AHA's Rural Podcast Series

00;00;00;08 - 00;00;18;01
Tom Haederle
Welcome to Advancing Health. Today we learn about geriatric psychiatric programs offered by two rural New England hospitals, and how both organizations are leaning in to meet the mental health needs of older adults in their communities.

00;00;18;04 - 00;00;43;10
Rebecca Chickey
My name is Rebecca, and I'm the vice president of the Health and Trustee services for the American Hospital Association. And it's my honor today to be joined by three leaders at rural hospitals who are improving access to mental health services in their rural communities. I am joined by Holly McCormack, who is president and chief executive officer of Cottage Hospital.

00;00;43;13 - 00;01;24;09
Rebecca Chickey
I'm also joined by Doctor who is a consultant psychiatrist and medical director at senior Behavioral Health unit at Sharon Hospital, which is part of Northwell Health, and as well the CEO and president of Sharon Hospital, part of Northwell Health. Christina McCullough rounds out this wonderful panel discussion today. So I'm going to jump right in. And Holly, I'm going to start with you, if I may share with the listeners a little bit about Cottage Hospital and why you decided to open your unit for older adult behavioral health care called the Ray of Hope.

00;01;24;15 - 00;01;49;05
Holly McCormack, DNP, RN
Sure. Happy to. So Cottage Hospital is an independent critical access hospital located in Woodsville, New Hampshire. We were founded in 1903, and at the time, the community built this hospital to respond to a lot of surgical type needs that were happening, from injuries related to working in logging and other industry in the area. And so we have been here supporting our community for over 123 years now.

00;01;49;10 - 00;02;20;06
Holly McCormack, DNP, RN
We are a 35 bed critical access hospital, and that's because we have our 25 bed hospital with our med surge unit and our ICU beds, but we also have a ten bed distinct part unit that is focused on geriatric behavioral health. And so we call that unit the Ray of Hope unit. We also have multi-specialty rural health clinic across the street from a hospital campus which has internal medicine, podiatry, endocrinology and behavioral health integrated into the care there as well.

00;02;20;14 - 00;02;44;16
Holly McCormack, DNP, RN
So the Ray of Hope unit was opened in 2016 as a response to the behavioral health crisis that was happening in New Hampshire. We found that a lot of hospitals were boarding behavioral health patients in the emergency department, and we decided to do something to become part of the solution. The demographic of Woodsville, New Hampshire, tends to be older, and we have a lot of older adults in our community and in communities that we serve.

00;02;44;17 - 00;03;05;10
Holly McCormack, DNP, RN
So this made a lot of sense for us. So early in 2016, we had a unit that we were using for physical therapy. We moved them to a different part of the building, and we were able to redesign this unit to safely house acute beds for ten Jerry psych patients. And so on October 1st of 2016, the unit opened.

00;03;05;16 - 00;03;15;16
Rebecca Chickey
What is the unit look like for the listeners? If you can paint a picture of what it looks like and also how it's staffed, because with only ten beds, I know that can be a challenge.

00;03;15;23 - 00;03;53;28
Holly McCormack, DNP, RN
Yeah. So the unit has ten private bedrooms. The unit is painted in calming colors that you would see in nature. So sage green, a lovely cream yellow color that we find to be very soothing. The artwork on the walls is inspired from local landmarks, but also things that might inspire. Reminiscing when patients are to tour the unit. One of the pictures is very popular is we have a photo of older trucks that look like they're rusting in a field, but you wouldn't believe how many patients actually gather on the picture and talk about having had a truck like that in their younger years, or knowing what kind of truck that was, or knowing somebody that

00;03;53;28 - 00;04;16;01
Holly McCormack, DNP, RN
had that truck. So it's very interesting. We have an activities room. We have a quiet room so that we can separate patients if they need a space that's quieter while we're doing group therapies. And then we also have an outside area with a patio where patients can go and be in a covered space outdoors. And we have raised garden beds so that they can work in the garden beds.

