Since the inception of USF Emergency in 2003, our department has strived to become a preeminent training and research institution. Fast forward to present day, USF Emergency Medicine has led several projects that improve the outcome of patients within our department and the broader public health community.  Let’s take a look back at where we’ve been, where we are, and where we are going under the current direction of Dr. Jason Wilson. 

USF EM Prior Works

From 2003-2010, Dr. Rich Paula led the research department and USF participated in notable projects such as: The Protocolized Care for Early Septic Shock (ProCESS) trial, ADHEREM, and a multicenter trial investigating oseltamivir.  Following Dr. Paula, Drs. Gentry Wilkerson (2010-2011) and Preethi Joyce (2011-2013) served as our research directors and worked towards increasing our department’s participation in clinical trials and further developing the reputation of USF’s research department.  In 2013 Dr. Jason Wilson stepped into the role of research director and he continues to serve in this position today. 

2013-Current

Since becoming director in 2013, Dr. Wilson has advanced research in several important domains including the development of a resident research track that enables USF’s residents to invest in research to create systemic changes in healthcare. Under the leadership of Dr. Jason Wilson, the Acute Care Research Team provides 24/7 staffing (co-investigators, research nurses, research assistants) which has contributed to large scale expansion in the projects in the Emergency Department. Dr. Wilson’s vision has been to create a leading acute care research program with the ability to provide any drug, any device, or any intervention 24/7, at the same high level as clinical care. In addition, to this clinical work though, Wilson keeps an eye on how to move research to the bedside as well as to clinical operations by adapting hospital policies based on clinical trial findings.

Complementing the clinical excellence though is a focus on how social forces impact why emergency department patients arrive and why different patients have different healthcare outcomes. Prior training and continued work as a medical anthropologist has led to an integration of a social scientist and biocultural perspective into many of our study designs and an overarching goal to improve health inequities. 

Our department has completed several large industry sponsored research studies during Dr. Wilson’s tenure, as well as studies with national federal funding (e.g. NIH) and investigator initiated grants. ANENEXA-1 trial was a prospective study evaluating efficacy of a novel Xa Inhibitor in acute major bleeds. LEX-209 was a phase III trial also looking at bleeding reversal in anticoagulated patients with a new 4 factor concentrate. Several studies such as SOAR, UPSTREAM, and RE-COVERY DVT/PE studies, have investigated the efficacy and safety of oral anticoagulants. This department has also evaluated new medical advances such as the EZ-NG, coral snake antivenin and the Nephrocheck test. Other notable studies included the evaluation of discharging pulmonary embolism patients home on outpatient therapy (MERCURY PE), investigating the role of non-con CT abd/pelvis in acute abdominal pain, and reversal of ACE-I induced angioedema. The studies have led to novel pathway developments in our emergency department, including transitioning DVT and PE patients home on oral anticoagulants. Anticoagulant and management of bleeds on anticoagulants have become a specific area of expertise for Dr. Wilson who currently serves as the site PI for the ongoing ANNEXA-I and ANNEXA-S trials at Tampa General Hospital. The work on bleed management, as well as work to manage DVT and PE patients in the outpatient setting has landed Wilson on national guidelines committees, traveling multiple times over the last few years to the Dallas, Texas ACEP headquarters to discuss, write and disseminate that work out to the emergency medicine world.

Currently, we have several ongoing projects including but not limited to the FOCUS project (1.5 million dollar grant that supports HIV and HCV screening and linkage in the ED) and the National Institute of Drug Abuse (NIDA) sponsored ED-INNOVATION Buprenorphine Validation Network which builds off the previous work that Wilson has done to create medication for opioid use disorder (MOUD) at our hospital., Through the FOCUS project, Dr. Wilson has identified a need for HCV/HIV screening and created a process through which newly diagnosed hepatitis C and HIV patients are connected to appropriate care clinics. Over the last 4 years though, that work has led to other investigator initiated grants and emphasis on testing alternative HIV and HCV screening algorithms that recognize the acute nature of an ED encounter and drive towards more rapid turn around times for HIV and HCV viral RNA results. In the continued efforts to transition work outside of the hospital, the successful MOUD program and FOCUS efforts have also now led to a countywide Syringe Services Program (SSP) and a partnership with the USF Tampa Bay Street Medicine Program, conducting HIV/HCV screening and sterile syringe exchange in mobile units, as well as opening the door for potential pre-hospital research that may reduce hospital admissions.

