Innovations in Healthcare and Technology

Cedars-Sinai continues to champion—and seek out—novel approaches to improving the health of patients in clinics across the country. The Campaign for Cedars-Sinai accelerated the pace of discovery by utilizing technology designed to yield invaluable benefits for people in our community and beyond.

Reinventing the OR

Cedars-Sinai surgeons and investigators partnered with the United States military to design the operating room (OR) of the future, enabling emergency medical teams to respond more effectively to patients with life-threating injuries. Under the project, called OR 360, research teams reconfigured the OR with movable walls and equipment for more flexible use, identified ways to eliminate disruptions during surgery, and developed an iPhone app that provides diagnostic information about blood pressure and other vital signs before a patient arrives at the emergency room. The initiative, drawing on practices from surgery, psychology, aviation and other disciplines, addressed potential breakdowns in the coordination of trauma care during the so-called golden hour, when prompt medical attention can mean the difference between life and death. OR 360 has reduced medical errors as much as 50 percent.

Digital Tools for Healthy Lives

An ongoing investigation at Cedars-Sinai examines the use of virtual reality goggles to ease patients' stress. The study, recently published in JMIR Mental Health (and co-authored by Brennan Spiegel, MD, director of Health Services Research and Clinical Transformation), found that virtual reality therapy is effective in significantly reducing pain for hospitalized patients. Another recent study sought to determine whether the language people use on Twitter to describe their health could provide clinically meaningful insights into a patient's quality of life. This innovation, also spearheaded by Spiegel, could ultimately help caregivers understand, in a cost-effective and timely manner, the comparative value of prescribed therapies and ensure that patients receive the treatments most appropriate for their individual needs.

In 2014, Spiegel was appointed to lead the new Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), overseeing a digital health strategy aimed at enhancing quality and reducing excessive use of resources. His team of investigators transformed the way patients, doctors and hospitals communicate through innovations. For instance, wearable biosensors track patients' vital signs and activities at home, and the data is transmitted to electronic medical records. Investigators also developed computer programs that allow patients to explain their medical histories online at home, saving time and providing up-todate information for doctors.

Virtual reality therapy is effective in significantly reducing pain for hospitalized patients.

Building for the Future

As Cedars-Sinai expands its areas of specialty and increases its patient population, the institution also seeks to meet the explosive rise in demand for new, state-of-the-art clinical and research spaces. The Advanced Health Sciences Pavilion, which opened in summer 2013, is instrumental in fulfilling this need and in broadening the medical center's reach in the community. The 11-story, 820,000-square-foot healthcare facility is unique because it brings patient care and translational research together in one place, allowing physicians and scientists to collaborate closely in developing new procedures and treatments. This collaboration accelerates the pace of discovery—all that is discovered is quickly and safely translated into novel therapies that have a tangible and immediate impact on patients' lives.

The Pavilion, which accommodates about 600 patients each day, houses outpatient services for the Smidt Heart Institute as well as neurosciences, the Board of Governors Regenerative Medicine Institute and other programs, including:

• The Women's Guild Simulation Center for Advanced Clinical Skills, dedicated to training medical professionals with the newest tools and technology.
• The Sue and Bill Gross Surgery and Procedure Center, a state-of-the-art facility featuring eight general surgical rooms, two interventional radiology rooms and two cardiac catheterization laboratories.

The Campaign for Cedars-Sinai focused on innovation at the scientific, clinical, technological and even architectural levels. The Pavilion was awarded Leadership in Energy and Environmental Design (LEED) Gold certification from the U.S. Green Building Council. This distinction recognized the Pavilion as meeting or exceeding the strategic elements of sustainability, including energy and atmosphere, materials and resources, water efficiency, indoor environmental quality and overall sustainability that minimizes the impact on ecosystems and natural resources.

