Research Positive: A Day in the Life of a Research Coordinator at Arkansas Children’s Hospital

"I love seeing medicine progress and being part of a very intricate system," Masson Spriggs, RN, BSN, said. Spriggs is a clinical research nurse coordinator in the pediatric intensive care unit (PICU), a 26-bed unit at Arkansas Children's Hospital. She is one of three research coordinators dedicated to PICU patients. A three-person team is the core of her intricate system. The larger system includes physicians, nurses, bedside staff, pharmacists and researchers from other hospitals and, most importantly, the patients and their caregivers.  

Research benefits children in the future but is dependent on patients in the present. Research requires caregivers with children in the PICU to be willing participants during difficult days and nights. Spriggs was a bedside nurse in the PICU before becoming a research coordinator. Her genuine heart and skill with patient care help her maintain the delicate balance between patient families' needs and research goals.  

Trauma season 

Summertime is trauma season at ACH. The number of patients admitted after being in an ATV accident or for diabetic ketoacidosis (DKA) increases when children aren't in school. Eight new patients arrived in the PICU the night before we shadowed Spriggs, making it a busy morning. Arkansas Children's Research Institute (ACRI) is involved in over 630 studies. The PICU research team is actively involved in 26 of those, studying conditions ranging from COVID-19 to multiple organ dysfunction. Research coordinators like Spriggs determine if a patient's condition matches the precise needs of any of the projects. Screening requires meticulous attention to detail and multiple sets of eyes. Spriggs mentors the PICU research team's newest member as they comb through patient records, noting everything from age and white blood cell counts to the specific date and time of treatments. These details determine which research studies the patient qualifies for and are critical factors in maintaining patient safety, which is the top priority. Based on the data, two of the eight patients meet the criteria for multiple active research projects.  

Next, Spriggs contacts the physicians and nurses who've provided treatment and interacted with the patient's caregivers. Bedside staff help research coordinators understand the caregivers' mental and emotional state. Spriggs is mindful of being an additional stressor and will only approach if she believes the caregiver can mentally process the consent forms (some of which are more than 20 pages long) that must be signed before participation. 

Interventional and Non-interventional Studies 

When patients qualify for more than one research study, the team discusses which studies are the highest priority and if the patient can safely participate in more than one study. Research projects fall into two broad categories: 

• Interventional studies, which test new treatments
• Non-interventional studies, which collect patient data, often through blood tests or other lab results 

Even with non-interventional studies, patient safety is the most crucial factor. Infants and toddlers have less total blood volume than older children; therefore, less blood is available for blood samples. The research team limits the number of samples by restricting the number of studies a patient participates in. With interventional studies, the team must decide which experimental treatments might benefit the patient. Research coordinators aren't allowed to know if a research participant receives an experimental medication or a placebo. Still, if a new medicine or treatment might help the patient, it becomes a factor when prioritizing.  

Many of the 26 active PICU-related research studies ACRI participates in are hosted by other hospitals and research institutions. Arkansas Children's team members developed some of the 26, including a new study examining how white blood cells in the lungs respond to sepsis, a severe reaction to infection. One of the day's qualifying patients could be the first participant in the non-interventional study developed by an attending ACH physician.    

"Luckily, we work with great clinicians who are enthusiastic about research," Spriggs said. "We work in a place that's very research positive." 

Consenting 

When prioritizing is particularly complicated, like this day, the team consults research director Olivia Irby, M.D., a pediatric critical care medicine physician at ACH and assistant professor in the division of critical care medicine at the University of Arkansas for Medical Sciences. 

After consulting with Dr. Irby and the patient’s care team, the research team approached the caregivers about participating in one of the longstanding projects, which rarely has qualifying patients.  

Spriggs and a fellow PICU research team member joined Dr. Irby in the patient's room to explain the study, answer questions and provide support. The caregivers are immediately receptive to anything that might help their child. They trust the care provided at ACH. Instead of getting a quick signature, the research team slows the conversation. They want to ensure the caregivers understand the potential risks and that the potential benefits aren't guaranteed. Over the next hour, the caregivers talk more about the joys and frustrations of parenthood than the research project. Once the research team believes the caregivers can make an informed decision, they share the project details. 

Dedicated Labs and Pharmacists 

After caregivers give consent, data collection can begin. ACH has labs and pharmacists dedicated to research studies. Being solely focused on the studies ensures the integrity of the research. Spriggs first contacts the pharmacists if an interventional study involves a new medication, sometimes requiring specialized syringes or containers. Spriggs often recruits PICU nurses if blood samples are needed, thanking them with candy for going above and beyond their regular duties. She regularly provides educational materials on active studies, especially interventional studies, because, she said, "Research wouldn't move forward without help from the bedside staff."  

Arkansas Children's is home to around 80 research coordinators across all departments. Research coordinators, like Spriggs, champion children every day by dedicating themselves to work that focuses on making a healthier tomorrow.