Can anyone help research faculty understand hospital operations? The answer is “YES” with PRIOR (Pilots, Research and Innovation Operational Review)
For Jay Koyner, MD, it began four years ago when he and other University of Chicago colleagues, published a paper around predicting acute kidney injury in hospitalized patients and thought that if he could intervene early, patient outcomes could be improved. Dr. Koyner found himself bounced from manager to manager trying to figure out how to implement his idea: integrating an algorithm into Epic to predict who would develop acute kidney injury and intervene early with a preemptive nephrology consult. If he got a grant, how would he test if the risk score and intervention was clinically useful? Was the data available for the algorithm? How long would it take to implement the algorithm into EPIC and was there a cost? Who from UChicago Medicine would explain how to work with the rescue response team and nursing staff for this project?
UChicago Medicine leaders had been grappling with similar questions for years. The Center for Healthcare Delivery Science & Innovation (HDSI) spent a few years building, testing and socializing the research consultation service now called PRIOR. PRIOR fills a gap in coordination between faculty (principal investigators or PIs) and hospital staff around how to implement projects that impact hospital operations (for example, bringing in special equipment, changing how patient care is provided, or requesting changes to the EHR).
HDSI asked if Dr. Koyner agreed to be the “guinea pig” for the process while he was writing his grant. He met with a committee of operational leaders, including the essential John Moses (UCMIT). “It was helpful to [build] relationships with these folks because when it came time to implement the algorithm, I was a known entity, John Moses and his fantastic team were known entities,” Dr. Koyner said. “When we hit bumps in the road in implementing, I was dealing with people I knew, [who knew the project].”
Dr. Koyner’s test case helped to develop the PRIOR process, wherein during project design the researcher: 1. submits the PRIOR intake form, 2. either gets immediate feedback or is invited to present to the PRIOR committee of operational leaders, 3. receives hospital contacts, and 4. is offered a UCM Letter of Support. Formally rolled out in September 2019, PRIOR is available as a service for pilots, research, and QI projects that will impact hospital operations.
This fall, Valerie Press, MD sent through an EHR-based project looking to improve medication adherence and safety. “I’m someone who likes to know what resources exist,” she said. “You don’t know what you don’t know [… for example,] I wouldn’t have thought about [looping in] Supply Chain.” She had already submitted a grant when she presented to the PRIOR committee, but nevertheless she found it useful to open the lines of communication and bring together the various elements of her project to plan for the future.
Dr. Press emphasized, “The form is easy to fill out. It’s not a huge time commitment. You don’t have to bring slides to the review committee, and even if you’ve already been in touch with people, it can be helpful to sit around the table and make sure everyone’s aligned.”
Dr. Koyner suggested, “Have a vision of what you want to achieve. Have an understanding of the granular details of what you need so they can help guide you through the process […] Everyone knew what I was trying to do and they wanted to make sure it was being done safely and appropriately […] PRIOR was easy to work with, and they made it clear they wanted to have my work be successful.”
Both doctors agree: “Just do it.”
HDSI coordinates PRIOR, which is a free consultation, not approval, service to support collaboration. PRIOR benefits both researchers and the health system by facilitating communication and planning as well as advocating for more efficient project implementation.
To learn more about PRIOR and submit a project, visit https://hdsi.uchicago.edu/prior/.
Jay Koyner, MD is an Associate Professor of Medicine, Medical Director of Acute Dialysis, and Director of ICU Nephrology.
Valerie Press, MD, MPH is an Assistant Professor of Medicine and Pediatrics and Executive Medical Director of Specialty Value Based Care.
Author: Kimisha Cassidy, MS is the Project Manager for the Center for Healthcare Delivery Science and Innovation (HDSI), which coordinates PRIOR. Please reach out to her at firstname.lastname@example.org with any questions.