00;04;16;01 - 00;04;51;11
Holly McCormack, DNP, RN
Or sometimes we'll just do our morning activities and our morning stretch out there. The unit is staffed with registered nurses, lens nursing assistants. We have a recreational therapist, a licensed clinical social worker, and we have a psychiatrist that is affiliated with the local academic medical center that oversees the aprons, who are on site seven days a week, and that relationship with the local academic medical center, providing the expertise has been a way for us to have this specialized care locally, where we don't have to transfer people to a higher level of care.

00;04;51;13 - 00;05;14;24
Rebecca Chickey
I think that is great. I grew up in rural Alabama, and so I know how important it is for individuals to be able to stay close to their community, to stay close to their homes. And that provides a healing element that I think is hard to measure. But when you talk to the patients, equally important. And so that's my next question to you.

00;05;15;00 - 00;05;26;00
Rebecca Chickey
What type of patients do you treat in terms of diagnoses, and what impact have you seen? What's been the response from the community and from the families that you've helped as well of those you treat?

00;05;26;06 - 00;05;42;03
Holly McCormack, DNP, RN
The patients and families that we treat are very thankful to be able to have a place in the state of New Hampshire where we can care and provide the specialty care for them. But we've not only cared for patients in the state of New Hampshire, we provide care to patients in the state of Vermont and also Maine and Massachusetts as well.

00;05;42;10 - 00;06;10;21
Holly McCormack, DNP, RN
These specialty units are very hard to come by, and typically we'll have a waiting list for patients to get into the beds on our unit. In the state of New Hampshire, there are 221 towns, and we have represented patients from 110 of those towns so far. And we typically see diagnosis such as depression, bipolar or dementia schizophrenia. But the providers on the unit describe Jerry psych as complex and involving overlaps of psychiatry and neurology, internal medicine and palliative care.

00;06;10;27 - 00;06;14;12
Holly McCormack, DNP, RN
Those are the types of things when you see patients in this particular age group.

00;06;14;17 - 00;06;42;09
Rebecca Chickey
It's interesting. There's been a lot of discussion over the last couple of decades around med psych units. And I think that geriatric psychiatric units by default are medical psychiatry units, because by the time you're over 65, more than likely you have more than one comorbid physical condition, much less a mental illness or addiction. So such an important aspect of care to bring to a critical access hospital, to any rural hospital itself.

00;06;42;16 - 00;06;58;24
Rebecca Chickey
So thank you so, so much. It is my honor now to transition to Sharon Hospital. So doctor, tell us a little about Sharon Hospital and why the organization decided to open your senior behavioral health unit.

00;06;58;27 - 00;07;30;06
Sabooh Mubbashar, M.D.
It was established more than 20 years ago, and this was in response to a growing recognition that the rural communities, they really lacked adequate resources for older adults suffering from severe psychiatric and neurobehavioral illnesses. And as Holly mentioned, this is truly an area of great need. Just given the statistics of geriatric psychiatric problems that we are dealing with, which are actually expected to double in the coming decade.

00;07;30;08 - 00;07;59;24
Sabooh Mubbashar, M.D.
I personally have been involved in this role as the medical director with a unit for about 18 years. Probably also goes to show how much I believe in the work that we're doing. Despite the hospital and the unit being located in a rural community. You know, we started out with an 11 bed geriatric unit, and the demand increased so significantly that we then expanded into a 17 bed inpatient unit, as Holly was mentioning.

00;07;59;26 - 00;08;30;17
Sabooh Mubbashar, M.D.
We received referrals from much larger metropolitan areas, including New Haven, Hartford, Albany, upstate New York areas, Massachusetts. And I think some of that all to do with the unique location of Sharon Hospital, because we're at the northwest border of Connecticut. So we are right at the at the border of New York and Massachusetts. But also it has a lot to do with the with the very unique patient population that we serve.

00;08;30;22 - 00;08;38;16
Sabooh Mubbashar, M.D.
Expansion is really part of, as I said, much larger national reality with the patient population that we serve.

00;08;38;22 - 00;09;01;23
Rebecca Chickey
Well, the baby boomers are aging. And I think I heard a statistic about something like 10,000 people turned 65 every day. So if one out of every four of those has a psychiatric or substance use disorder in the year, then the math is clear that the demand is going to increase. Holly shared what her unit looks like physically and how it's staffed.

