Research, patient care drive Emergency Medicine’s CollinsSep. 13, 2018, 9:19 AM
by Nancy Humphrey
Sean Collins, MD, MSc, was no stranger to Vanderbilt University Medical Center when he was offered a faculty position in Emergency Medicine in 2011. A heart failure study that he was leading at the University of Cincinnati included faculty and patients from Vanderbilt.
He and his wife, Kim, had just built a new home in Cincinnati. “We thought it was going to be our 20-year home. We thought we’d be there until we retired.”
But the position in Nashville and the reputation and strength of Vanderbilt Heart and Emergency Medicine for his heart failure research tipped the scale, so the Collins brought their house plan with them and built the same home near Nashville.
“Our oldest child was going into fifth grade, and we didn’t want to move the kids in middle or high school, so it was either now or never,” Collins said. “The stars just aligned, and Kim and I moved our four kids and a geriatric dog here. When our friends from Cincinnati come to visit they say ‘you just moved your house down here.’ And we did — it’s even the same color brick.”
Collins, professor of and executive vice chair of Emergency Medicine, was vice chair for Research until recently. In that position he worked with the faculty in the Division of Research to make sure the current programs of research remain successful and also to identify what areas of research to add to the department’s research inventory, including projects with other departments and divisions. Collins also holds the Endowed Clinical Directorship for Emergency Medicine Research.
The majority of the research done in the Emergency Department (ED) is clinical research — studying how to improve the diagnosis of a disease, such as heart attack, pneumonia or poorly controlled blood pressure, and how patients can better take care of the disease process both in the hospital and after discharge.
“We try not only to improve the care of the patient while they’re in the hospital, but also make it sustainable. When you think about emergency medicine, that’s not what you traditionally think of. You think about gunshot wounds and trauma and heart attacks and strokes where the first 90 minutes matters a lot. But we’ve also realized we see a lot of people who have difficulty seeing their doctor. We really should be good at taking care of that population of patients and embrace the idea that we can figure out what they need, that we’re the stopgap, until they can get in to see their doctor or specialist.”
One Emergency Department research project involves medication adherence and helping patients understand why it’s important for their long-term health to take their medication. The patients in that study are followed up with in a few weeks to see if the motivational work has helped.
“It’s the lights, sirens and drama of the ED for some of our studies. Others are not as time dependent, but we’ve realized that we’re the touchpoint in the hospital for the majority of people who are admitted. So, we have the opportunity to study everything,” Collins said.
He also spends a fair amount of time figuring out how to expand the Emergency Department’s portfolio of studies. “My job is to empower faculty to think about what their next steps are. We need to make sure we’re considering things that are of interest to the National Institutes of Health (NIH), the Department of Defense, to PCORI (Patient-Centered Outcomes Research Institute). We need to make sure we are targeting areas that are highly likely to get funded in the next few years.”
The department’s other area of research — systems/operations — is looking at systems in place in the ED where every second counts.
“We aren’t actually studying a patient, but we’re studying ED and hospital systems and how we get patients to the right care they need more efficiently,” Collins said. “There’s a science behind coordinating that care. When events are fairly rare, but are very important events, it’s crucial that we do it correctly every time. So, we study ways to improve upon that process. If we need to get someone here in less than 60 minutes, and our current time is 75 minutes, how do we trim off those 15 minutes?
“It’s upfront recognition at the other hospital that the patient is having a stroke; it’s the ease of calling us and getting LifeFlight sent; it’s letting them know they should come to the ER or go directly to the ICU.”
Collins, the son of a pharmacist and a schoolteacher, is a 1993 graduate of Boston University. He received his medical degree from the University of Wisconsin Medical School in 1997 and was an emergency medicine resident at the University of Cincinnati, where he was chief resident. He earned a Master of Science in Epidemiology from Harvard School of Public Health in 2005.
He became interested in research during his residency, when a colleague at the University of Cincinnati, Alan Storrow, MD, now at Vanderbilt, pointed him in the direction of studying heart failure.
“We’re getting very good at taking care of people who have had heart attacks. They’re surviving their heart attacks, but they have damage to their heart and are living longer, but with heart failure.”
He found out quickly that he couldn’t just learn on the go. “I tried to do some research, but I felt like I was in a different country and couldn’t speak the native language.”
So, he returned to school — this time as a research fellow at Harvard University, and went on to earn his Master of Science in epidemiology.
“That allowed me to really understand research and the language everyone was speaking and design my own studies,” he said.
While getting his degree at Harvard he received an NIH K23 career development award, which allowed him the time to focus more on his heart failure research.
While at Cincinnati, Collins worked with colleagues at Vanderbilt on how to safely discharge patients with heart failure. Nationally, nearly 1 million emergency department visits for acute heart failure are associated with admissions each year, consuming significant resources, Collins said.
“We have a pretty good process of ruling out heart attacks or finding that we need to admit a patient and study them more. If 10 people come in with chest pain, more than five will go home. If 10 people come in with heart failure, 9.5 will be admitted. “We need a better process of figuring out who should be admitted and who should be discharged to home.”
The study, with 1,033 patients enrolled over four years, looked at a new decision tool to identify ED patients with acute heart failure who are at low risk for adverse events within 30 days and can be safely discharged. The work was published in the Journal of the American College of Cardiology.
“We are now in the process of testing it in larger group of patients in several medical centers, including Vanderbilt,” he said.
Collins said it’s easy to be consumed by research, so part of his job at Vanderbilt includes a fair amount of nurturing and looking out for his colleagues.
“My job is to help faculty think about what their next steps are — about how they can have a sustainable career, but also have work/life balance. You can truly do research all the time — not just when you’re in the office, but at home, on the plane, when you’re in the store. The key is knowing when you should turn it off for a while.”
He also advises ED residents to add something else to their careers, besides just seeing patients. “Be on a hospital board. Be a mentor to someone. I’ve seen too many people who graduated with me, 10 years out saying ‘I can’t do this for another 15 years. I need to do something else.’”
Being at an academic institution, for example, allows faculty to teach, do research, have an administrative role. “It helps avoid the B word — burnout — because these opportunities provide a good balance in what you do.”
Collins tries to practice what he preaches. He changes hats often. He sees patients at both Vanderbilt and the Veterans Administration Medical Center, relishes his administrative role and does his own research. “There’s a different challenge every day.”
Outside of work, he spends time with his wife and children, who range in age from 11 to 17. He and Kim, a pediatrician who now stays at home with their children, met in their gross anatomy lab at the University of Wisconsin and married in their fourth year of medical school.
“We’ve had a dry erase calendar on the back door since medical school. Each person in the family has a color. We just kept adding colors every time we had a kid. That’s how we keep things straight.”
Collins makes sure he’s home at least a couple of nights a week for family dinner. “I love hearing the goings on of the day. It’s important to me that I have that time with them.”