Georgia Tech’s Stewart School of Industrial and Systems Engineering (ISyE) and the Pediatric Heart Network (PHN) led an interdisciplinary team named as one of six finalists for the Institute for Operations Research and the Management Sciences (INFORMS) Franz Edelman Award. The Edelman Award is a prestigious honor given for achievement in the practice of advanced analytics and operations research. For more than four decades, Edelman finalists have been recognized for revolutionary contributions that transform some of the world’s most complex problems. ISyE is the No. 1-ranked industrial engineering program in the U.S. PHN is a cooperative research effort between leading medical centers and the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH).
Congenital heart defects are the most common birth defect, occurring in around one percent of births. They are the most common cause of infant deaths due to birth defects, and survivors often face health issues into adulthood. Congenital heart defects impact nearly 2.5 million children and adults in the United States. However, a lack of standard guidelines for either pre-, intra-, or post-surgical care had resulted in substantial inconsistencies in surgical outcomes among different health care centers. To remedy this, PHN (which is funded by NHLBI) partnered with ISyE to create and implement clinical practice guidelines (CPGs) to reduce inconsistent cardiac surgical outcomes and improve the care of children who require heart surgery.
“This marks the first time a network of pediatric clinical sites has been selected as a Franz Edelman finalist. The Georgia Tech team is extremely honored to be working alongside these outstanding clinicians who are dedicated to advancing clinical care and saving the lives of these fragile children,” said Georgia Tech Professor Eva Lee. Lee holds ISyE’s Virginia C. and Joseph C. Mello Chair, and she is the director of the Center for Operations Research in Medicine and HealthCare, a center established by sponsorship from the National Science Foundation (NSF) and the Whitaker Foundation. Lee first won the Edelman Award in 2007 with Dr. Marco Zaider from Memorial Sloan Kettering Cancer Institute for innovative advances in cancer treatment.
“To be selected as a Franz Edelman finalist, which recognizes the greatest achievements in operations research and analytics, is an incredible testament to the hard work and dedication of so many,” said Dr. Gail Pearson, PHN director and associate director of the Division of Cardiovascular Sciences at NHLBI. “We are tremendously honored that our application of operations research to improving the lives for patients with congenital heart defects has had such an impact.”
“To be named as a finalist is an incredible honor and a strong testament to the value of developing novel strategies to advance medical outcomes,” said Dr. William Mahle, Marcus Professor of Pediatric Cardiology of Children’s Healthcare of Atlanta (CHOA). Dr. Mahle is the principal investigator of this project leading the clinical implementation. “We’re proud to be part of the PHN, which facilitates strong relationships between pediatric institutions across the country to foster collaboration and innovation. This project far exceeded our expectations, and we hope that this model of exchanging ideas and best practices across industries can lead to many more improvements in healthcare, including pediatric cardiac care, for years to come.”
The collaborative project, entitled “Collaborative Systems Analytics: Establishing Effective Clinical Practice Guidelines for Advancing Congenital Cardiac Care,” aims to decrease the time patients require intensive care, because long stays in the ICU are associated with both short- and long-term complications. The work showed that early removal of breathing tubes and lowering the rate of reintubation are key factors to swifter and fuller recoveries.
The study, which began in 2010, resulted in clinical practice guidelines for pre-, intra-, and post-surgical care of patients with congenital heart defects. The ISyE analytics team, led by Lee, along with her doctoral and undergraduate students, were in charge of devising a customizable model and decision support framework that combines systems modeling, simulation-optimization decision analytics, clustering and machine learning, and influence networks within a collaborative learning paradigm to improve clinical outcome. The team objectively observed, analytically pinpointed, and prioritized potential areas for focused collaborative learning. One of the key factors identified is early extubation (removal of the breathing tubes).
Cardiac patients often have their breathing tubes left in place for hours or days after heart surgery, thereby leaving them attached to a mechanical ventilator. Through round-robin site visits, deep learning, and consensus building, the team established a clinical practice guideline to reduce practice variation by extubating patients within six hours of admission to the cardiovascular ICU.
The team implemented the advanced practice of early extubation at four congenital heart programs through North America, including CHOA, in 2014. The new approach resulted in a reduced need for the mechanical ventilator following surgery, with the majority of patients able to breathe on their own within hours after surgery.
Additionally, the newly adopted strategy resulted in reduced (37-55 percent) need for pain medication (including opioid medications such as fentanyl), decreased time (24 percent) in the ICU, faster feeding (37 percent) by mouth post-surgery, and greatly reduced hospital costs for cardiac patients across participating sites (up to 27 percent, or $13,500 per surgical procedure).
“Across disciplines, there is an increased emphasis on both improving quality and reducing costs. This early extubation CPG has unique potential to improve value in infant heart surgery by both improving clinical outcomes and reducing costs.” said Lee. “It is rather unusual that such cost savings are realized so rapidly. This is very exciting, as it proves that sophisticated analytics can prioritize and help clinicians to focus on those factors that matter most.”
This work is partially supported by grants from the NSF and the NIH.
This year’s Edelman Award finalists include innovative projects by Intel, the Federal Communications Commission, Turner Broadcasting System, Inc., China National Petroleum Corporation, and Europcar. Lee, along with Drs. Michael Gaies of Mott Children’s Hospital, Pearson, and Mahle, presented the findings to a panel of judges in Baltimore, Maryland on April 16. The annual event drew over 1,000 attendees composed of the world’s leading professionals in analytics and operations research.