Shane Elmore, RN

A few weeks ago, I wrote about how we strive to improve the lives of ED Nurses and the patients they serve. This week, I want to focus on ED Doctors (did you know Pulsara was founded by one?). In this post, my aim is to help ED Doctors understand how a communication platform like Pulsara can make their lives better.

In my opinion, if there is any group in the hospital who doesn't get the love they deserve, it's the ED Nurses. ED Nurses are the front door of the hospital, but too often, they are treated as the doormat. When people are sick and hurting, they take it out on the people in front of them (as long as they aren't wearing a white coat). The ED nurse is the person who takes what comes at them and still provides the highest level of care and compassion for the patient. ED nurse, you are the first line of defense, and here at Pulsara, we salute you. Here are five areas where we're doing our best to help make your job a little easier and ultimately, improve your life and the lives of those you serve:

"Try and fail, but do not fail to try" - Stephen Kaggwa.

Have you ever felt like you made a mistake or failed as a leader? Of course you have, because all leaders -- whether in the hospital, EMS organization, or even the home -- have failed. What separates the best leaders from the rest of the pack is how they view their failures. For them, failure is a gift rather than a curse. They view failure as a way to assess a better way forward, an opportunity to learn, or an experience that will shape their next decision.

When it comes to healthcare, we track a lot of metrics. We know how many beds the hospital has and the number of annual ED visits. But there's one area that is still uncharted territory: just ask anyone in the hospital how many teams they have. I promise you will hear crickets.

At Pulsara, our focus is on real time TEAM communication that crosses healthcare entities. Okay, but which teams exactly are we referring to? While the answer is essentially endless (Pulsara can be used for ANY patient, ANY condition, ANY EMS or Hospital team member), here are 10 teams that immediately jump to mind when asked what our customers use Pulsara for.

Here at Pulsara, the vision is clear: to be the evidence-based standard of care.

What drives us tirelessly toward this ambitious goal? It's simple really: our team is comprised of many clinicians who have lived the pain and frustration of poor communication. We've seen its impact on the people who have placed their trust in us. And we’ve felt the impact on our own sense of competence, success, and job satisfaction. Our driving passion is to improve the lives of both patients and caregivers through innovative communication.

I want to discuss a story that at first might seem an unusual and even confusing topic for a Pulsara blog post, and I want to start out with a disclaimer that this post isn't about religion. I'll use the ancient story of the Tower of Babel from the Bible to illustrate my point, but hopefully all readers will be able to glean value from my words regardless of views, beliefs, or religion. 

What is loss aversion and how does it impact us in healthcare? 

In cognitive psychology and decision theory, loss aversion refers to people's tendency to prefer avoiding losses to acquiring similar gains: it is better to avoid losing $5 than it is to find or gain $5. 

The loss aversion mindset is widespread in healthcare, and it makes sense. I've noticed as I've met with customers that they are in love with the process that they've worked so hard to create. I know because I've been there! You put a lot of blood, sweat, and tears into making things work and work well.

To make matters worse, you put in all of this hard work when things were a mess. When starting a program like STEMI, Stroke or Trauma, the whole idea is to bring order out of chaos. Your job is to provide some level of predictability in an environment that is unpredictable in nature. You've likely lived through those tumultuous times and, more than anything, you just don't want to go back.

Hands down the most popular question we are asked by prospective clients is the following:

In healthcare especially, it can seem impossible to stand out from the pack. Everyone has a million things on their plates. Every move you make has an impact on people's well being. Everyone else is also working long hours, on their feet all day and night, and constantly feeling like there's more they need to know or new skills they are trying to acquire.

I’m sure this happens in every industry, but most of my experience is in healthcare -- have you ever worked with that person who seems to have an abundance of organizational knowledge? I’ve learned from some amazing people like that over the years, and I've found that many people function either as a river or a reservoir when it comes to how they share that wisdom. 

