DESIGN & IMPLEMENTATION OF AN ED-BASED ACUTE CARE RESEARCH PROGRAM AT TGH/USF (active draft – need your feedback & comments ASAP)

The TGH/USF ED Based Acute Care Research team  increased our efficiency since initiating a novel operational model in Q2 2015 to enroll patients and conduct research that is synergistic to overall TGH goals while also integrating scholarly opportunities across learner types (residents, medical students, ARNP students, and premedical students) and across disciplines.

OUR TOTAL NUMBER OF SCREENS CONTINUES TO INCREASE WHILE OUR COST PER SCREEN HAS DRASTICALLY DECREASED

DISCLAIMER:I am working out my thoughts for an ACEP SA 2018 paper on how we designed and implemented an acute care research program based in the emergency department

 10 KEY ELEMENTS TO THE SUCCESS OF THE TGH/USF ACUTE CARE RESEARCH PROGRAM

  1. vision that a research program can operate like any other service line with an emphasis on high quality care delivery when the patient comes to us (2am on a weekend), not when we might desire a patient to present (9-5 on weekdays)
  2. a mission for acute care research to operate like any other acute care service line with the ability to provide a drug, a device or a procedure 24/7 with appropriate staffing, infrastructure and buy in place
  3. utilization of cross covering shift workers based on an emergency medicine model of care delivery (paid research assistants, research nurses)
  4. maximization of electronic medical record potential for ROI through optimization of clinical alert processes to screen the entire patient population for inclusion/exclusion criteria and to alert both clinically active providers that a potential research patient may be present during an acute encounter
  5. lean based approach that considers the PI as customer with an emphasis on our ability to make a PIs study achieve success as well as a streamlined flow for providers and staff to contact the research team (RESEARCH HOTLINE: 813.394.3025) and a faster turnaround time from study idea to initiation via a slimmed down feasibility process after IRB
  6. leverage of revenue (PI fees) to create a budget for formal premedical course work, paid course assistant positions, and small seed funding for investigator initiated studies
  7. formal funding of social science PhD students to expand scope of research questions while providing educational and research opportunities to additional learners
  8. clear negotiation with research sponsors that our work flow includes paid research assistant 24/7 and RN coverage 24/7 and those activities must be funded in study budget as we will not compromise our quality and track record of success
  9. development of research throughput and quality metrics that allow internal team members to meet expectations and for external stakeholders to realize our value
  10. continued efforts to deliver transparent pricing and cost understanding to our PIs and sponsors
the number of screens per month continue to increase but, more recently, the total screening hours have stopped increasing; again demonstrating an increasing program efficiency
THE cost is no longer increasing to the program while the cost per screen has gone down and the number of screens each month has increased
screens per monthApril 2015-February 2018. screens lead to enrollments
SPH has increased leading to more patient enrollments

 

this has decreased concomitantly with screens per hour increasing
Research Assistants are usually in a gap tear between undergrad and med school, grad students, or FMGs. They are paid hourly from sponsored research funds and make about $14.50/hour

 

ok – so what made us more efficient? i will talk about that on the next post but in the meantime, please add comments below – especially if you are or were a member of the team!

 

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Author: Jason Wilson, MD

Jason W. Wilson, MD, MA, FACEP is an emergency medicine physician at Tampa General Hospital. He serves as a core faculty member and Associate Professor in the Division of Emergency Medicine, Department of Internal Medicine at the Morsani College of Medicine at the University of South Florida. He also holds an affiliated faculty appointment with the Department of Anthropology at the University of South Florida. Dr. Wilson serves as the Medical Director for the Clinical Decision Unit at Tampa General Hospital as well as the Associate Medical Director for the Adult ED. In addition, Dr. Wilson is the research director for the emergency medicine residency program.

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