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First, I'm not a cat. Second, this is my first 
. Brace yourself it's like an ID consult note...
COVID-19 Diagnostic Clinical Decision Support: a Pre-Post Implementation Study of CORAL (COvid Risk cALculator) https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab111/6132091#.YCQUY3IDUWY.twitter
. Brace yourself it's like an ID consult note...COVID-19 Diagnostic Clinical Decision Support: a Pre-Post Implementation Study of CORAL (COvid Risk cALculator) https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab111/6132091#.YCQUY3IDUWY.twitter
1/12 Spring 2020 #COVID19 surge in Boston. MGH Infection Control & @mgh_id were faced with a challenge- need for round the 
evaluation of #COVID19 persons under investigation #PUIs. ~100 PUIs, the #infectioncontrol and #biothreats pagers were OFF THE HOOK 
evaluation of #COVID19 persons under investigation #PUIs. ~100 PUIs, the #infectioncontrol and #biothreats pagers were OFF THE HOOK
2/12 Anyone in the same 
? Test recs changing, new assays coming on-line, conservation of #PPE a priority, preserving bed capacity essential; post a workup algorithm today, and it was old news the following morning.
? Test recs changing, new assays coming on-line, conservation of #PPE a priority, preserving bed capacity essential; post a workup algorithm today, and it was old news the following morning.
3/12 #identifyisolateinform is critical for safety but so is d/c isolation when appropriate. Solution: take >5000 hours of ID and IC expertise and build #CORAL (COvid Risk cALculator), bake it into frontline clinician workflow in the #EHR. Make it an easy, data-driven work up.
4/12 what does #CORAL do? Open a note, and input
- pt epidemiology
- pt symptoms
- results of #COVID19 diagnostics
- radiology
- alternative diagnoses
#CORAL scores behind the scenes
score, work-up done, isolation is d/c'd
score, rec next step in work up, keep isolation
- pt epidemiology
- pt symptoms
- results of #COVID19 diagnostics
- radiology
- alternative diagnoses
#CORAL scores behind the scenes
score, work-up done, isolation is d/c'd score, rec next step in work up, keep isolation
5/12 and did I mention it is writing the note for you? #CORAL also uses structured radiology assessments with work led by @MGHImaging @RSNA; #NEMO is the pedi #CORAL (thx Dr. Vandana Madhavan from @mghfc!)
6/12 So what was the impact of #CORAL? 
repeat #COVID19
testing
time from test return to d/c isolation (~7 hours/patient)
total time in isolation (~19 hrs/patient)
ID MD time (~57 hours/day)
repeat #COVID19testing
time from test return to d/c isolation (~7 hours/patient) total time in isolation (~19 hrs/patient) ID MD time (~57 hours/day)
7/12
Bonus #1 teaching! Standardizing a work up has also made a #CORAL a teaching tool.
Bonus #2: Flexibility! As guidelines, epi, testing, change...so can #CORAL. This happens behind the scenes as our #CORAL team incorporates new knowledge
Bonus #1 teaching! Standardizing a work up has also made a #CORAL a teaching tool.
Bonus #2: Flexibility! As guidelines, epi, testing, change...so can #CORAL. This happens behind the scenes as our #CORAL team incorporates new knowledge
8/12
Bonus #3: it is generalizable. #CORAL is now live @newtonwellesley @northshoremed @MassEyeAndEar @cooleydickinson @wdhospital @ACKHospital @MV_Hospital @SpauldingRehab. We launched Ambulatory #CORAL this fall - in use at 100s of practices @MassGenBrigham
Bonus #3: it is generalizable. #CORAL is now live @newtonwellesley @northshoremed @MassEyeAndEar @cooleydickinson @wdhospital @ACKHospital @MV_Hospital @SpauldingRehab. We launched Ambulatory #CORAL this fall - in use at 100s of practices @MassGenBrigham
9/12 This was and continues to be a #teameffort bring together IC, ID, & informatics experts & getting lots of feedback from @MassGeneralNews community including @MGHMedicine @MGHHMU @MassGeneralEM @mghmedres . Thx to all the frontline clinicians who have used it >30,000 times!!!
10/12 the #teamwork is reflected in the author list. Co-first @CaitlinDugdale & @dmrubins; Dr. Hang Lee; Dr. Suzanne McCluskey; Dr. Ed Ryan; @KottonNelson; Dr. Rocio Hurtado; @aciaranello; Dr. Miriam Barshak; @DustinMcEvoy; @SandyNelsonMD
11/12 @BasgozNesli; @JacobLazarusMD 
; @drlouiseivers; Dr. Jennifer Reedy; @HysellMd; Dr. Jacob Lemieux; @HowardHeller; @ascetrix; Dr. John Albin; Dr. Tyler Brown; @zahadum5; Dr. Stephen Calderwood; @RWalensky; Dr. Kimon Zachary; Dr. David Hooper; and @EmilyHyle
; @drlouiseivers; Dr. Jennifer Reedy; @HysellMd; Dr. Jacob Lemieux; @HowardHeller; @ascetrix; Dr. John Albin; Dr. Tyler Brown; @zahadum5; Dr. Stephen Calderwood; @RWalensky; Dr. Kimon Zachary; Dr. David Hooper; and @EmilyHyle
12/12 a HUGE thank you to all who contributed. If you want to #CORAL at your 
, the supplement is packed with details. While the scoring system has evolved (that's the point), we provide the details to get you started.
Done- phew!
, the supplement is packed with details. While the scoring system has evolved (that's the point), we provide the details to get you started.Done- phew!
