HealthApril 30, 2021

UpToDate helps Philippines' Asian Hospital and Medical Center reduce ICU mortality, treat COVID-19 patients, and improve patient outcomes

Quality has always been the ultimate measure of healthcare success. For Asian Hospital and Medical Center (AHMC), a premier tertiary hospital accredited by the Joint Commission International (JCI) as one of the most advanced healthcare institutions in the Philippines, success is spelled with a downward trend in ICU mortality, treatment of COVID-19 patients, and improved patient outcomes.

Underlying all these is the hospital's commitment to embracing "innovations in healthcare for an unforgettable healing experience."

Introducing innovation into the health system is directed at enhancing clinical effectiveness, and this is what Dr Ana Maria Y Jimenez, Director of Quality at AHMC, holds on to when they first adopted UpToDate in 2018. UpToDate has since played a crucial role in the hospital's journey toward institutionalizing clinical effectiveness.

Critical to healthcare quality and safety, clinical effectiveness ensures patients' total healthcare experience remains the primary priority. "It means being able to achieve optimum processes and outcomes of care for patients," she explains. "This can be done through the application of best knowledge that is derived from up-to-date evidence. In other words, clinical effectiveness is using evidence to improve the effectiveness of clinical practice and service delivery."

UpToDate is updated daily following a continual comprehensive review of peer-reviewed journals, clinical databases, and other resources, by more than 7,100 world-renowned physician authors and editors. This "breathtaking flood of information," as described by Dr Jimenez, is "very useful" to address the main challenge faced by Asian Hospital in its quest for an enhanced clinical effectiveness program.

The toughest problem was always the availability of quick and reliable references to help inform clinical decisions.
Dr Ana Maria Jimenez, Director for Quality, Asian Hospital and Medical Center, Philippines

"The problem is not only at the point of care but also during morbidity and mortality case reviews, adverse event investigation, appropriateness review of drugs, adoption of clinical practice guidelines, pathways, bundles of care and/or protocols, or during the course of writing or reviewing policies to strengthen controls and help ensure consistent and safe care." This is where UpToDate enters the formula for clinical success and Dr Jimenez cites several instances.

Downward trend in ICU mortality

"Our ICU Intensivists and Fellows are among the top users of UpToDate and our ICU patient outcomes may be attributed to their provision of best practices as evidenced by a downward trend in our ICU mortality ratio." If, for instance, an ICU intensivist needs to review certain topics, be it about an illness, diagnostics, or differential diagnosis, and especially when they encounter these topics for the first time, they turn to UpToDate.

Fast and easy access to reliable information keeps them on top of their game. "As part of our hospital Intensivist Program, whenever the multidisciplinary team does their bedside teaching, rounds, endorsements with trainees (Fellows), they require them to use UpToDate to look for answers."

Treatment of COVID-19 patients

COVID-19 is novel and physicians require regular updates on the infection and its treatment. Good thing for AHMC, they have UpToDate which, according to Dr Jimenez, their multidisciplinary healthcare team relied on during the pandemic. "We believe the resource is updated daily, so it's where we refer to for evidence and information to support our decisions."

The ICU intensivists also use UpToDate to check if there are new guidelines on process measures for ICU as well as the contention with regard to how fast to lower FiO2 in ventilated Covid-19 patients. Our Emergency Physicians likewise refer to UpToDate for Covid-19 treatment updates like for the management of ARDS and for use of high-flow nasal cannulas. Furthermore, we consulted the literature when we created the hospital policy on protected code blue, which resulted in an improvement in our Healthcare Worker safety.

Enhanced patient outcomes

Variability in care is one of the most glaring problems in healthcare. Dr Jimenez observes the same in Philippine hospitals. "At least 80% of patient safety events are related to outdated practices and lack of collaborative care processes," she reveals. Medical departments, nurses, and allied health groups sometimes do not blend seamlessly with regard to clinical decisions, and patients are often the ones who suffer.

"When our healthcare staff have been introduced to UpToDate, and therefore the most current clinical information, care has become harmonized rather than varied." Consequently, AHMC is able to ensure that patients receive the best quality care, following latest evidence and recommendations from world-renowned experts.

Such is a top reason why AHMC decided to include UpToDate in its innovation lineup. "We conducted a health technology assessment and end-user evaluation to support our decision, and we are happy about UpToDate contents, graphical presentations, and its use of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach."

Another important benefit is that content for both UpToDate and Lexicomp, the clinical drug information solution, are harmonized, ensuring that doctors and pharmacists get consistent recommendations across drug dosage, interactions and other critical information. She adds how UpToDate is well-received by their clinicians, appreciating the tool's ease of use, organization, depth, and breadth of systematic reviews, and accessibility in mobile devices.

"Other organizations can definitely benefit from UpToDate. The intensive and regularly updated information in its database could come in handy to improve patient care. Subscribing to UpToDate is the first step. Clinical effectiveness assessment needs structures and processes to scrutinize the results and disseminate the findings in terms of performance and lessons learned, planning for service or practice modification, and remeasurement. Its purpose, therefore, is not only to provide assurance but also to suggest ways in which to improve."

About Asian Hospital and Medical Center

Asian Hospital and Medical Center was founded on a vision to provide the Filipino people topnotch medical service on par with international standards. This idea was translated into reality through the passion and dedication of its people who are burning with fervor to give more of themselves and stay true to its commitment of providing "Innovations in Healthcare for an Unforgettable Healing Experience."