00;09;01;24 - 00;09;06;01
Rebecca Chickey
Can you share some similar perspectives for the listeners?

00;09;06;04 - 00;09;35;04
Sabooh Mubbashar, M.D.
Absolutely. So, you know, I think that given the uniqueness of this population, as Holly was describing it, I could hear a lot of overlapping themes. So what makes geriatric psychiatry unique is that, you know, their symptoms in psychiatry are rarely isolated from the rest of medicine. These are patients with significant medical frailties, mobility limitations, swallowing difficulties, chronic medical illnesses.

00;09;35;04 - 00;10;13;08
Sabooh Mubbashar, M.D.
So as far as the multidisciplinary care model is concerned, all patients getting admitted to our 17 bed unit get evaluated by a psychiatrist and an internist within 24 hours of admission, or multidisciplinary team has physical therapy, occupational therapy, speech therapy, and these evaluations are all completed within 24 to 48 hours of admission. Because these are again frail patients from nursing homes, sometimes from community, high aspiration risks functional decline around their mobility.

00;10;13;09 - 00;10;51;23
Sabooh Mubbashar, M.D.
So we really like to get a sense from the get go about what we're working with from the moment they come in. A staffing includes registered nurses, licensed practical nurses, mental health workers, full time social workers, activity therapists and we also actually incorporate massage therapy several days per week. And we also have pet therapy several times a month as part of our therapeutic environment, because we find that both these modalities actually go a really, really long way in helping some of these patients.

00;10;51;23 - 00;11;16;14
Sabooh Mubbashar, M.D.
So the structure of the unit is that we have five private rooms, we have six semi-private rooms, we have two large day rooms and two small TV rooms. We also have a quiet room, as Holly mentioned, which is to, you know, separate if a patient is looking for a relatively low stimulation environment. So we can utilize that from time to time as well.

00;11;16;16 - 00;11;39;17
Rebecca Chickey
Both of those units sound so phenomenal, both in their structure, their staffing, and the incredibly integrated way in which you treat the whole person, not just their mental illness or addiction, but all of their health and getting upstream about it when they're first admitted so that you're not dealing with complications later on. Thank you so much for that.

00;11;39;18 - 00;12;03;06
Rebecca Chickey
I'm going to turn now to Christina, president of Sharon Hospital. And Christina, the two programs that have been described here are really for older adults in need of acute inpatient psychiatric care. But Sharon has begun to go upstream to provide prevention services. Can you share a bit about the senior meals program for adults aged 65 and older?

00;12;03;08 - 00;12;40;02
Christina McCulloch, RN
Yes. Thank you Rebecca. So our senior meals program has really been an honor to stand up here at Sharon Hospital. Our journey really started over a year ago and looking at our community through our community health needs assessment, through assessing our service area that we serve. And there were a few themes that were identified through that assessment. The first is really emphasizing that we are serving an aging population, and we really needed to implement new measures and initiatives to really support the full well-being of the seniors in our community.

00;12;40;07 - 00;13;17;18
Christina McCulloch, RN
28% of Sharon Hospital's service area is age 65 or greater, compared to the average 19% nationally, the significantly higher. And when we look at our future predictions, we know that that population is only going to grow as both Holly and doctor had mentioned. Also, through our assessment, we identified two other opportunities, one being food security, especially in a rural setting where transportation isn't as easily accessible as some other communities in the in the last being mental health.

00;13;17;19 - 00;13;46;25
Christina McCulloch, RN
And so when we looked at these opportunities, we saw a program at one of our sister hospitals that they called the Senior Supper Program, and we set forth to implement that program on a small scale. Here in Sharon, we call it the Senior Meals Program. We started with providing meals at lunchtime at a discounted rate. So we were able to provide affordable, healthy meals to seniors in our community here at the hospital.

00;13;47;02 - 00;14;12;28
Christina McCulloch, RN
We saw that there was great interest in the program. There was a lot of demand. So over the year we grew. We added days that the service was available. We added educational seminars, we invited clinicians, we hosted dinners, and the program really has grown into what it is today, which we call the C program. It's a senior education and engagement program.