The Acute Care Research Team

In its present form, the research group has matured to being called the “Acute Care Research Team.” The original concept for the group was to have research capabilities 24 hours a day, 7 days a week, 365 days a year, reflecting the way an ED operates.  This team is made up of 4 full-time research nurses, multiple research assistants, and 2 Anthropology PhD students. The research team is fully staffed 24/7/365. This team availability allows research enrollment to occur at any time of day. The relationship between the Acute Care Research Team and the USF Department of Anthropology and College of Public Health also continues to grow with faculty from those areas serving to oversee the SSP, as well as the collaborative support of the graduate students and program development. In 2020, Wilson was able to secure enough funding to add our first “post-doc” position as well, a recent PhD graduate who will focus on driving our qualitative and mixed-methods research forward.

Research in the Era of Covid-19

Florida began experiencing its first cases of Covid-19 in early March 2020. At a time when government officials were not concerned with community transmission, a research coalition was formed under the leadership of Dr. Wilson at Tampa General to address the growing public health threat. Since the formation of this coalition in March, University of South Florida and Tampa General Hospital were early participants in key studies during the Covid-19 pandemic. Important early initiatives we were involved in included participation in the clinical trials of hydroxychloroquine, remdesivir, the HERO trial, Toculizumab, and rapid antibody testing. 

The early months of the outbreak were brimming with uncertainty. With growing concerns of how a local outbreak would strain the healthcare system, the research coalition also worked on novel approaches to prepare for case surge. This included work on creating an outbreak model for the Tampa Bay area. This information was used in development of the disaster preparedness plan for TGH. When testing resources became strained, in collaboration with other departments, research projects were undertaken that included 3D printing of nasal swabs and alternatives for storage media for tests.  Our department continues to play an active role in Covid-19 research with multiple current studies actively enrolling. 

In addition, creatively meeting the challenges for seeing high volumes of Covid positive research patients, Wilson added Advanced Care Providers (PAs and ARNPs) to the research team, as well as the implementation of telemedicine to meet the changing the emergency medicine and acute healthcare clinical and research environment.

Community Impact

Dr. Wilson is committed to translating academic work to the public and finding ways to make relevant how changes in healthcare affect his local community but also how social forces impact health. Dr. Wilson is active in organized medicine as a member of the FCEP Government Affairs committee and has also appeared in the press with State Senator Janet Cruz and Mayor Jane Castor (with whom he was a guest on a one hour public Covid information session). In addition, Wilson has been a frequent guest on local, national (CNN) and international news outlets (BBC) to discuss research, Covid and the impacts of Covid on school reopening.     

Dr. Wilson has also carried a substantial social media presence. Accelerated by the necessity of evidence-based community dialogue, Dr. Wilson regularly posts updates to the community on our local Covid-19 response (some of his posts have been shared hundreds of times) and have included weekly updates on case growth in the early outbreak as well as summary weekly blog posts. Wilson has worked with the Hillsborough County Emergency Policy Group, advising local elected leaders on Covid mitigation strategies and was a key voice in their vote to mandate masks during an outbreak surge. In addition, Wilson has worked closely with the public schools trying to find reasonable pathways for reopening, frequently meeting with the Superintendent and school board. Taking the time to address the public's questions, both an individual basis as well with broad messaging, shows the drive Dr. Wilson has to improve public health both on and off shift.

USF is a Great Place to Train & Work

Dr. Wilson has undoubtedly strengthened the research department at USF Emergency Medicine.  His leadership and the development of the Acute Care Research Team make USF a great place to work for faculty and residents looking to conduct research. In addition, Wilson’s national seat at the table for anticoagulation and bleed management research positions our hospital well for future studies and his grant support has added multiple full time researchers who drive the program forward. The emphasis on clinical excellence with a special niche in social science and biocultural approaches through the relationship with USF Anthropology really makes USF Emergency Medicine stand out from other places. Residents have a unique opportunity to become involved with research at USF.  Whether you’re looking to conduct your own clinical trial, or research really isn’t your thing and you’d rather be involved in the periphery, USF provides an exceptional opportunity to get involved with research and public health advocacy. 

About the Authors

Dr. Jared Senvisky (Class of 2022) and Vincent Costers (Class of 2023) are current USF residents. Dr. Senvisky attended medical school at Northeast Ohio. When he’s not working hard in the department, he enjoys spending time with his wife and cats and paddling around the Bay. Dr. Costers graduated medical school at USF, and like a true Floridian, he enjoys fishing, traveling, and enjoying time with his wife and family.

Post edited by Dr. Enola Okonkwo