Now that we’ve seen how powerful a sector-wide collaboration of this type can be, it’s an increasingly attractive option to take this approach and apply it to other clinical areas of importance

THE National COVID-19 Clinical Evidence Taskforce was formed in March 2020 to provide consistent, up-to-date, evidence-based guidance for Australian clinicians caring for people with COVID-19.

The Taskforce consists of 34 organisations representing all the health professionals involved in care for patients with COVID-19. We have seven panels of clinical and consumer experts covering the full range of illness including primary and chronic care, paediatrics, pregnancy, care of older people, and acute and critical care. Our panels include more than 200 leading clinical experts from a wide range of disciplines and across states and settings, providing nationally unified guidance and decision support tools.

The guidelines and associated decision support tools are widely used and have become the de facto standard of care across Australia, regularly cited by the Commonwealth Department of Health, and jurisdictions, and with more than a million page views and 500 000 users.

The significant volume of publications on COVID-19 over the past 2 years has meant daily global searches for new research evidence, and often weekly updates of the guidelines. It has been a challenging, and world-leading, undertaking. In this piece we reflect on what we have learned so far.

What we’ve learned

Two and a half years ago, as a health community, we didn’t know anything about COVID-19 – how it spread, or how transmission could be prevented, no vaccines and no treatments. Things have come a long way.

Living guidelines are feasible and valuable

As a Taskforce, we’ve learned that it is possible to rapidly and rigorously find, evaluate and synthesise evidence to guide clinical decision making (here and here). In the 2.5 years since the Taskforce was established, the guidelines have grown to include over 180 recommendations, covering the full spectrum of care for COVID-19, and have been updated more than 100 times.

While living guideline methods were trialled pre-pandemic (the Australian living stroke guidelines are a notable, world-first example), COVID-19 provided a stress test of these nascent approaches, and took frequent updating to a whole new level of frequency.

Our experience also shows that living guidelines are used and are hugely helpful. While there was early talk about clinicians being potentially uncomfortable with guidelines being updated so frequently, it’s clear now that clinicians really value guidelines that they know will be up-to-date, available whenever they need them, and with accompanying decision aid tools.

A broad coalition of organisations is effective and possible

There’s no question that one of the major strengths of this work has been the broad coalition of health professional groups that have come together to form the Taskforce. The 100% consensus approach across these groups has meant that clinicians, regardless of their discipline or specialty, all get the same evidence-based advice. The reduction in duplication and increased consistency in guidance have been valuable. Speaking with one voice has also really bolstered the strength of that voice, as has been noted by some correspondents with some chagrin – “when you guys are all saying the same thing, it’s pretty hard to argue”. Our members also value the opportunity to learn collaboratively together and from each other, across disciplines and professions.

Our clinical and consumer contributors are fantastic

The work of the Taskforce has been made possible by the unpaid contributions of hundreds of clinicians, often at weekly panel meetings. We estimate that we’ve benefited from more than 25 000 hours of their time, on top of their clinical and academic workloads during a time of great need. Producing the guidelines simply would not have been possible without their immense depth and breadth of real-world clinical expertise and extraordinary generosity.

And as the pandemic has endured, one of the happy outcomes has been the collegial support – both clinically and socially – across the panels and our leadership groups. The opportunity to question, compare and contrast clinical practice between states and settings during such a period of uncertainty has benefited not only the guidelines but also our individual clinical experts.

We’ve also been amazed by the contributions of consumers, many of whom have had COVID-19 themselves, or cared for loved ones with COVID-19. The generous, authentic contributions of the Taskforce Consumer Panel have been vital, rich and deeply appreciated.

Where to next?

With new variants and new treatments continuing to emerge, the work of the National COVID-19 Clinical Evidence Taskforce to continually update the guidelines is still needed for the foreseeable future. We are hopeful that research will soon be available to evaluate treatments for long COVID, and also to compare the effectiveness of current treatments with each other, providing vital evidence to guide decisions about which of the current treatments is most likely to be effective for patients.

Now that it’s been shown to be possible to have up-to-date, evidence-based clinical guidelines in COVID-19, it’s perhaps becoming less palatable that guidelines in other areas of clinical uncertainty may be updated only every 3–5 years. Similarly, now that we’ve seen how powerful a sector-wide collaboration of this type can be, it’s an increasingly attractive option to take this approach and apply it to other clinical areas of importance to the sector.

Associate Professor Steve McGloughlin is Executive Director of the National COVID-19 Clinical Evidence Taskforce and Director of the intensive care unit at Alfred Health.

Professor Caroline Homer AO is a leading midwifery researcher and is Co-Program Director of Maternal, Child and Adolescent Health at the Burnet Institute.

Associate Professor Julian Elliott is an infectious diseases physician at the Alfred Hospital and is Lead for Evidence at Cochrane, and Senior Research Fellow at Cochrane Australia, Monash University.

Associate Professor Tari Turner is Director of the National COVID-19 Clinical Evidence Taskforce, and Associate Professor (Research) at Cochrane Australia, Monash University.

 

 

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.

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