00;14;13;04 - 00;14;38;18
Christina McCulloch, RN
We're looking to further expand this program so that we can have these offerings outside of the hospital, out in the community. We've already hosted a couple of events at different settings in different towns in our community, where seniors can go out to a venue, have a nice meal, listen, connect with one of our clinicians on a topic related to aging.

00;14;38;21 - 00;14;59;08
Christina McCulloch, RN
We've done seminars on heart healthy fall prevention, and so our goal over the next year is really to continue to expand. In addition to having affordable, accessible meals, this is really helping to combat that social isolation that so many of our seniors are facing in our community.

00;14;59;09 - 00;15;35;20
Rebecca Chickey
So it sounds to me that you're addressing the loneliness epidemic that you are addressing food insecurity that you're able to perhaps prevent, as you indicated, the social isolation, which can often trigger depression, and really getting into the prevention mode so that perhaps you won't have to expand the unit again by more beds. I'd like to ask each of you to maybe give a sentence or two of what call to action would you share with the listeners?

00;15;35;21 - 00;15;37;11
Rebecca Chickey
Holly, I'll start with you.

00;15;37;15 - 00;16;00;26
Holly McCormack, DNP, RN
Well, I think what we've already discussed regarding the aging of our country and how important it is that we provide services for patients that need our help, especially the geriatric community. But it's not only the patients, it's the families. What we see with the caregivers often is there's a high degree of burnout trying to care for their loved one, trying to find the services they need for their loved one for many, many years now.

00;16;00;26 - 00;16;18;23
Holly McCormack, DNP, RN
And they are feeling guilty about not being able to provide that support. And so that's something that we need to consider. And it's also important for us when our patients come to us, they're frightened. They're often grieving. They're confused. Sometimes there's a loss of independence. And so we need to help them cope with that. And we need to help families cope with that.

00;16;18;24 - 00;16;40;13
Holly McCormack, DNP, RN
The last thing I'd like to leave with all of you about the Ray of hope is we say that we measure success differently at the ray of hope, and this came directly from my nurse practitioner that works on the unit. She likes to say we help people sleep through the night. We reduce fear, we reduce stress, we avoid restraints, and we return them safely to their community or to long term care environment.

00;16;40;13 - 00;16;46;20
Holly McCormack, DNP, RN
And we provide families with hope and guidance so that we can help them get through a very overwhelming time period.

00;16;46;22 - 00;17;06;00
Rebecca Chickey
I mean, if each and every one of us could go home every day saying that that's what we did with our time, what a beautiful place this would be. So thank you for that very much, doctor. I'll turn to you. How would you inspire others to go on this journey, since you've been doing it for 18 of the 20 years that the unit has been open?

00;17;06;02 - 00;17;47;25
Sabooh Mubbashar, M.D.
Yeah, I really believe that when it comes to serving this patient population, rural hospitals can make a profound difference when it comes to treating older adults with dignity, humanity and clinical sophistication. With the right model development that I'm very proud that we have been able to emulate at senior behavioral health, multidisciplinary infrastructure and a long term institutional commitment, rural programs can actually develop a highly specialized, niche serving population at times that larger tertiary care hospitals come to rely upon.

00;17;47;25 - 00;18;12;06
Sabooh Mubbashar, M.D.
So this only is not only is an area of great need, this can actually be a lifeline on many levels for rural hospitals. And I think I strongly feel that this is how it should be looked at as not only a clinical need, but something that actually would probably help the bottom line of most rural and small hospitals that are struggling.

00;18;12;10 - 00;18;40;19
Sabooh Mubbashar, M.D.
I'm very aware of the almost crisis like shortage of specialists, especially psychiatrist. Not well. Health now also has a residency program and we actually have residents rotate for about three months. And I can tell you as a as a teacher and mentor that they will routinely say that out of all of their rotations, working with geriatric patients is actually some of the most satisfying work that they do.

00;18;40;19 - 00;18;46;02
Sabooh Mubbashar, M.D.
So there is plenty of hope for us to be able to deal with this shortage of psychiatrists as well.

