FutureNHS with a corresponding WhatsApp group, provided:  

• rapidly synthesised insights from inter/national interviews with frontline staff and reviews of grey/ published literature
• a mechanism to engage with peers across London to share their experiences and learning, highlight challenges and seek advice
• clinical moderation to facilitate discussion and synthesise the learning that emerges in the online discussions, which will feed into research studies and national guideline development

Our aim was that through the support and insight provided on the forum, teams would be able to rapidly share actionable insights to help improve care and outcomes for their patients.

Sharing learning

Our learning about clinical academic leadership in a pandemic was pulished in BMJ Leader. Read the report here.

Resources

• COVID-19 Wave 1: Reflections and learnings from practice across a sample of UK intensive care units (22 October 2020)
• COVID-19: Highlights of Emerging Evidence and Resources for ICUs (26 April – 6 May)
• COVID 19: Highlights of Emerging Evidence and Resources for ICUs, 22- 30 April 2020
• COVID-19: Highlights of Emerging Evidence for ICUs
• COVID-19: Emerging Evidence 24 April
• COVID-19: A synthesis of clinical experience in UK intensive care settings
• COVID-19: Shared experiences in international intensive care settings
• COVID-19, thromboprophylaxis and anticoagulation of ICU patients: share clincial experience
• Responding to COVID-19 and beyond: A framework for assessing early rehabilitation needs following treatment in intensive care