Dr. Macy is a pediatric emergency physician at the C.S. Mott Children’s Hospital Emergency Department and a pediatric health services researcher in the Child Health Evaluation and Research (CHEAR) Unit. Her current research focuses on improving emergency department efficiency and optimizing resource utilization for children likely to experience a short-stay hospitalization for common conditions such as asthma and dehydration. She has expertise in observation medicine as an approach to pediatric short-stays.
Disclaimer: This is a transcript from a verbal interview
What kind of research are you excited about?
The thing I am particularly excited about in relation to CHEPS is taking my perspective of the health system from little individualized sections to look at it as a full system, and trying to think through how the emergency department plays into both the inpatient and outpatient worlds. CHEPS gives me the tools to bring it all together.
What problems are keeping you up at night?
The thing that hits me hardest when I’m working clinically is the lingering question about of whether or not I am doing the right thing for this particular patient. It’s not a clear black and white question. There is a lot of personal history in any given patient and family that you have to incorporate with the hard facts about their medical condition. Then you have to be able to piece all of that together with what’s going on in the health system at large at that moment. If they are a family from a different primary care network, we also have to figure out how we can loop the primary care providers back in with the care delivered at University of Michigan. How do we communicate with that provider at two in the morning when we are trying to make decisions? The interconnectedness, or lack thereof, between emergency medicine and other settings is a vexing problem.
How do you think engineers and healthcare professionals can work together to improve patient care?
The thing that is most exciting to me about the work I have done with CHEPS is the different way of thinking that the engineers bring to the medical setting. For example, when we were trying to think through some of the data that we had on timing for discharge, the students said, “Let’s try different data visualizations,” which led to this whole idea of thinking about things in a grid format and shading the grid to highlight different patterns. It really made the information pop in a way that I wouldn’t have come up with as a healthcare provider. I would have sat there and done the same thing over and over again, but by having that different perspective, you really get outside of your own framework and I think it can be really incredibly eye-opening.
When did you first become involved in CHEPS and how did you come across CHEPS?
It was very much at the beginning. I don’t know how far into the formation of CHEPS they had gotten before I became involved, but it was very serendipitous. There was a group of emergency providers who were looking at operations research questions. One of Amy’s students was giving a presentation of her final project to that group. It just so happened that I ended up coming to the talk. The research was very much focused on how things looked for the adult patient population in the emergency department. I asked a couple of questions about how that might apply over to pediatrics. Amy was there and took an interest in thinking a little bit more about the pediatric patient population. So Amy took me out to coffee and the rest is sort of history.
What makes CHEPS unique compared to other teams or projects you have been a part of?
I think that the most unique aspect for me is the close work with students and students across different levels. That is a really cool opportunity for me as a healthcare provider to feel comfortable being in the engineering space because the students are often learning too. If it was just with all of the professors of engineering, it might feel intimidating or uncomfortable to be asking a question, but because CHEPS is a learning environment, it is more comfortable to be a healthcare provider taking a jump into a new space. Another unique aspect is the involvement of students from different healthcare fields together in one place now, nursing, medicine, and public health are getting into the mix.
What do you like most about working with CHEPS?
I like the people a ton. I like the collaboration and I really think that data visualization and being able to say, “Alright, we’ve looked at it this way” and have somebody new come to a meeting and say, “Well, how about if you look at it this slightly different way.” I feel like those things crack open new ideas and lead us into different directions in terms of our work.
I would say another thing that I think is an advantage and a unique aspect of CHEPS is the organic nature of how the projects have evolved. I think if we were in a position in terms of having to seek federal funding, it probably would not be so fluid. However, I think the fluidity is what gets us looking at interesting spaces that are a little bit more novel or innovative. It lets us be at a point where there aren’t that many risks associated with not getting to the final answer right away.
How has working with engineers changed or altered your way of thinking about healthcare problems?
Working with the engineers has helped me to realize that you can start to look at a whole system in the questions you’re asking and I don’t feel like that has been a traditional mode of thinking about healthcare. That has been an important leap forward and I think healthcare is moving in that direction. CHEPS is really jumpstarting that and pushing our health system forward on that front.
How has working with engineers changed or altered your approach to tackling problems?
It has freed me up to say, “We’re going to look at the data for three months during the summer at this aspect of things and if nothing comes from that, then we’re going to go a different direction and try something else out” and recognizing that there is still learning in exploring that process even if it turns out not to be something that is going to be academically fruitful. I think that helps the students think through things and also helps shed a lot of light for me in terms of what questions can be answered this way and what are things that are insurmountable in terms of man hours to be able to better understand the process.
Originally published on 1/15/2015.