Research Presentation CHLA 2014.07.23

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





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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





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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





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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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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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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





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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


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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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3. Improve Quality & Impact of all Studies


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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%

Research Presentation CHLA 2014.07.23

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