Div of EM Research & ScholarshipConference #1 - Vision
Todd P Chang, MD July 23, 2014
Disclosures / Conflicts of Interest
None…yet
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Objectives
1. Present the new Framework for Research & Scholarship within the Division
2. Develop a Shared Vision and Expectations
3. Highlight ongoing scholarship within the Division
4. Plan Next Steps to enable Transformative Change within Research & Scholarship
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Ground Rules 1
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Ground Rules 2
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Objectives
1. Present the new Framework for Research & Scholarship within the Division
2. Develop a Shared Vision and Expectations
3. Highlight ongoing scholarship within the Division
4. Plan Next Steps to enable Transformative Change within Research & Scholarship
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ReFraming
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The 4 Frames
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Structural
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Human Resource
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Political
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Symbolic
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Objectives
1. Present the new Framework for Research & Scholarship within the Division
2. Develop a Shared Vision and Expectations
3. Highlight ongoing scholarship within the Division
4. Plan Next Steps to enable Transformative Change within Research & Scholarship
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Exercise 1
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What are barriers that hinder your scholarly and research work?
TimeShift
Exercise 2
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How can the Division Research & Scholarship (R&S) Team help remove these barriers?
SupportWrite
Exercise 3
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How can you help further your colleagues in R&S?
‘for them’Support
Shared Vision
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Why this is important
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1. Model the Way
2. Inspire a Shared Vision
3. Challenge the Process
4. Enable Others to Act
5. Strengthen Others
Objectives
1. Present the new Framework for Research & Scholarship within the Division
2. Develop a Shared Vision and Expectations
3. Highlight ongoing scholarship within the Division
4. Plan Next Steps to enable Transformative Change within Research & Scholarship
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Traditional Nurse Triage vs. Physician Telepresence in a Pediatric ED
Marconi GP, Chang TP, Pham PK, Grajower DN, Nager ALePub 2013 Dec 21
Background
Telemedicine is a rising phenomenon within hospitals
Telemedicine feasibility and accuracy has been studied for the adult population
The objective of the study: 1. Compare accuracy between RN & tele-MD 2. Compare time between RN & tele-MD 3. Compare tele-MD triage orders to ED MD orders
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Research Question / Disclosures
Concise Research Question (PICO or PPO) P: CHLA ED patients (Levels 3, 4, or 5) I: Tele-MD triage C: RN triage O: total triage time (not counting vitals), # items
filled out correctly by triage, triage score (per treating MD), parent & pt satisfaction (Likert), # lab orders (strep, urine, XR, blood)
Disclosure None; RP-7i telemedicine robot donated by vPICU
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N = 54
Approach
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N = 132
N = 100
N = 32 declined
N = 46
teleMD
RN teleMD
RN
Direct observation Data Collected
Satisfaction Survey
Data
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RN Tele-MDTime (min) Mean +/- SD 2.8 +/- 0.9 3.0 +/- 0.6
95% CI* 2.6 – 3.0 2.9 – 3.1
Errors (#) Mean +/- SD 0.3 +/- 0.6 0.18 +/- 0.595% CI 0.2 – 0.5 0.1 – 0.3
Triage score Agreement (%) 71 9595% CI* 62 – 80 91 – 99
Questions for Next Steps
ePublished in American Journal of Emergency Medicine Dec 2013
1. Is this study Interesting OR Interesting & Impactful?
2. How do we make it Interesting & Impactful?
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Emergency Department Transfer of Care Sign-Out Analysis
Festekjian A, Nager Aenrolling
Background
Telephone EM transfer-of-care (TOC) is a high-risk environment for medical error
Hypothesis: use of a standardized sign-out guide will improve communication
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Research Question / Disclosures
Concise Research Question (PICO or PPO) P: CHLA or Rotating trainees in the ED performing
TOC sign-outs I-1: Use of TOC guide I-2: Use of FaceTime I-3: Use of TOC guide + FaceTime C: No guide O: Points earned on Checklist, Duration, pt RRT, pt
adverse event (undefined)
Disclosure None
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Approach
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Control ControlTOC Guide FaceTime FaceTime
+TOCControl
ED: Training program___________ Year of training ___________
Res evaluated patient since initial presentation: □Yes □ No
Study ID #
Chief ComplaintPrevious history
Mark “Yes” or “No” for item communication □Yes □ No □Yes □ No
Reason for admission / HPI □Yes □ NoTreatments in ED nebulized treatments (#)/medications consultant recs fluid resuscitation radiographic studies
□Yes □ No N/A □Yes □ No N/A □Yes □ No N/A □Yes □ No N/A
Vital signs At Triage: At Sign out:
□Yes □ No □Yes □ No
Physical Exam Pertinent positives Pertinent negatives
□Yes □ No □Yes □ No
Pertinent laboratory values □Yes □ No N/AImprovement noted in EDIf not, comment on action taken
□Yes □ No N/A
Questions?? □Yes □ No
Duration of sign out (minutes) ED Res :_________ Total:_____________
Time (hours) in ED bed at time of sign out
Hours:_____________
Timeline
Fall 2014 – Control / Validity phase Winter 2014 – 2015 – Continued enrollment &
Intervention phases Presentations – AAP 2015 Manuscripts - 2016
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3 Questions to Improve Study
