In the Summer and Fall of 2021, I was a research intern at Hennepin County Medical Center (HCMC), which is a Level I adult and pediatric trauma center and safety net hospital in Minneapolis, Minnesota. The Emergency Department of HCMC houses multiple research programs, one of which is the Research & Quality Improvement Program. This program has enabled Emergency Physicians to advance patient care through investigational research, ranging from public health surveys to studies on the efficacy of medications and procedural interventions; the goal of this research is to improve the quality of healthcare at HCMC and improve accessibility to care. My job in this program was to assist with conducting department quality improvement initiatives and collecting data to help address their investigational research questions. All of my shifts took place in the Emergency Department, where I attended codes (traumas, strokes, and cardiac arrests) to screen study patients, as well as utilized EPIC to screen and enroll patients for a variety of studies. Through my work at HCMC, I was also able to interact with patients from diverse backgrounds and observe the practice of emergency medicine.

HCMC is a diverse urban hospital, serving patients from many races and ethnicities: 37% White, 31% Black/African American, 20% Hispanic/Latino, 3% American Indian/Native American, 3% Asian, and others (Hennepin County Medical Center). Given HCMC’s safety net focus, the community it serves within Hennepin County primarily includes minorities, low-income individuals, and those with distinct health needs (Hennepin County Medical Center). Hennepin County Medical Center cares for patients from across Minnesota, not just Hennepin County. In 2012, HCMC treated 154,626 patients from all 87 Minnesota counties. Many of these patient encounters came through referrals from their local physicians, often for specialized care and regional services available only at HCMC. Patients and practitioners statewide depend on the high level of expertise based on HCMC’s extensive array of services, capabilities, and staff (Hennepin County Medical Center). Not only is clinical research a significant way to make the biggest impact on patients; in this setting, it is vital that clinical research is conducted, and conducted appropriately, especially when considering the population served at HCMC, which is continuing to grow more diverse. A clinical trial that ultimately brings a new drug or treatment to the market could potentially impact thousands of lives.

Growth in diversity of patient population (race and ethnicity) at HCMC from 2000-2012

From a public health perspective, these studies overall aim to influence medical decision-making in a diverse urban hospital through a variety of means: by assessing patient health outcomes pre/post-treatment, and assessing health outcomes based on specific measures. In addition to patient outcomes, we aim to assess how effective certain treatments are, as well as assess patient perspectives and knowledge about certain interventions and hospital systems, and assess the circumstances by which patients receive certain interventions. Our data collection also aims to assess how well providers are able to predict certain health outcomes, and assess how care changes based on co-morbidities. I was able to observe patient care on multiple levels: from the level of the EMT/paramedic to residents, to nurses, and health care assistants; I was also able to observe the effects of hospital administrative measures on patients' stay at HCMC.

I was able to participate in this program throughout the COVID-19 pandemic, which was both a heartbreaking and insightful experience. Due to the pandemic, some of the studies (assessing asthma or intubation) we conducted had to be terminated or paused. In addition to this backlog in potentially helpful research about patient outcomes with various treatments, I was able to observe how attending doctors and nurses were incredibly overwhelmed in the Emergency Department and in the ICU at HCMC. The hospital itself was overwhelmed, in part by the rise of cases during peaks in the pandemic. As part of my research, I was able to access patient charts and document their movement through the hospital. It was not rare for all ICU beds to be full, and I noticed that at some points in my research that the people that needed to or should have been in the ICU were stuck in the stabilization room, where only the most critical of patients should be sent for constant monitoring by several providers. Through this research, I was truly able to see how the pandemic negatively impacted hospital systems.

I was also able to see and learn how important it is to have a diverse group of health care providers to reflect a diverse patient population. I saw that patients would go out of their way to approach certain providers about sensitive issues, although their primary provider, whose identity they did not feel comfortable with, was more accessible. Additionally, HCMC medical interpreters were rapidly called on and greatly facilitated patient interaction with providers; this was a crucial component of an accurate history-taking process for a provider, so they could give the best care possible.

Through my experience as an intern at HCMC, I learned about the translational process of a drug moving from preclinical research to clinical trials and then to a patient in the form of treatment. As the data we collected are part of clinical trials, I learned about the regulations for the conduct of clinical trials, good clinical practice, the protection of human subjects, informed consent, and investigational new drug regulations. Not only did I learn about information like good clinical practice or informed consent, but I was also able to apply it as I interacted with patients from diverse backgrounds. The life experience and stories patients shared with me I have held onto and will continue to hold onto, as they have truly changed my perspective on the importance of the people in my life, gratitude, respect, and care. They have motivated me to become a compassionate and thoughtful provider moving forward.

Hennepin Healthcare. (2020). Retrieved April 20, 2020, from https://www.hennepinhealthcare.org

Information for Prospective Volunteers. (n.d.). Retrieved April 18, 2020, from https://www.hennepinemresearch.org/prospective-volunteers

Hennepin County Medical Center. (n.d.). Retrieved April 18, 2020, from https://www.mnhospitals.org/Portals/0/Documents/data-reporting/CHNA/hcmc_p_050360.pdf

Image Credits:

Hennepin Healthcare System - Health Services Plan and Community Assessment