00;18;46;05 - 00;18;59;04
Rebecca Chickey
We need to get that message to every medical school across the country. So, Christina, I'd like you to bring us home. What are you going to leave the listeners with in terms of inspiring them to go on this journey with you?

00;18;59;04 - 00;19;31;04
Christina McCulloch, RN
So my call to action is for more advocacy. We need advocates not only for seniors and their families, but we need advocates for our hospitals, our communities. We need funding. We need resources in order to provide these services that have such a great impact on this population. And so advocacy is critical. And so my call to action is advocate for your community, advocate for your hospital, both at a local, state and federal level.

00;19;31;05 - 00;19;42;13
Christina McCulloch, RN
Because in order for us to provide these this comprehensive care to support the full well-being of our seniors, what we all do is crucial.

00;19;42;16 - 00;20;07;07
Rebecca Chickey
That's phenomenal. So, Holly, Christina, doctor, thank you so much for being willing to share your time and expertise with the listeners to inspire them to consider the fact that their rural hospital can become a center of excellence for the treatment of older adults with mental illness and or addiction. Thank you so much for what you do each and every day.

00;20;07;09 - 00;20;16;01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:06 - 00:00:16:02
Tom Haederle
Welcome to Advancing Health. In this episode, we hear from a father-daughter physician team who are delivering babies in their hometown, keeping care in the family, and exploring what it means to care for families across generations.

00:00:16:04 - 00:00:45:18
Julia Resnick
It's not every day you get to practice medicine alongside your family, let alone deliver babies together. Today's guests are doing just that. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. Today, I'm joined by a father-daughter duo from Southwest Health in Platteville, Wisconsin. Dr. Kevin Carr is a family medicine physician who also provides obstetric care, and his daughter, Melissa Carr, has returned to her hometown to practice as an obstetrician and gynecologist.

00:00:45:25 - 00:00:56:00
Julia Resnick
We'll talk about what it's like to work and even deliver babies together, and what it takes to provide high quality maternal care in a rural community. Drs. Carr, welcome to the podcast.

00:00:56:04 - 00:00:56:26
Kevin Carr, M.D.
Thank you.

00:00:56:27 - 00:00:58:00
Melissa Carr, M.D.
Thanks for having us.

00:00:58:01 - 00:01:13:24
Julia Resnick
So this episode feels especially meaningful as we think about Father's Day. And the two of you are not only colleagues, but father and daughter working side by side. What has it been like to build a professional relationship alongside your personal one? Kevin, I'll start with you.

00:01:14:00 - 00:01:38:06
Kevin Carr, M.D.
Well it's awesome. It's obviously very exciting to see your daughter do well and be well liked in the community. She's actually now starting to deliver people that I actually delivered. So I think fair amount of those has happened. It's also very nice to have somebody very knowledgeable that I can walk down the hallway and ask questions to that I think knows more than I do right now.

00:01:38:07 - 00:01:40:22
Kevin Carr, M.D.
So it's pretty it's pretty awesome all the way around.

00:01:40:26 - 00:01:43:03
Julia Resnick
Amazing. Melissa, what's it been like for you?

00:01:43:06 - 00:02:03:06
Melissa Carr, M.D.
Yeah, kinda just to reiterate that, I think it's just it's really an amazing experience. I mean, he's such a great role model and just an overall mentor. I mean, he's been practicing medicine here at this location for 35 plus years. So, you know, with that, he brings a wealth of knowledge and all the experience that comes with it.

00:02:03:06 - 00:02:23:28
Melissa Carr, M.D.
And he's just so willing to offer that advice both clinically and, you know, from a personal standpoint as well. So, you know, there's just so insightful. And it's like you said, his office is down the hall. So, you know, you can just pop in and, you know, ask questions and bounce ideas off of him. And it's just it's so such a nice resource to have, you know, readily available to me.

00:02:24:00 - 00:02:28:04
Melissa Carr, M.D.
So I take advantage of it as much as I possibly can.

00:02:28:06 - 00:02:36:12
Julia Resnick
That's amazing. And my dad used to work in the building next to us, so we'd have lunch all the time. But that's different than being in the same profession and actually working together.

