This document outlines the objectives and content of a conference on research and scholarship within the Division of EM. The objectives are to present a new framework for research, develop a shared vision, highlight ongoing projects, and plan next steps. Several ongoing and proposed research studies within the Division are then summarized, including studies on pediatric telemedicine triage, emergency department handoffs, attitudes towards ultrasound procedures, and respiratory assessment techniques. Barriers to research are discussed and ways the Division research team can provide support are explored. Developing individualized research plans and improving collaboration are presented as ways to enable transformative change. Goals for the next few years include cultivating a positive research culture, centralizing support structures, increasing collaboration and output, and raising

1. Div of EM Research & Scholarship
Conference #1 - Vision
Todd P Chang, MD July 23, 2014

2. Disclosures / Conflicts of Interest
None…yet
2

3. 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
3

4. Ground Rules 1
4

5. Ground Rules 2
5

6. 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
6

7. ReFraming
7

8. 8

9. The 4 Frames
9

10. Structural
10

11. Human Resource
11

12. Political
12

13. Symbolic
13

14. 14

15. 15

16. 16

17. 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
17

18. Exercise 1
18
What are barriers that hinder your
scholarly and research work?
Time
Shift

19. Exercise 2
19
How can the Division Research &
Scholarship (R&S) Team help remove
these barriers?
Support
Write

20. Exercise 3
20
How can you help further your
colleagues in R&S?
‘for them’
Support

21. Shared Vision
21

22. Why this is important
22
1. Model the Way
2. Inspire a Shared Vision
3. Challenge the Process
4. Enable Others to Act
5. Strengthen Others

23. 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
23

24. Traditional Nurse Triage vs. Physician
Telepresence in a Pediatric ED
Marconi GP, Chang TP, Pham PK, Grajower DN, Nager AL
ePub 2013 Dec 21

25. 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
25

26. 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
26

27. N = 54
Approach
27
N = 132
N = 100
N = 32
declined
N = 46
tele
MD
RN
tele
MD
RN
Direct
observation Data
Collected
Satisfaction
Survey

28. Data
28
RN Tele-MD
Time (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 +/- 0.5
95% CI 0.2 – 0.5 0.1 – 0.3
Triage score Agreement (%) 71 95
95% CI* 62 – 80 91 – 99

29. 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?
29

30. Emergency Department Transfer of Care
Sign-Out Analysis
Festekjian A, Nager A
enrolling

31. 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
31

32. 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
32

33. Approach
33
Control Control
TOC
Guide
FaceTime
FaceTime
+TOC
Control
ED:
Training program___________
Year of training ___________
Res evaluated patient since initial
presentation:
□Yes □ No
Study ID #
Chief Complaint
Previous history
Mark “Yes” or “No” for item communication
□Yes □ No
□Yes □ No
Reason for admission / HPI □Yes □ No
Treatments 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/A
Improvement noted in ED
If 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:_____________

34. Timeline
 Fall 2014 – Control / Validity phase
 Winter 2014 – 2015 – Continued enrollment &
Intervention phases
 Presentations – AAP 2015
 Manuscripts - 2016
34

35. 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?
35

36. Attitudes and Barriers to Foley Catheter
Placement for Trans-abdominal Ultrasound
in Adolescent Females
Waterhouse MR, Pham PK, Yang M, Chang TP
IRB phase

37. 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
37

38. 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
38

39. 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
39

40. 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
40

41. 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
41

42. 42

43. 43
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

44. 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
44

45. Transformative Change 1
45
1. Plan individual scholarship goals that
align with your own personal &
professional goals

46. 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

47. 20152014
20162015
July Dec Jun
Sept 1:
Meet with Karen Yaphockhun
Dec 31: Festekjian et al.
Validity of ToC Checklist
– manuscript submit
June 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. Constipation
2. Septic Shock in Cancer pts
3. 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

48. 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
AAPAbstract
July 31:
Literature Review write-up
Submit 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

49. Transformative Change 2
49
2. Improve Collaboration in all Scholarly
Projects

50. CAGE
50

51. Within CHLA
51
1 3 2 1
3 3 2 6
1 4

52. Across the Country & Around the World
52

53. But Collaboration starts here
53
2

54. Transformative Change 3
54
3. Improve Quality & Impact of all Studies

55. Transformative Change 3
55

56. Transformative Change 3
56

57. 2014 – 2016 Goals & Objectives
57
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%

58. 58