Next-Generation Imaging

At the Biomedical Imaging Research Institute, experts worked to improve the diagnosis and treatment of patients, as well as their preventive care, by developing novel medical imaging technology. An interdisciplinary team at the institute received a prestigious grant from the National Institutes of Health (NIH) to develop an advanced imaging technique that provides doctors with a detailed roadmap to disorders of the spine, identifying a biomarker that can be an indicator of disc degeneration and pain. Director Debiao Li, PhD, the Karl Storz Chair in Minimally Invasive Surgery in honor of Dr. George Berci, and her team:

• Received a $3.3 million NIH grant to develop a noninvasive, radiation-free MRI technique for detecting myocardial ischemia. The condition is a reduction in blood flow that commonly results from coronary artery disease and can lead to heart attack. An early diagnosis could help save lives.
• Received a $1.7 million NIH award to develop and validate a 3D MRI technique to identify plaques in the carotid arteries that may trigger neurovascular events such as a stroke or transient ischemic attack. The new technique, unlike traditional MRI, does not require contrast agents to enhance the image.
• Developed technology behind functional MRI of the heart, showing the coronary information of an angiogram, plus functional data such as blood flow and muscle injury, adding temporal resolution to special information to give cardiologists the most complete 3D image, which enables more accurate treatment decisions.

Accelerating the pace of discovery to impact patients' lives.

New Possibilities in Transplant Medicine

Across the medical center, scientists and clinicians worked together to make critical advancements in transplant medicine—important initiatives that will create new possibilities for patients in vital need of new organs.

The Campaign for Cedars-Sinai helped support promising clinical research that will change the lives of patients here and across the country, including:

• Successful advancement of the paired exchange initiative by the Cedars-Sinai Kidney Transplant Program. Teams in six operating rooms simultaneously performed three laparoscopic nephrectomies on donors and three transplantations in patients. Paired exchange programs allow donor-recipient duos to swap living-donor kidneys with others in need, providing a vital option for patients who are incompatible with the friends or family members who are willing to be their donors.
• An investigation into intravenous immunoglobulin therapy, a process that prevents the body from attacking a newly transplanted kidney in highly sensitized patients—who comprise approximately 40 percent of all kidney transplant recipients. The research was conducted by Stanley Jordan, MD, director of the Division of Nephrology, medical director of the Kidney Transplant Program, and medical director of the Human Leukocyte Antigen and Transplant Immunology Laboratory.
• Progress toward determining whether a transplanted organ will be rejected before the procedure even begins. The protein human leukocyte antigen is essential to matching organ donors to transplant patients. But rejection of the transplanted organ may still occur because of donor-specific HLA antibodies, which some patients have in their systems due to previous transplants or exposure to blood products. The findings could help safeguard transplanted organs by enabling doctors to better plan appropriate clinical interventions.
• An outpatient program implemented by Cedars-Sinai Pharmacy Services to support patients with complex medical conditions, including those who have had transplants. A team-wide effort helped patients understand how to take their prescriptions, what to do if they missed a dose, how to manage side effects and how to dispose of medications that are no longer needed.
• Research to speed the emergence of cell therapy as a means of treatment for, and prevention of, transplant rejection. Faculty in the Kidney Transplant Program participated with experts from the University of California, San Francisco to create a novel therapeutic agent derived from a patient's own T cells. This may suppress inflammation and regulate immune response, potentially staving off kidney transplant rejection. This agent may also enable physicians to minimize immunosuppressive drugs—and in the process, prevent dangerous side effects.

Excellence in Orthopaedics

Cedars-Sinai Orthopaedics, established in 2016, appointed internationally renowned surgeon Mark Vrahas, MD, as founding chair and the Levin/Gordon Distinguished Chair in Orthopaedics in honor of Myles Cohen, MD. The creation of the department brought together some of the nation's leading experts in the field. Since its founding, Orthopaedics has seen its ranking by U.S. News & World Report improve—from No. 10 to No. 9, well ahead of other world-class programs at similar institutions. In just the last year, researchers in the department published 113 scientific papers in peer-reviewed journals and presented 161 papers at major meetings.

The department also continued to add training programs, residencies and fellowships—positions in the spine, trauma and sports fellowship programs are highly sought. This past year, an arthroplasty fellowship was established, and there are plans to add a hand and upper extremity fellowship next year.