00:02:36:14 - 00:02:54:27
Kevin Carr, M.D.
And I'll have one more little anecdote. My dad was a veterinarian, and so for many years when I heard Doc Carr, I was looking around because it was my dad they were talking to. And I think Melissa will share that same anecdote that it's we're used to having that in the background.

00:02:55:02 - 00:03:01:01
Melissa Carr, M.D.
Yes. In fact, I had a patient this morning bringing up Doc Carr, who is Grandpa Carr, the veterinarian.

00:03:01:01 - 00:03:07:08
Julia Resnick
I love that. And I imagine that your dad being in this field influenced your decision to go into it as well.

00:03:07:10 - 00:03:14:22
Kevin Carr, M.D.
I was not sure if I was going to do veterinary medicine or people medicine, so obviously I made what I think is a very good choice.

00:03:14:25 - 00:03:18:07
Julia Resnick
And Melissa, you stuck with delivering babies.

00:03:18:09 - 00:03:46:15
Melissa Carr, M.D.
Yeah, same thing. I mean, I had a front row seat to, you know, to healthcare from a very early age. Growing up, I just remember seeing, you know, number one, seeing, you know, get up in the middle of the night to go deliver a baby or, you know, that side of things. But then, you know, you'd walk into the grocery store or to a ball game and there would be a patient that would track him down and telling stories about their family members or their loved ones that he took care of, and just or just being thankful and expressing their gratitude for the care he provided them, you know,

00:03:46:16 - 00:03:59:26
Melissa Carr, M.D.
so I saw from a very early age kind of how meaningful that was. And I feel like that's kind of a perspective that not a lot of people get going into healthcare. If you haven't been exposed to that, especially in more rural type setting.

00:03:59:28 - 00:04:08:16
Julia Resnick
Absolutely. So as you've been working together, what have you learned from each other, both as clinicians and his family members? How does that shape how you're caring for patients?

00:04:08:20 - 00:04:29:10
Melissa Carr, M.D.
Well, again, to kind of just like as I mentioned, you know, I saw the relationships that he developed with patients, both in the clinical setting and outside. You know, how patients just felt so grateful for their care. And I just I got to see how, you know, how you played that role in their lives. And I would just, you know, thought that was really pretty amazing.

00:04:29:11 - 00:04:36:07
Melissa Carr, M.D.
And so that really kind of impacted, number one, me to go into medicine. And then, you know, continuing to build those types of relationships with my own patients.

00:04:36:09 - 00:04:37:06
Julia Resnick
And Kevin.

00:04:37:12 - 00:04:54:12
Kevin Carr, M.D.
Well, again, I kind of go back to my parents again, I think kind of I was always taught you show up, be there and care for people and the rest will take care of itself. We're small town of 10,000, and it's just different care out here than using the big city because of that. And I think the patients see that.

00:04:54:13 - 00:04:59:14
Julia Resnick
Say more about that. What makes providing maternal care in rural communities special?

00:04:59:16 - 00:05:22:25
Melissa Carr, M.D.
So our model for maternal health care here is a little bit different than what you're going to get in some of the bigger health care systems. And we tend to have one provider that follows their patients through their prenatal care from the first visit through delivery and then postpartum. And so because of that, we really start to build these relationships with patients.

00:05:23:00 - 00:05:38:09
Melissa Carr, M.D.
You get to know them at a much more personal level. And I just think that that brings a whole other level of care to these moms and babies. So it is a little bit more of a unique experience here. And I think that that's part of what makes us special.

00:05:38:15 - 00:05:40:18
Julia Resnick
Kevin, anything you want to add to that?

00:05:40:20 - 00:05:55:27
Kevin Carr, M.D.
Yeah, I think especially with OB, once you take care of somebody and see them 12, 13, 15 times, they kind of remember you forever because it's one of the biggest days of their life that they're going to remember for every single day. And you're a big part of it.

00:05:55:28 - 00:06:15:06
Julia Resnick
Absolutely. And it's one of those few times in healthcare where you're getting care for a happy reason, and it's amazing that you get to be there for them throughout that entire journey. So, Kevin, I know you're an FM who does OB and Melissa, you're an obstetrician/gynecologist. And you know, how does that work together, working as a care team?

