The National Institutes of Health Clinical Center is the nation’s largest hospital dedicated exclusively to clinical research, with over 3.3 million square feet of facilities committed to advancing patient outcomes through clinical investigation.
by Lori Sichtermann
The National Institutes of Health (NIH)—part of the US Department of Health and Human Services—is known throughout the world for being one of the largest and most advanced clinical research centers. Yet, as its staff reveals, the institute has some unknown attributes as well.
For more than a century, scientists and physicians at the Bethesda, Md-based campus have paved the way for discoveries that have improved health and saved lives. According to the NIH, 144 Nobel Prize winners have received support from the institute; their studies have gone on to develop magnetic resonance imaging (MRI), led to understanding how viruses can cause cancer, provided insights into cholesterol control, and have explained how the brain processes visual information.
For all that has been accomplished by the country’s leading research institution, there is a profoundly large element of the NIH that is unbeknownst to many: its hospital.
Much of the groundbreaking research that takes place at the NIH occurs in one of two state-of-the-art facilities: The Warren Grant Magnuson Clinical Center, a 14-story, 2.5 million-square-foot building that houses 15 outpatient clinics and the Department of Laboratory Medicine. Also on campus is the 870,000-square-foot Mark O. Hatfield Clinical Research Center, which features 240 inpatient beds and 82 day-hospital stations. Together, these buildings house more than 1,200 credentialed physicians, dentists, PhD researchers, and an estimated 620 nurses.
“The whole mission of the NIH is designed to enhance the health of the nation. As a result, we have a number of different departments that have protocols designed to study unusual disease processes,” said Dennis Brown, RRT, Section Chief, Critical Care Therapy and Respiratory Care Section. “The flip side to this is that much of the public doesn’t realize there’s an actual hospital here—the Clinical Center—that houses these departments. The common thought is that we are a research facility, which is true. But we also have doctors, nurses, and physicians who treat patients in a hospital setting. These patients range from noncritical to severely ill.”
Brown and his team in the Respiratory Care Department are charged with assisting the numerous ongoing research protocols taking place within the Clinical Center. The tasks are varied, and the specializations are broad. Yet, as Brown explained, the respiratory therapists and technicians within his department have the advanced skills and knowledge to provide care to patients who have multiple system problems, much of which involve respiratory issues.
“Our entire staff is trained to deal with those unknowns,” he added. “That’s one of the unique aspects about the respiratory department at the NIH.”
What It Takes
Inside the Mark O. Hatfield Clinical Research Center is a talented and diverse group of 22 respiratory therapists, two ECG technicians, and one equipment technician. These individuals make up the Respiratory Care and Therapy Service Department at the NIH.
On a daily basis, these professionals help to shape the world’s understanding of respiratory research by working with patients in the department’s ICU, heart station, inpatient/outpatient nursing units, and the pentamidine laboratory, which provides aerosolized pentamidine treatments to immunosuppressed patients for the prevention of pneumonia.
Therapists and technicians in the Respiratory Care Department are also involved in the institute’s stat laboratory, which serves patients in the ICU. Here, the team performs blood glucose and electrolyte analysis and test for activated clotting times in patients on continuous renal replacement therapy. According to the NIH, the stat laboratory has a rapid turnaround rate, which allows ICU care providers to make quick decisions regarding patient treatment.
What’s more, Brown and his team of therapists in the respiratory department also routinely perform studies of indirect calorimetry—a method of estimating energy expenditure by measuring respiratory gases, oxygen and carbon dioxide—in support of various Clinical Center protocols designated to the department’s metabolic cart consult service.
“Pretty much every service we provide within the Respiratory Care Department supports the ongoing research here at the NIH,” noted Nicole N. Sartain, BS, RRT, education coordinator for Respiratory Care and Therapy Service. “As a department, we’re extremely versatile in our abilities to be in so many different settings of the Clinical Center and provide respiratory care and expertise. That’s very unique to the NIH, and it’s very rewarding as well.”
For the Respiratory Care Department, tasks may range from the systematic to the extremely complex. Yet, as Brown explained, the types of diseases he and his staff encounter at the NIH are not the same ones that are commonly found in community-based hospitals.
“We have a very unusual patient population. We don’t see a lot of asthma patients or COPD. Instead, we see new diseases and processes that are unknown,” he said. “The most common of these disorders are hematologic malignancies, solid tumors, and patients who have inherited diseases of immunity. We do a lot of research in those particular areas.”
The NIH Clinical Center sees 10,000 new patients each year, as well as 6,000 inpatient admissions and 105,000 outpatient visits annually. For those patients who require respiratory therapy at the NIH, they are privy to some of the most innovative treatments.
