Hennepin Healthcare Research Institution
Emergency Medicine Research and Quality Improvement Intern
by Georgia Cannan
Introduction
From summer 2022 through spring 2023 I worked as Research Quality Intern (RQI) and lead RQI at Hennepin Healthcare Research Institution (HHRI) at Hennepin County Medical Center (HCMC). HCMC is a level 1 trauma, safety net, and public teaching hospital in Minneapolis. The aim of this research program is to help advance emergency medicine and patient care through investigational research that ranges from public health surveys to studies on effectiveness of medicines, procedural interventions, and quality improvement initiatives (What we do).
The main public health issues looked at during my time in the RQI program were focused around overdoses in Minnesota, violence intervention, and quality improvement in patients' hospital stays. Clinical research was used to address these public health issues as they are presented to the ED in order to better the patient care and community well being.
Background
HCMC is a hospital that has an extremely diverse patient population. Due to the diversity of their patient population HHRI is able to conduct many important public health studies that aim to understand determinants of health that may be causing patients to present to the ED. The studies have great importance as they reach many communities within the twin cities. HCMC sees patients from 87 counties in Minnesota, and 25% of patients are born outside the United States. As of 2018 the patient population was 38% White, 34% Black, 19% Hispanic or Latinx, 3% Native American, 4% Asian, and 14% of patients living below the federal poverty line (Community Health Needs Assessment - Hennepin Healthcare). See chart below.
HHRI has previously published studies such as “Gender Differences in Patient-Described Pain, Stress, and Anxiety Among Patients Undergoing Treatment for Painful Conditions in the Emergency Department” (Patel et al), “Hunger and Food Insecurity Among Patients in an Urban Emergency Department” (Miner et al), and “ The Relationship Between Chronic Illness, Chronic Pain, and Socioeconomic Factors in the ED,” (Hanely et al).
My Role
My role was to gather data, screen, and consent patients in the Emergency Department for current clinical studies. I worked two 4 hour shifts a week with 1-2 overnight shifts per month. While on shift I was stationed in the research office where I would utilize EPIC to monitor patients in the ED watching for any eligible for current studies. If they were, I would talk with the provider to make sure they agreed the patient would qualify. I would then approach the patient, explain the research, and obtain informed consent. Along with this I would report to cases brought into the stabilization room. These were mainly acute tramas and medical codes. I would montier any accidental overdoses presented to the ED looking for abnormal presentations, with the goal to find cohorts of tainted drugs in the cities. I would observe patient agitation levels and de-escalation techniques used by the ED staff in the locked unit of the ED reserved for cases of altered mental status. I also would perform follow up interviews with patients about their time in the ED. Overall there were 17 ongoing studies during my time in the program that I was screening, collecting data, and enrolling patients for.
Stabilization Room (STAB) where critical cases go in the ED. Many of the studies took place in STAB.
Lessons Learned
During my time as an RQI I learned many valuable skills I can take with me in the next stages of my professional career. I was able to understand the flow of the ED and what it is like to work in a fast paced medical environment. On my shifts I spoke with Emergency Medicine Physicians, Nurses, and health care assistants, gaining an understanding of the importance of all the roles in an ED.
I was able to gain a lot of patient interaction experience. Through the research I did, I looked at patients' charts in EPIC to see what brought them in and the determinants of health that affected them before going to speak to them about a study or their experience in the hospital. This allowed me to learn how to adapt to interact with patients from very diverse backgrounds and life experiences. I learned to take a holistic view of what brought patients into the ED and the different determinants of health that affected HCMC’s patient population.
I also got to learn and experience the ins and outs of clinical research. The program taught us in depth the Belmont report and how it related to our specific research. Taking into consideration how the past has affected current research involving humans. I learned to never enroll someone who is pregnant or prisoner, and the lengths needed to begin a trial that would involve waving patient consent. In the waving patient consent case, we have been surveying as many people as possible from the community in order to see whether we should continue with a project or not.
Research Interns at HCMC
References
Hanley O, Miner J, Rockswold E, Biros M. The relationship between chronic illness, chronic pain, and socioeconomic factors in the ED. Am J Emerg Med. 2011 Mar;29(3):286-92. PubMed PMID: 20825800
Hennepin Health. (n.d.). Community Health Needs Assessment - Hennepin Healthcare. Community Health Needs Assessment Implementation Plan - Health Services Plan 2020-2022. Retrieved March 29, 2023, from https://www.hennepinhealthcare.org/wp-content/uploads/2020/01/2019-Community-Health-Needs-Assessment-2020-2022-Community-Health-Needs-Assessment-Implementation-Plan-Health-Services-Plan.pdf
Hennepin EM Research & Quality Improvement. (n.d.). Retrieved March 29, 2023, from https://www.hennepinemresearch.org/
Miner JR, Westgard B, Olives TD, Patel R, Biros MH. Hunger and food insecurity among patients in an urban emergency department. West J Emerg Med. May 2013;14(3):253–262. PubMed PMID: PMC3656707.
Patel R, Biros MH, Moore J, Miner JR. Gender differences in patient-described pain, stress, and anxiety among patients undergoing treatment for painful conditions in the emergency department. Acad Emerg Med. 2014 Dec;21(12):1478-84. doi: 10.1111/acem.12543.
Publications. Hennepin EM Research & Quality Improvement. (n.d.). Retrieved March 29, 2023, from https://www.hennepinemresearch.org/publications-1
What we do. Hennepin EM Research & Quality Improvement. (n.d.). Retrieved March 29, 2023, from https://www.hennepinemresearch.org/what-we-do
Georgia Cannan
Hello! My name is Georgia and I am from Portland, OR. I am a neuroscience major and psychology minor with a concentration in community and global health. During my time at Macalester I have worked as a research volunteer in the ED, volunteered in a neuroscience lab at the University of Minnesota and have worked as a Health Promotion Assistant in the Hamre Center.