00:06:15:12 - 00:06:19:26
Julia Resnick
And how can those kind of collaborations help improve care for patients?

00:06:19:28 - 00:06:42:26
Kevin Carr, M.D.
Yeah, it works amazingly well. We have five family practice docs that deliver OB patients, and one of the family practice docs actually does C-sections, along with three of the OB doctors here. We still take care of our own patients. Obviously, they're very available for any consult, anything that happens, and if a C-section happens on their patient, we're also there first assisting.

00:06:42:26 - 00:06:58:19
Kevin Carr, M.D.
We're helping out and taking care of the baby. So it absolutely works very seamlessly. There's no turf battles. There's a lot of helping each other out and very willingness to answer questions if there's any problems or concerns about any kind of care.

00:06:58:24 - 00:07:15:24
Melissa Carr, M.D.
And we are located in the same building. We're two separate clinics or two different offices, but we're separated by hallway. So people will pop into my office all the time just to bounce ideas or ask questions, and vice versa. I'll do the same thing. I'll put my head in and say, okay, I got this patient. What do you think of this?

00:07:15:25 - 00:07:28:09
Melissa Carr, M.D.
And everybody is always so willing to, you know, to help out and provide advice and, you know, just kind of help coverage. And like you said, it's, you know, we're a pretty well oiled machine and it works really well for us.

00:07:28:12 - 00:07:43:24
Julia Resnick
That's amazing. And in a lot of rural communities these days, we're hearing about hospital closures or hospitals that are having to retract their OB services. But it sounds like you all are doing the opposite of that. So what do you think has been driving that growth and how are how are you adapting to meet that need?

00:07:43:26 - 00:08:14:28
Melissa Carr, M.D.
So we've seen that firsthand. We had a hospital in a neighboring county closed their maternal health services probably about ten years ago, give or take. And so those patients now had to travel further for their obstetrical care. Many of them do come our direction now. Another hospital, neighboring hospital, has also lost some of their OB providers and their gynecologist for whether it was from those providers relocating or retiring.

00:08:15:01 - 00:08:36:08
Melissa Carr, M.D.
So there's just less access to care. And so we have seen more patients coming our direction because of just there isn't as many options available to them. And they're now having to travel further. So to kind of combat that, number one, we've increased our OB providers since I've been here. We have more physicians that are providing OB care, whether it's family medicine, physicians and OBGYNs.

00:08:36:10 - 00:08:56:00
Melissa Carr, M.D.
And we've also opened outreach clinics through our organization. So that's where OB care is available. So people aren't having to drive as far for their prenatal care visits. They still come to our main hospital campus for deliveries, but at least for their visits, they're not having to travel as far.

00:08:56:07 - 00:08:58:20
Julia Resnick
Fantastic. Kevin, anything you want to add?

00:08:58:26 - 00:09:19:26
Kevin Carr, M.D.
Just to show you the numbers, in 2010, we were about 140 deliveries, and I believe this year we're going to be at 240 delivery. And some of it's the culture of the hospital. The whole hospital has exploded over this period of time. Going back to the American Hospital Association meeting a few years ago, quite a few years ago, we started a Journey to Excellence program

00:09:19:26 - 00:09:40:27
Kevin Carr, M.D.
after one of the meetings, we learned at the Rural Health Leadership Conference. And our hospital does that, and patients that walk in the door from the outside can tell the difference in every single employee the attitudes, the smiles, the willingness to help out everybody from the janitor to the CEO, every single step along the way. Every person is important.

00:09:40:27 - 00:09:57:07
Kevin Carr, M.D.
And it shows in how we take care of patients and how patients respond to what we do. And it's every single one of our sort of different programs, you know, OB, ortho, everything has literally exploded because of some of the things we've done.

00:09:57:09 - 00:10:05:22
Julia Resnick
That's fantastic and really just speaks to, you know, your organizational culture and how that exudes between providers and also to the people you care for.

