In this article we discuss Firstline, a platform that helps ID teams empower their providers to make better clinical decisions.
A Discussion with Firstline Co-Founder Michael Campsall by Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
Article Posted: 2 October 2021
Firstline (formerly Spectrum) integrates local guideline documents into a user-friendly interface for mobile and desktop use. Both users of their product and the people who work at Firstline are excited about it – but why? To explore the topic more, I recently connected with Michael Campsall (MC), one of the founders of Firstline. We discussed what they have happening today, and what they are looking forward to in the future.
This article summarizes a discussion we had centering around five questions that were posed to Mr. Campsall about how Firstline is making a difference.
1. What problem is Firstline working to help solve?
MC: Our service helps hospitals improve prescribing appropriateness. Firstline is a decision support tool that gives providers easy access to their hospitals guidance at the point of care.
TG: Having a readily accessible institutional antibiogram can translate to greater awareness for ever-changing local antibiotic resistance patterns. Having access to institutional infectious diseases guidelines can mean enhanced use of locally developed treatment pathways to support optimal patient care.
MC: Accessibility is key, which is why our service, including antibiogram data, can be used on a mobile device — even offline — or on desktop.
2. What value does Firstline add and how can it be quantified?
MC: The most important value is our service has been proven to increase appropriateness of prescribing in both the adult and pediatric settings, reducing DoTs/DDDs, and C. diff infection rates.
One of the organizations we work with published a study on the impact of using Firstline. You can see how their guidelines are set up in Firstline here. In monetary terms, they saw a reduction in antimicrobial usage that led to a reduced cost of $403 per bed per year and huge benefits from reduced C. diff infection rates (with associated cost savings estimated at $82,078 per year). In clinical terms, their prescribing appropriateness increased by ~20%. And this is an organization that already had an established stewardship program in place.
By providing a helpful tool at the point of care, clinicians can be guided to the most current evidence-based information that includes local considerations, balancing risks, effectiveness, and costs.
TG: When it comes to measuring impact, there are numerous potential ways to do this for a platform like Firstline. Given that antimicrobial stewardship programs have significant inter-institutional variability in scope and resources, it is preferable to be able to use existing tools to perform impact assessments. Two of the more likely areas to investigate if exploring the impact of Firstline would be in drug consumption (e.g., Days of Therapy per 1000 patient days) or in adherence to institutional infectious diseases guidelines.
A nice thing about Firstline is that the build and direction a stewardship program takes is at the discretion of the local leaders. This means the platform can be locally developed to target high-priority items, which can secondarily streamline impact quantification assessments to align with ongoing initiatives.
3. What obstacles can Firstline help antimicrobial stewardship programs navigate when resources are limited?
MC: Often Antimicrobial Stewardship programs are viewed by organizations as an expense without recognizing the potential for antimicrobial stewardship programs to save hospitals a lot of money. We know from published studies that Firstline can save over $550 per bed per year which is more than 20 times the cost of the platform itself. We work with stewardship teams to develop a business case justifying the investment in Firstline and the projected return on investment.
TG: Firstline provides an easy way to communicate and can pay for itself. For resource-limited stewardship programs, it is exciting that a platform like this is available where it can be high-impact but not high-cost. Antimicrobial stewardship is relevant to nearly all corners of the healthcare landscape, however a single full time equivalent (FTE) or partial FTE that an institution may appoint as an antimicrobial stewardship champion is not going to be able to routinely connect with all front-line staff members. Firstline can provide the critical value of extending the reach of the people at the helm of the program, putting a user-friendly tool in the hands of front-line staff so they can easily identify first-line antimicrobial choices.
4. What does Firstline offer that can take an antimicrobial stewardship program to the next level?
MC: For hospitals with a full set of guidelines, Firstline increases the use of those guidelines, yielding far better results for the antimicrobial stewardship program (ASP) team. For hospitals without a full set of guidelines (or any at all), we have a community library of thousands of guidelines that can be copied and adapted to suit any location. The library, and its content is continually being updated and improved. It takes minutes for ASPs to expand their guidelines and monographs. Our service complements both audit and feedback and surveillance software by helping providers make the right decision the first time, so fewer interventions are needed down the line. Firstline is loved by ASP teams and providers. The experience is more like high five stewardship, than handshake stewardship.
TG: Back in 2015 the Firstline (then Spectrum) team started their journey and today they continue to learn, grow, and evolve. The current mission of Firstline is to help solve humanity’s greatest health challenges by bringing people and knowledge together. To that end, it is not a surprise to find community as a key element in their trajectory. As a stewardship champion, you can leverage the Firstline Community to engage your institutional community in antimicrobial stewardship.
Many (if not all) antimicrobial stewardship leaders struggle with the impossible workload of the task at hand – to ensure rational antimicrobial drug use everywhere, all the time. Bringing community-focused tools like Firstline into the picture is a logical next step to help bridge the gap between what we can do versus what we want to do. That can certainly help take a stewardship program to the next level and it is a good reason to get excited about bringing Firstline onboard.
5. How can Firstline help with antibiotic guideline development and implementation?
MC: Though we have a fully featured platform to manage guidelines, we also have a dedicated clinical content design team. They are experts at optimizing local resources for use at the point of care. This allows providers to get just what they need, right when they need it, usually in 90 seconds or less.
Our team can help build something that is easy to use and modify, which grows organically. The success of this approach is often a type of advertising for a stewardship program.
TG: When regulators visit and inquire about how stewardship initiatives are integrated into the workflows of the organization, this type of awareness can support staff being able to speak to the importance of antimicrobial stewardship and what they are doing to be good stewards (i.e., using institutional guidelines for making good clinical decisions!). In considering some of the 2021 proposed revisions to the Joint Commission Antimicrobial Stewardship standard MM.09.01.01, Firstline may be a tool that can help with various areas of accreditor regulation on the horizon.
6. What does the future hold for Firstline?
MC: We are focused on accelerating knowledge flow in health systems around the world to clinicians. With support from the Canadian federal government, we just launched a beta version of Firstline Community, a free platform to share guidelines, learn from each other and spread trusted knowledge. We believe this will become an end-to-end solution – from clinical research, all the way to the point of care.
TG: The future is wide open for Firstline as they work on harnessing the power of a network to enhance accessibility to resources and empower antimicrobial stewardship programs to level-up. Firstline is already used at a pharmacy school and with healthcare providers as a teaching tool and is getting ready to launch with veterinary guidelines as part of a One Health initiative. Who knows what will happen next? One thing is for sure right now, Firstline has some health care professionals excited about how they can use the platform today!
ABOUT THE INTERVIEWEE
Michael Campsall is the co-founder of Firstline Clinical, the #1 rated mobile and web app for Infectious Diseases.
With a background in education and visual design, Michael is responsible for the creative direction of the company and has been instrumental in designing and evolving the platform to solve for the needs of infectious disease professionals.
You can follow Firstline on Twitter @FirstlineOrg
Learn more about Firstline by visiting the home page here.
Editor’s Note: I would like to express my utmost gratitude to Michael for taking the time to share his insights and provide information about this topic for which his passion is truly infectious! We need to advance our capacity to do antimicrobial stewardship globally and as a passionate antimicrobial steward I love that Firstline may enable people to achieve this goal.
Disclaimer: The views and opinions expressed in this article are that of the contributors and do not necessarily reflect those of any past, current, or potential future employer. TG has worked with Firstline in a financial capacity.
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