1. Is having the guide an appropriate intervention?
2. How will we know our sign-out assessment would suffice?
3. How can we determine what teaching methods lead to a good TOC sign-out?
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Attitudes and Barriers to Foley Catheter Placement for Trans-
abdominal Ultrasound in Adolescent Females
Waterhouse MR, Pham PK, Yang M, Chang TPIRB phase
Background
Institutions & practitioners are inconsistent regarding IV fluds, po fluids, or foley catheters for transabdominal pelvic ultrasounds
Little is documented regarding patient / family wishes or preferences, nor practitioner preferences, nor effect on efficiency and ultrasound quality
Objective: Characterize & Explore pt attitudes and barriers to having foley catheter placement
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Research Question / Disclosures
Concise Research Question (PICO or PPO) P: Non-sexually active Adolescent females and
family members P: Salient themes regarding foley catheter
placement and IV fluid administration O: Decision or tendency to decide IV fluids therapy
or foley catheter therapy
Disclosure None
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Approach
1. Focused 1-on-1 Interviews to gather salient themes for thematic analysis using grounded theory
2. Conversion of themes into statements to agree and rank
3. Secondary validation using different population of adolescent females
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Timeline
July 2014 – IRB approved Aug 2014 – Begin 1-on-1 interviews
Expect ~ 10 interviews until thematic saturation Oct 2014 – Planning for Q-Sort statements Winter 2014 – 2015 Q-Sort interviews Presentation – AAP 2015 Manuscript – Summer 2015
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3 Questions to Improve Study
1. “Consensus opinion” on statements, attitudes, beliefs
2. Other populations – ethnic differences? MDs and RNs beliefs?
3. Next steps: prospective comparison study (IV vs Foley), US training for RNs to verify bladder full
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Congratulations to the 2014 AAP SOEM Ken Graff Endowment Award Recipient: Dr. Kelly Ochoa, M.D. for the Study:
LA Phonospirometry technique compared to Pediatric Respiratory Assessment Measure as a novel technique to assess the severity of an asthma exacerbation
Objectives
1. Present the new Framework for Research & Scholarship within the Division
2. Develop a Shared Vision and Expectations
3. Highlight ongoing scholarship within the Division
4. Plan Next Steps to enable Transformative Change within Research & Scholarship
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Transformative Change 1
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1. Plan individual scholarship goals that align with your own personal & professional goals
20152014
20162015
July Dec Jun
Aug 13:Ally with other KC physicians
June 14:Submit IRB
May 15: Meet with Todd
Dec 1:Submit / Amend Phase 2 IRB
Nov 1:Submit PAS Abstract
July 24: Submit IRB
Spring 2016:Grantsmanship
Enrollment
Oct 1:Draft due:
Introduction, Methods
Apr 25-28:Attend PAS (San Diego)
High clinical
New Project Planning
Oct 1:Marconi et al.
manuscript submit
Phase 2 Planning
High clinical
Jan 15: Meet with Todd
Aug 31: Meet with Mentors
Feb 1:Marconi et al. manuscript submit
20152014
20162015
July Dec Jun
Sept 1:Meet with Karen Yaphockhun
Dec 31: Festekjian et al.Validity of ToC Checklist
– manuscript submitJune 30:
Enrolled 100 Constipation subjects
July 10: Meet with Todd
ToC Checklist Validity only
Dec 31: Festekjian et Yaphockhun
Obesity & PICU admits– manuscript submit
Winter 2016: Prepare for ToC Research
March 16:Festekjian et al.
Enemas in Children RCT– manuscript submit
August 1: Find Co-Authors:1. Constipation2. Septic Shock in Cancer pts3. Diastolic Index
June 30: Festekjian et Yaphockhun
Socioeconomic status & PICU admits– manuscript submit
No ToC Research
Summer 2016: Only 2 1st author projects on
Septic Shock & Hand-offs
February 1: 1000 admits for SE Study
June 30: Waterhouse et al.
– manuscript submit
Dec18:Introduction &
Methodology due
20152014
20162015
July Dec Jun
Aug 4:Plan Qualitative Designs
July 5: Meet with Todd; new Year Plan
March 1: Waterhouse et al.– manuscript submit
Apri l25:Submit AAPAbstractJuly 31:
Literature Review write-upSubmit IRB Application
Course 1
Aug1:Objective Data Collection
Apr 25-28:Attend PAS (San Diego)
Course 2
Sep 1:Meet w/ Qualit expert
Focus Groups
Nov 1:Refine Qualit Methods
Feb 1:Begin Thematic Analysis
High clinical Next Study
Planning
March 31:
Complete Thematic Analysis
May 15:Submit IRB Application
High clinical
Transformative Change 2
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2. Improve Collaboration in all Scholarly Projects
CAGE
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Within CHLA
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1 3 2 1
3 3 2 6
1 4
Across the Country & Around the World
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But Collaboration starts here
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Transformative Change 3
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3. Improve Quality & Impact of all Studies
Transformative Change 3
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Transformative Change 3
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2014 – 2016 Goals & Objectives
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1. Cultivate a positive culture of fellow and faculty research and scholarly output
2. Centralize a structural, staffing, and mentorship system within the Division
3. Increase collaboration within the Division and outside of the Division
4. Increase print and presentation output by 10% annually
5. Increase grant fund applications by 20%
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