Hyperlinked Dynamic Standard Operating Procedures for Ensuring Team Safety during the COVID-19 Pandemic.

Abstract

The COVID-19 pandemic was a rapidly evolving situation that demanded frequent revisions to standard operating procedures1 and published guidelines. This high frequency of revisions was a peculiar aspect of the pandemic. We work in a high-volume plastic surgery department at an apex medical institute in India, and with the onset of the pandemic, sweeping changes to the hospital and departmental functions ensued. Considering the need for implementing stringent and uniform infection control protocols to ensure patient and personnel safety,2 we embarked to design standard operating procedures for the activities of our department that were adherent to the superseding institutional guidelines while being specifically tailored to the unique aspects and functions of our clinical specialty. Case-specific standard operating procedures were also necessary to ensure that our management teams were well informed and could minimize procedural delays, especially in time-critical cases of reimplantation and revascularization.3 Intended for doctors, physiotherapists, and nursing staff, we distributed the initial version as a read-only PDF file through e-mail and the WhatsApp Messaging platform (Facebook Inc., Mountain View, Calif.). When preparing the first revision to our standard operating procedures, we recognized several potential problems with this distribution method. For these standard operating procedures to be effective, the new essential information, especially revisions to previously published guidelines, had to be rapidly disseminated to those concerned. Because multiple revisions were expected over a short time span and we did not have the ability to prevent access to obsolete versions, there would be a fragmentation of versions and poor penetration of updated documents over time. This would cause confusion and could lead to accidentally following the outdated guidelines (Fig. 1, left).Fig. 1.: Diagrammatic representation of the fundamental differences between static standard operating procedures and hyperlinked dynamic standard operating procedures. (Left) Static standard operating procedures distributed individually. (Right) Hyperlinked dynamic standard operating procedures distributed using cloud services. SOPs, standard operating procedures.To address this flaw, we decided to host the standard operating procedure document (Fig. 1, right) on Google Drive (Google, Inc., Mountain View, Calif.) (dynamic standard operating procedure), one of many free online cloud storage and synchronization services. This gave us the ability to store our document online as a single file that can be accessed through a unique URL link. Any changes to the standard operating procedure were stored as new versions of the same file and could be accessed through the same URL. Thus, whenever the link is accessed, it will always serve the most recent version. Hyperlinks4 (Web links) were used to provide access to relevant institutional documents and external sources, allowing users an easy access to all relevant information at a single location, rather than having to search for them externally. The file could also be shared with others individually, whereby access is provided only after authentication through their Google account. This can prevent unauthorized individuals from accessing the document and provide feedback regarding which recipients have accessed and are thus up to date. We encouraged all members to always use the link to access the document and to not store an offline copy. We highlighted the changes in each version and maintained an amendment log at the end of the document. Added benefits included the ability for recipients to leave feedback in the form of comments and to be notified of updates. There are many other free and paid services with similar capabilities.5 DISCLOSURE None of the authors has financial conflicts of interest to disclose.