Innovative ideas get leadership backing at 2021 MUSC Shark Tank

May 05, 2021
screenshot of zoom call with people clapping upon announcement of winners
Competitors in the MUSC Shark Tank pitching event applaud the winners.

What if?

What if there were a better way?

What if trying something new led to better patient care or student education?

The health care field is ever evolving – and leaders at the Medical University of South Carolina want faculty, staff and students to be at the forefront of change. The annual Innovation Week event showcases innovation occurring across the enterprise and encourages everyone to see themselves as innovators, too.

The highlight of the week is the live Shark Tank funding pitch. Nine teams out of 100 got the chance to describe their ideas to a team of "sharks,” and three teams won funding to pursue their projects.

This year, the sharks – President David Cole, M.D., FACS; Kathleen Brady, M.D., Ph.D., vice president for Research; Lisa Saladin, PT, Ph.D., executive vice president for Academic Affairs and provost; and Patrick Cawley, M.D., CEO of MUSC Health and vice president for Health Affairs, University – threw their support behind teams proposing a new surgery, a new method of training students and a new way for doctors to order fluids for patients.

Each of the winning ideas will receive funding and other support. Stephanie Brown, program manager with the Office of Innovation, noted that the staff will be in touch with other teams as well to offer support for their ideas.

The 2021 MUSC Shark Tank winners:

“Partial Heart Transplantation: a New Operation for Children Requiring Valve Replacement”

Jennie H. Kwon, M.D.; Morgan Hill; Steven W. Kubalak, Ph.D.; Satish Nadig, M.D., D.Phil.; John Costello, M.D.; T. Konrad Rajab, M.D.

Seven in 1,000 newborns have congenital heart defects, which often involve the heart valve. Unfortunately, unlike for adult patients, there are no good options for doctors and patients to replace the heart valves of a newborn.

Doctors can implant mechanical valves in older babies and children, but these valves do not grow with the child. Instead, as the child grows, new valves must be implanted, meaning a child could undergo five or more open heart surgeries, said medical student Morgan Hill.

There are no mechanical valves on the market that are small enough for a newborn. There are a few procedures that doctors can perform on small babies, but none have emerged as a gold standard.

Neonatal heart transplant, on the other hand, has the best outcomes of any solid organ transplant.

With this in mind, the MUSC team proposed a transplant variation aimed at children with valve defects. By transplanting only a valve, not the entire heart, not only would the valve grow with the child, but the medical team could implant a mechanical valve once the patient was full-grown, allowing the patient to stop taking immunosuppressant drugs.

zoom screenshot of team presenting with a slide from their presentation 
The partial heart transplant idea team presents its proposal to the sharks.

Hill explained that up to a third of potential infant donor hearts aren’t used because of poor functioning, but those deficits rarely affect the valve.

“We expect partial heart transplantation to have an immediate impact in the clinic,” Hill said.

Cardiothoracic resident Jennie Kwon, M.D., said the team has done preliminary work on developing the proper technique but will refine the surgery further. Although similar to existing surgeries, there are technical challenges that must be addressed, she said. For instance, mechanical valves are manufactured with features to simplify implantation. Donor valves, on the other hand, don’t have these features. She is also working in the Transplant Immunobiology Laboratory under the mentorship of Satish Nadig, M.D., D.Phil., to clarify the immunobiology of this new type of transplant. 

Pediatric heart surgeon Konrad Rajab, M.D., M.Chir., expects the process to take several months before the team is ready to publish an article describing its surgical techniques. The team is also designing a pilot clinical trial, which will be led by Rajab and John Costello, M.D., the vice chair of clinical research in the Department of Pediatrics and director of research for the Children’s Heart Center.

“Changing Your Reality”

Andrew Novak; Sarah Screws, R.N.; Kasey Jordan, Ph.D., R.N.; Christina McDaniel, DNP, R.N.

The past year has elevated the role of virtual learning in education, but a team from the College of Nursing proposed that virtual learning could not just substitute for in-person learning but actually provide experiences that students wouldn’t otherwise have.

Andrew Novak, senior simulation specialist at the Health Care Simulation Center, developed a virtual reality mass casualty simulation for nursing students. The program is fully customizable, he said, so different scenarios can be programmed, and the simulations can be set up for an individual or a team.

