TMC PULSE

t m c » p u l s e | n o v e m b e r 2 0 1 5 30 Shadowing for Solutions Follow the fellows of TMC Biodesign—from the operating room to the emergency department— as they look to identify persistent problem areas impeding patient care B y A l e x O r l a n d o I n the emergency department at Harris Health System's Ben Taub General Hospital, the shuffle of hurried footsteps and the squeak of stretchers whistling past reverberate through the halls. Punctuated by the sharp, irregu- lar beeping of all types of monitoring equipment and the hum of urgent conversation, a symphony of controlled chaos is conducted. At the center of it all, Dave Morris scribbles diligently in his notebook. Occasionally flattening himself against the wall to avoid a collision, he surveys the scene with the mindset of a hyper-vigilant reporter. "We're really looking for any kind of inefficiencies, redundancies or rote tasks being performed," said Morris, a digital health fellow in the inaugural class of TMC Biodesign, the Texas Medical Center's one-year innovation fellowship that brings together tal- ented, multidisciplinary individuals to create digital health solutions and new medical devices. "If you stop some- one and say, 'Hey, why did you do that?' you can find all kinds of interesting things about that process. Through our questioning, we really dig in and try to get medical professionals to tell a story about why they did something a certain way." Several blocks away at Texas Heart Institute, medical device fellows act as silent sentinels in the cardiovascular surgery operating room. As anesthesi- ologists, nurses and surgeons maneu- ver their instruments in tandem, the fellows keep a keen eye on the proceed- ings, trying to distill potential problem areas from a visually tangled tapestry of tubes, wires, organs and veins. In every operation, from coronary bypasses to valve replacements and left ventricular assist device (LVAD) implantations, that guiding question is the same: "Why did they do that—and is there any way that they can do it better?" "We're really trying to understand how these procedures are performed, what steps the practitioners take and how we can identify anything that stands out as inefficient or clunky from an engineering standpoint," said Jessica Traver, a TMC Biodesign med- ical device fellow. "We see the surgery differently than the people who do it every day, so we look to see if the pro- cess seems hindered by any obstacles, or if it takes substantial time and effort to get it right." Traver and Morris—and their teammates in the medical device and digital health tracks, respectively—are currently in the "identify" stage of the biodesign process, an established methodology for streamlining innova- tion cultivated by Paul G. Yock, M.D., at Stanford University. The first part of the program's curriculum, the "iden- tify" stage involves the fellows going through an immersive clinical shad- owing experience, during which they closely monitor patients and providers in distinct clinical settings. Afterward, they use those initial observations to [Physicians] aren't trained to push back against [our training] and ask, 'Why do I have to do it this way?' That's the skillset that these biodesign fellows are trying to cultivate. It'll be interesting to see what they come up with. — WILLIAM "BILLY" E. COHN, M.D. Director of the Center for Technology and Innovation at Texas Heart Institute catalogue unmet needs that might ben- efit from the creation of a new medical device or digital health technology. This stage is followed by two more: "invent" and "implement." For the four members of TMC Biodesign's digital health team, the emergency department at Ben Taub Hospital—a bustling, Level I trauma center that cares for more than 100,000 emergency patients each year—was ripe for disruption. "A lot of our emergency depart- ments across the country are afflicted with the problem of having too many people in the waiting room and triaging patients to appropriate care areas," said Farzad Soleimani, M.D., assistant pro- fessor of emergency medicine at Baylor College of Medicine and co-associate director of TMC Biodesign. "They're also seeing problems with transitions of care. There's a certain disconnect in the emergency room—you see a snap- shot of a patient, unfortunately, at the moment when they're the sickest. One of the themes that's emerging is how to provide the necessary infrastructure, tools and IT insights to allow the health care providers to get a better sense of that patient's journey through the medical system." While the digital health fellows have been keeping pace with the frenetic atmosphere of the ER, the medical device team has become embedded in the world of cardiovascular medicine. From the operating room and the clinic to the electrophysiology suite, they've gracefully accepted their roles as infor- mational sponges, piecing together the intricate patchwork of cardiovascular health from as many angles as possible. 8 FELLOWS 510 APPLICATIONS 1.6% were selected out of the acceptance rate was Farzad Soleimani, M.D., co-associate director of TMC Biodesign and assistant professor of emergency medicine at Baylor College of Medicine, confers with digital health fellow Dave Morris.

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