According to Brown, his department is constantly pushing the envelope when it comes to new treatments and respiratory research. Current highlights include the use of nitric oxide during catheterization in the MRI suite, as well as the administering of novel inhaled therapies. The department also is working with patients with bronchiolitis obliterans after stem cell transplant, as well as the use of inhaled carbon monoxide as an acute anti-inflammatory agent.
“There are some exciting things happening within the hospital today,” Brown noted. “As a department, we’re excited because we get to contribute our expertise within those areas.”
A Cohesive Team
For the Respiratory Care and Therapy Service Department at the NIH, education is the name of the game. As Brown explained, the therapists and technicians working within his department are responsible for a range of patients. Thus, the department is adamant about educating its staff, in order to deliver the best quality of care to each patient.
“When new professionals come on board, they are subjected to a minimum of 6 weeks’ worth of orientation, which includes an overview on the various protocols that we support,” Brown said. “If an error is made during a protocol, or if something is not done on a timely basis or is completed outside the limits of the protocol, that patient can be excluded from the research that’s under way.”
As the education coordinator, Sartain is responsible for making sure each member of the department is current on all information related to a specific protocol or disease, as well as providing the therapists and technicians within the department with information on what to expect with certain disease processes.
“Our staff is multiskilled, and they’re responsible for many different aspects that occur here in the Clinical Center,” Sartain said. “Because of that, it’s important that they know about all of the moving parts that go on here, and that they are completely competent in all aspects of respiratory therapy.”
Brown and Sartain noted that the culture within the Respiratory Care Department at the NIH is one of camaraderie and respect, and those feelings extend into the various departments respiratory therapists and technicians work in throughout the institution.
“The thing I’m most proud about in our department is our autonomy,” Sartain said. “We work really well with the whole multidisciplinary team, but especially with the critical care physicians. This is a teaching hospital, so we work closely with the fellows when they rotate through. I feel like they take stock in what we say when we make suggestions regarding patient care.”
A Progressing Industry
It’s no secret that the respiratory care profession is evolving and the demands placed on RTs today are considerably more challenging and nuanced than they were only a decade ago. But, as Sartain noted, the respiratory technology of the future is filled with advancements.
“Our field is so fast-growing with electronic documentation and everything we can do with that technology, it’s amazing,” she said. “We can download patient information from the mechanical ventilator and apply that into a usable format where we can manipulate the effectiveness of the therapies that we’re doing for the patient. This type of technology really supports our department.”
What’s more, Sartain explained that the department’s documentation systems are designed for specialized research. Team members are able to pool all data collected from patient documents and then utilize it for advanced areas of research. “Using this technology, we can see if our therapies are making a difference in the patient’s care and to make the therapy more beneficial to the patient.”
From an administration perspective, NIH management can access and conduct real-time analysis of data in order to assess the productivity of its team members and to improve the use of department resources. Despite any technological advances in the industry, the NIH believes the best investment is in its staff, and therapists and technicians are encouraged to continue their education throughout their careers.
“The future of our profession is to strive to follow our allied health counterparts and have a higher level of required education—at least starting with a bachelor and then going toward master’s and post-docs,” Brown said. “That’s really what will bring our profession as a whole to the next level.”
The topic of continuing education is an issue that is close to Brown, who started his career with the NIH in 1976 as an equipment technician. Through continued education and the support of the staff, he was able to advance to department director, as well as assist with some of the most groundbreaking research within the field.
The department also is heavily involved with teaching other members within the NIH Clinical Center the important issues of respiratory care. As Sartain explained, the Respiratory Care Department works with physicians and nurses in a simulation environment that helps to evaluate the competency levels of staff and to improve interventions for critically ill patients.
“The area of respiratory education is extremely important. Having a staff that is very knowledgeable and skilled in specialized areas increases the quality of care throughout the NIH,” said Brown.
On a daily basis, Brown and his respiratory care team tackle clinical protocols. “I’m very much involved in talking with principal investigators about what to administer via the numerous protocols and how that impacts the Respiratory Care Department,” he said. “Many of these systems involve air polarization of various drugs or special delivery devices that we may not be aware of. Regardless, we receive the training and education and are able to use those devices.”
At the world’s foremost research institute, thankfully, the work is never finished. As both Brown and Sartain noted, there is always something new, something that’s exciting to investigate, and something pivotal to share with the medical community. “We’re happy to be able to contribute,” Sartain said.
“Over the years, I’ve seen a lot of change in the NIH and the respiratory care profession,” Brown said. “It’s a great place to work. We do things that are different and exciting, which keeps the staff excited about coming to work. That’s what is unique about this environment that we work in.” RT