“Thankfully, we do not have mass casualties every day, but our students certainly need to be prepared,” said nursing instructor Christina McDaniel, DNP. She noted that although the program was developed with nursing students in mind, it could easily be adapted for use in the other colleges.

screenshot of a virtual reality simulation with description of patient condition and choices for what to do with the patient 
A screenshot of the mass casualty simulation that can be used to train students.

The program allows the instructor to track each student’s actions. This is key because during team exercises, there’s a tendency for one student to emerge as the leader of each group, making it difficult to properly evaluate each individual’s knowledge and skills, she said.

Novak said the simulation center has VR headsets that students can use to participate, but the program will also work on a regular desktop or laptop, so students could also participate remotely.

To fully roll out the simulation, however, the team asked for funding for hardware. Novak said he developed the prototype on his laptop, which was struggling to keep up with the software demands.

He expects to have a proof of concept ready for testing with students by this summer.

“Work Smarter, Not Harder: Innovative Re-Design of Computerized Provider Order Entry (CPOE) to Drive Evidence-Based Fluid Prescribing”

Michelle Spiegel, M.D.; Carolyn Bell, Pharm.D.; Amanda Davis, M.D.; Annie Simpson, Ph.D.; Lindsay Smith, R.N.; Janet Byrne, R.N.; Achsah Philip, Pharm.D.; Greg Hall, M.D.; Andrew Goodwin, M.D.

Nearly every person admitted to a hospital gets intravenous fluids at some point, with many of them receiving a saline solution.

But some newer research indicates that balanced fluids might be better for many patients, said third-year pulmonary fellow Michelle Spiegel, M.D. Balanced fluids, like lactated Ringer’s, contain a mix of calcium chloride, potassium chloride, sodium chloride, sodium lactate and water, whereas normal saline contains sodium chloride and water. The research shows a greater risk of kidney injury with normal saline, potentially due to its high chloride content, she said.

At MUSC Health, 60% of the time, providers were ordering saline, although the percentages varied greatly by specialty, she said.

The multidisciplinary team decided to try to increase the ordering of balanced fluids, where appropriate, so that more patients would receive balanced fluids and also so there would be a standard practice across disciplines throughout the hospital system.

zoom screenshot of a team presenting 
The fluid prescribing idea team presents to the sharks. 

Before they instituted an educational campaign, team members noted a small 1.5% increase per month in orders for balanced fluids, which they attributed to a growing but uneven knowledge of the latest research. The team instituted an educational campaign in October 2019, at which point team members began to see a 4.4% increase in balanced fluid orders each month.

The real change, though, happened when the team was able to change the appearance of the electronic order panel. The new panel includes clinical decision support that explains the preference for balanced fluids and outlines the specific instances when another fluid should be used; it also moves lactated Ringer’s up the list of fluid choices so that it is listed first.

After that change in March 2020, the team saw an immediate 21% increase in orders for balanced fluids, Spiegel said. The new ordering levels were maintained at least through December, when the team stopped tracking, she said.

The team was careful to promote the most cost-effective balanced fluid, Goodwin said. At 10 cents more per bag, lactated Ringer’s is similar in price to normal saline, although those costs can add up, he said. He estimated a cost of $8,300 per year to move to balanced fluids. However, he thinks that cost would be offset by savings from not having to treat kidney injury.

Part of the team’s request to the sharks was for funding to perform a proper cost analysis to see if its intuition about the cost offset is correct. Team members also need additional technical support to adapt additional electronic ordering systems that weren’t included in the pilot.

2020 winners

Attendees also got an update on last year’s winners.

The Care and Safety Resource Avatar is currently in development. This avatar was designed to orientate floating nurses quickly to the procedures on the unit they’ve been assigned. A nurse can click on different body areas to pull up relevant information.

A mobile, text-based screening and remote care coordination system that connects pregnant women with mental health care has already enrolled more than 900 women in the program and is creating a collaboration with Pee Dee Healthy Start.

Finally, an automated preprocedural planning method for transcatheter aortic valve replacement has completed the institutional review board process and is in the late stages of artificial intelligence software development.

About the Author

Leslie Cantu
MUSC Catalyst News

Keywords: Innovation