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ED, researchers learn to co-exist
System enables parties to focus on their tasks
In most EDs, the last thing a provider wants is an extra, non-clinical individual "getting in the way."
"I remember an ED physician picking me up and carrying me across the room and saying, 'Let me take care of my patient!'" recalls Christopher Lindsell, PhD, director of research in University Hospital's Department of Emergency Medicine in Cincinnati.
However, that action is highly unlikely to happen in this ED, even though there's at least one researcher in the department 24/7. The reason is that a detailed system has been worked out to allow the ED to continue functioning with minimal interruptions, while allowing the researchers the access to patients that they require.
Arthur Pancioli, MD, executive vice chairman of emergency medicine and professor of emergency medicine at the University of Cincinnati School of Medicine, said, "It grew out of the concept of a rich and yet incompletely explored domain for research, but clinical demands of the team down there that did not really allow much flexibility [for them to delve] into the research domain. We had to have an extra team to do the screenings and the enrollments. We have a team of 20 clinical study assistants who tend to be students looking at a future in health care as a doctor or RN, or in the life sciences." Lindsell notes that each shift lasts about four hours.
How do they keep out of each others' way? Pancioli says, "They come into the picture after triage. Primary medical care, resuscitation, and screening come first. They are never allowed to impede the medical mission."
These individuals are hired by the ED, he says. "A nurse coordinator trains them, and they are very well instructed in how to work in the system without being intrusive," Pancioli explains.
Lindsell says, "One of the first things you have to do is teach them how the patient comes in and leaves the hospital. They don't understand the system. They are taught about patient flow and enough anatomy and physiology so they understand what the providers are talking about, things like knowing that heart failure can involve leg swelling."
The students go through 100 hours of instruction, including shadowing others and then working with a preceptor looking over their shoulders, he says. They don't go out alone until they pass their final tests, Lindsell emphasizes.
A tiered process
The actual process for getting patients enrolled in a research project flows through several levels, Pancioli explains.
"If they find a patient who meets their basic inclusion criteria, they do a second level screening that often involves the clinical research nurse/coordinator who is running that trial," he says. "Then if it looks like it's a go, they check with the medical care team to make sure it will really work."
Lindsell says, "They want to make sure the patient sufficiently understands what's going on around them to consent to enrollment in research."
This tiered system enables the researchers to cast a broad net "and gives us access to a tremendous number of patients and gives those patients the opportunity to benefit from research," says Pancioli. For example, he explains, they might become enrolled in a therapeutic trial that gives them access to medications they otherwise would not have been able to receive.
"If this were not done properly, it could be a problem, but it was built by us and is owned by us, and that makes it all right," Pancioli concludes.
For more information about integrating research and ED care, contact:
Christopher Lindsell, PhD, Director of Research, Department of Emergency Medicine, University Hospital, Cincinnati, OH. Phone: (513) 646-2222. E-mail: email@example.com.
Arthur Pancioli, MD, Executive Vice Chairman of Emergency Medicine, University Hospital. Phone: (513) 558-8103.
Let ED know the benefits of research
One of the ways to make it easier for researchers and ED staff to learn to "live together" is to educate the clinical staff about the benefits of research, says Christopher Lindsell, PhD, director of research in the University Hospital's Department of Emergency Medicine, Cincinnati, OH.
"There are always objections," says Lindsell, noting that most clinicians do not see research as part of their job and believe they are there solely to save patients' lives. "The way to get around that is to explain that research is what gives them the medicines they need to practice in the right way and to learn how to be even better at saving lives," he says.
In addition, the ED at the University Hospital already has reaped several concrete benefits from the research done in the department, he says:
"The amount of documentation and information on the patient [that the ED receives] far exceeds what they had previously been receiving," Lindsell says.
'Time is brain' in ED research
The need to treat stroke patients as quickly as possible is no less critical in research programs than it is in a more traditional care environment, says Arthur Pancioli, MD, executive vice chairman of emergency medicine at University Hospital in Cincinnati, OH, and professor of emergency medicine at the University of Cincinnati School of Medicine.
"I work to facilitate therapeutic trials of neurological emergencies," Pancioli explains. "Once you've determined a patient has had an acute ischemic stroke, you start tPA as soon as possible." Once that has been done, he says, the researchers can offer additional drugs, devices like angiography, or work inside the brain using endovascular techniques. "But if they don't show up on time, there's no chance for benefit," he emphasizes.