I don't know about you, but I love a good story about special military operations. I guess it's just cool to know that there are those people who have received specialized training to do a job that nobody else can do. Many of us have seen the heroics of Chris Kyle - American Sniper, or Seal Team 6. Secretly, I wish I were part of a team like that.

What if I told you that you have a special ops team within your department? I know what you're thinking, "Shane, you're crazy. My people are special but in a different way."

I recently read an article about how a young boy helped save his mother's life by getting an ambulance on its way, and it made me pause and think. The piece reminded that sometimes it’s the simple things that are most important.

Recently I was approached by a nurse who is the Director of the Operating Room at her hospital. She began to list the problems her team has with communication when they are called out for emergencies. She shared how they are struggling to get the right team to the right place in the right amount of time.

In a meeting recently, she was venting her frustrations, and a VP with Cardiac Services explained how they had struggled with problems like these for years, but since they purchased Pulsara, those issues are a thing of the past. She heard that the Stroke Team was using us too and they reported the same results.

Based off of those testimonials, this nurse reached out and asked if we could build another package specifically for her team to use. In business, there are many metrics for evaluating success, but you know you're doing something right when your current customer base is finding new problems for you to solve based off of other problems you've solved for them!

I knew this problem was dire for STEMI and stroke teams, but I was a bit surprised to learn this is a common problem with after hours Operating Room teams in the emergency setting. What is the issue? Why is it so hard to get the team called in for an emergent appendectomy, for example?

Every year, breast cancer claims 40,000 lives. The opioid epidemic causes 50,000 deaths per year. Motor vehicle crashes cause 38,000 deaths each year. And gun violence is responsible for 36,000 fatalities annually.

What if instead of recording treatment delays in minutes, your stroke coordinator recorded them in number of brain cells lost?

Would your team still say "Oh well, it's only five minutes, that's not too bad" if the metric referred to were "Only 10 million brain cells?"

As nurses, we have an interesting challenge: We need to make sure we are doing our jobs as quickly and efficiently as possible while still making sure to carefully pay attention to and make note of every detail in the care process. This can be especially tricky when it comes to conditions like stroke where every second makes a difference. 

I sometimes pick on ER physicians for hesitating to give tPA for stroke despite data that supports administering, but the responsibility isn't 100% theirs. Our nursing skills play an important part in ensuring that a patient stays within the guidelines. As hospital systems, sometimes we push a little too hard to go straight to CT, for example. In general, I think pushing to go directly to CT is a good thing ... but problems arise when we get tunnel vision and forget the little things that can make a difference down the line. John Wooden, the legendary basketball coach of the UCLA Bruins, has a famous quote that I love: "Be quick, but don't hurry." 

Silly pager, emergencies are for modern technology!

I've written on this topic before, but I heard a story a few days ago that made it worth revisiting. The following is an all-too-familiar scenario to anyone still trying to use outdated systems of patched-together technology to coordinate critical care. 

The nurse in the Emergency Department at a level II Trauma Center was receiving report from EMS. To be honest, I don't know if this was a telephone called report, or one given over the radio. At the end of the day, the point is that the information shared by EMS wasn't received by the ED due to a poor connection. The nurse heard wrist injury, with a list of other seemingly minor injuries. Though there was a period that the connection was abysmal, she thought she captured all the information.

When EMS arrived, they were told to go to room 10 which isn't one of the major trauma rooms. When the nurse walked into the room to take report "again," the medic vented his frustration about the Trauma Team not being present. Upon taking the bedside report, the nurse realized that during that poor connection, the MOA was high-speed roll-over with partial ejection.

What if you could get inside the mind of a Stroke Program Consultant who helps hospitals and EMS systems get ready for certification (through the Joint Commission, for example)? You'd probably want to know what things she commonly sees hospitals doing wrong. What tricks does she have for making sure your facility is ready?

Shane Elmore, Pulsara's Vice President for Clinical Innovation and Development, recently sat down for an interview with Debbie Roper, RN, MSN, President and Founder of Strokes R Us. Debbie is a consultant who travels across the country and advises hospitals that are going through the stroke certification process.