Discoveries Magazine


Beyond the Bench

Clinical research is breaking out of the lab and into the world. Investigators make house calls, study trauma bays, partner with barbershop owners and community organizations, and tap into fundamental human experiences. Meet the new faces of medical research in eight case studies that take you from L.A. to Portland, and from the barbershop to the Twittersphere.

Eric J. Ley, MD

LAB: The operating room
INVESTIGATOR: Eric J. Ley, MD, director of Surgical Intensive Care Units and the Surgical Critical Care Residency Program, Cedars-Sinai Department of Surgery
STUDY: OR 360, a simulation space designed to develop improvements in trauma and emergency care
STUDY PARTNER: U.S. Department of Defense

CASE STUDY 1: In the Trauma Bay

Trauma care is by nature chaotic. Victims of car wrecks, gunshot wounds, or cardiac arrest arrive at the Emergency Department amid a cacophony of sirens and shouts that flings surgeons and nurses into a flurry of activity. The IV tubes get tangled, the staff bumps against each other in narrow operating rooms, and someone dashes off to find an interpreter who speaks Cantonese. Cedars-Sinai’s research project OR 360 aims to curtail the chaos with a combination of 21st century technology and enlightened new practices.

The medical center partnered with the U.S. military to design what has been called the “operating room of the future.” The initiative, drawing on practices from surgery, psychology, aviation, and other disciplines, addresses potential breakdowns in the coordination of trauma care during the “golden hour,” when prompt medical attention can mean the difference between life and death.

“The quicker we get patients cared for, the better the outcomes. So our goal is to improve the efficiency and effectiveness of acute trauma care by introducing innovations in communication, technology, and workflows,” says Bruce L. Gewertz, MD, surgeon-in-chief, chair of the Department of Surgery at Cedars-Sinai, and the H & S Nichols Distinguished Chair in Surgery.

Military medical centers are exceptional at streamlining practices and avoiding workflow disruptions. Funded by $3.8 million in grants from the Department of Defense, members of the Cedars-Sinai team studied military surgical teams in the U.S. and Europe. They observed their practices and interviewed surgeons, nurses, and other medical personnel.

The international collaboration led OR 360 teams to rethink the way operating rooms are designed, with movable walls and equipment for more flexible use and a ceiling built like a gridded trolley system that allows the space to be endlessly reconfigurable. They identified ways to improve communication among staff and eliminate disruptions during surgery. And they designed an iPhone application that instantly conveys patient information to caregivers as they rush to the OR from far-flung parts of the hospital.

As an outgrowth of the initial research, Cedars-Sinai has introduced innovations to streamline trauma care, including color-coded trauma bays that enable staffers to quickly locate supplies, whiteboards that display vital information as teams respond to shifting situations, and pre-briefings that allow doctors and staff to quickly establish their roles in complex cases.

Early results are promising. The whiteboards and pre-briefings, for example, reduced the time to capture the first radiological images by more than 10 percent and the time to draw blood for the first lab tests by more than 20 percent.

“This is a new way to think about the improvement and delivery of healthcare,” says Ken Catchpole, PhD, director of Surgical Safety and Human Factors Research at Cedars-Sinai. “By putting patients and clinicians at the center of the system, we can design trauma care for the 21st century that is of the highest quality possible.”

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