There is a tidal wave of change in the healthcare landscape generated from external forces. Cuts in federal research funding threaten to slow the pace of progress, affecting how we conduct our research and translate the latest developments into improved surgical patient care.
This summer, the MUSC Department of Surgery embarked on developing a research roadmap that will adapt to our changing environment by developing a culture of innovation and continuous improvement with a strong return on investment (ROI) strategy.
The department continuously improves the art and practice of surgery and the roadmap positions the surgeon-scientists and researchers to build on the strengths of the existing research structure.
As part of the roadmap, the team leaders plan to create and develop:
• an engineering theme to our surgery research effort
• a workable and transparent research management structure that benefits all stakeholders
• compelling, motivational stories for each research effort• technologies that change patient outcomes
As the team maintains their curiosity needed to drive continuous improvement, their goal is to develop technologies to bring to the clinic and change patient outcomes. More specifically, they aspire to improve patient care with shorter stays, greater post-operative quality of life, and reduction of cost to our patients and the hospital system.
“It is a well thought out roadmap,” said Michael Yost, Ph.D., vice chair of Research in the Department of Surgery. “Detailed plans are in the development phase and they will continuously roll out over the next eight months. We will include methods to measure our progress and adjust as needed through our faculty-driven framework.”
RETURN ON INVESTMENT
Michael Yost, Ph.D., Jamie Meyer, vice chair of Finance, Prabhakar Baliga, M.D. chair of the Department, and Satish Nadig, M.D., Ph.D., associate vice chair of Research, developed an outline for the research projects to serve as starting points for ROI evaluation and project selection.
The criteria include
:• potential to have sustained impact on the practice of surgery
• time to implement
• market size
• disruption potential
• cost and time savings potential as well as cost of project
Outcomes research serves as the driver for research within the department.
The outcomes research arm of the roadmap will focus on epidemiology (EPI), clinical trials and implementation.
More specifically, within EPI, the study of the causes, distribution, and control of disease in populations, there are three categories of research: database research, electronic medical records research and observational studies.
Clinical trials encompass government and industry sponsored research. Within implementation are both quality and process improvement projects.
Dave Taber, Pharm.D., associate professor of Surgery, leads the effort by creating the ORION Center for Surgical Outcomes Research currently focused on growing the effort in clinical trials.
Taber reports that the department’s portfolio of clinical trials is expanding with representation in most divisions, and new CT, Trauma and Transplant trials are about to open. There are currently 350 patients active in clinical trials.Moving forward,
Taber plans to grow investigator-initiated research. “We have a good portfolio of pharma and therapeutic sponsored research,” he said. “Our goal is to grow the supportive research where the investigators are actually driving the hypothesis generation. To that end, I put together a research toolkit to give to each division.”
Another step is to establish a directory of funding opportunities, including foundation funding such as the Duke Endowment, Blue Cross Blue Shield Foundation, and provide the deadlines and information to each division. This makes it user friendly and centralized so faculty can easily access the information.
HUMAN CENTERED DESIGN
Using a human-centered approach by incorporating human factors and system engineering principles to improve both patient safety and job satisfaction, David Mahvi, M.D., vice chair of Clinical Affairs, is in the process of hiring a designer who will incorporate ergonomics, human factors, and sustainability integrating the needs of the user from the very beginning of the development process.“
After carefully observing how surgeons are using instruments, or how they interact with the health care system the designer can develop improvement options into the new design,” explains Mahvi.Yost plans to disseminate training so all clinicians can get an idea on what human centered design is and how they can get involved.
“When human centered design is implemented, you see improvement in quality, cost and job satisfaction,” said Yost.
ENGINEERING IN MEDICINE
The digital age is upon us. Surgical innovation using 3-dimensional imaging (3D), Virtual Reality (VR) and Augmented Reality (AR) are advances in technology that enhance data in the surgical workplace.
At MUSC, the bioengineering lab, led by Yost, conducted a pilot study to investigate these disruptive technologies and their role in a surgeon’s repertoire of tools.3D printed models can optimize perioperative planning.
Transplant surgeon Satish Nadig recently used a 3D printed model of a patient’s horseshoe kidney to better understand the unique vasculature and to identify the spatial relationship between the vasculature and tumor as well as the depth of infiltration of the tumor. A horseshoe kidney is a rare congenital disorder where the patient’s kidneys fuse together to form a horseshoe-shape.
Thoracic surgeon Barry Gibney also used a 3D model of a chest wall tumor in preparation for surgery.
Katie Morgan, M.D. chief of GI Surgery used a 3D model to plan for a surgery involving a patient with a pancreatic tumor. The group found that 3D models were excellent resources for shared decision making with the patient.
Trauma surgeon Evert Eriksson, also participated in the 3D leg of the pilot study, Trauma surgeons often don’t have time to print a 3D model perioperatively, so Eriksson chose to create the model post-operatively as a learning and teaching mechanism.
While VR is interesting, the cohort found it is not as useful as desired. Limitations include inability to interact with others while in the virtual space and inconvenience due to connectivity to the device. AR provides more flexibility and the department is moving in the direction of incorporating this technology into its toolkit for researchers and clinicians.All three technologies provide excellent training opportunities for surgical residents, providing opportunities for them to more deeply explore patient-specific anatomy.
NEW FACULTY MENTORING AND SUPPORT
Faculty mentoring and support are paramount to the success of new faculty. Nadig leads this charge and met with all divisions to assess the current research teams and assist with building, formalizing and strengthening the team structure for research.The next step is to assist the junior faculty by building a team around them and addressing their logistical issues. “Fostering Team Science is the only path to success in my opinion,” said Nadig. “As it turns out… we go farther together.”
The roadmap allows members of the research division to operate on a continuous improvement time line where they can rapidly bring innovative technologies into the clinic within 6 months, while they develop technologies that have a 2-3 year time horizon and continue federally sponsored research that has much longer time lines for implementation.“Moving forward with the strategy outlined in our roadmap will bring technological improvements to patient care much more quickly and allow for continuous improvement of the art and science of surgery,” said Yost.