00:10:05:25 - 00:10:31:02
Melissa Carr, M.D.
And I think there's a lot of word of mouth that spreads too, you know, people are very grateful for their care here. And they really enjoy their experience. And they spread that to their friends, their family members. And, you know, so that catches on. And we're starting to see patients that are willing to travel further for their OB care, even if they have options that are closer to home, because they're choosing to come to our facility to come to deliver and coming to see us for their prenatal care.

00:10:31:04 - 00:10:44:28
Julia Resnick
That is great. And so you've both really been talking about like, the human piece of this. And I know a lot of hospitals, including yours, are using technology to help extend care. Can you talk about how you're thinking about incorporating technology into your work?

00:10:45:01 - 00:11:03:15
Kevin Carr, M.D.
They are starting to do AI to help with notes here. We just started six months ago. So we're learning from many of the providers. There's some very good things about it. There's some things they got to learn. But it sounds like so far so, so good that it's saving some time so they can spend more time with the patient and do those things.

00:11:03:15 - 00:11:05:19
Kevin Carr, M.D.
So that's one of the things they're doing.

00:11:05:24 - 00:11:10:00
Julia Resnick
And wasn't there a piece about a telemedicine program for neonatology.

00:11:10:02 - 00:11:42:02
Kevin Carr, M.D.
Oh yes. We were the first - and it might still be the only program in the state - that has a telemedicine NICU program, neonatal intensive care unit program associated with University of Wisconsin-Madison. And it's been going on for a couple of years. It took us a while to tweak and fine tune some things, and it's really nice in the sense of in our newborn nursery, we have computer set up, we have cameras set up, and we basically call a number and usually within minutes we have a neonatologist on the phone.

00:11:42:02 - 00:12:01:03
Kevin Carr, M.D.
We can see them, they can see us. There's a video on us, there's a video on the baby. And back in the day where we take care of lots of babies who need a little bit of oxygen, need a little bit of help, a little CPAP to help them get through the breathing, and you kind of sit there and try to decide, okay, is this baby sick enough to be transferred?

00:12:01:03 - 00:12:20:06
Kevin Carr, M.D.
Can I watch for another two hours? Well, now we make that call right away and we talk to them and we go, hey, I'm pretty comfortable with this, but I just want to make sure that I'm doing the right thing. And you have them on the phone, they assess the baby, they help you sometimes in making the decision, do we order a few tests and then, hey, we'll keep an eye on things and get back to us an hour.

00:12:20:07 - 00:12:29:20
Kevin Carr, M.D.
And if the baby transitions and looks great, wonderful. If the baby doesn't do well, then we already have the numbers in and they're ready to send the transport team.

00:12:29:25 - 00:12:34:28
Julia Resnick
That sounds incredibly helpful for rural hospitals that probably don't see a ton of cases like that.

00:12:35:00 - 00:12:57:27
Melissa Carr, M.D.
We also have a new SIM lab here as well, so we can run different types of simulations for both physicians and the rest of the hospital staff that are on the OB unit. And that's been really helpful, especially in a rural setting, because, you know, our volumes are lower, which also means that our types of high risk clinical scenarios are also going to be lower.

00:12:57:27 - 00:13:18:09
Melissa Carr, M.D.
So you may have a nurse that might not experience a postpartum hemorrhage or a shoulder dystocia or those types of situations, but have only heard about it. So this allows people to, you know, get that training and doing that repetition through simulation, even if we don't necessarily see it very often to keep those skills up.

00:13:18:12 - 00:13:33:00
Julia Resnick
Absolutely. And to close, I just want to bring this back to Father's Day, since that's when we're releasing this. And you are a father-daughter duo, so can you just share a moment or a story that reminds you why this work is so important to your community?

00:13:33:02 - 00:13:54:16
Kevin Carr, M.D.
I called a patient this morning to ask if I could share this story without saying her name. Obviously, I've delivered a lot of patients and this specific family, I delivered all four of the girls. Several of them, I believe they're all going into nursing school. And so back in the start of Covid in 2021, she was in nursing school and came to me with symptoms.

00:13:54:24 - 00:14:13:18
Kevin Carr, M.D.
You just get gut feelings if something isn't right. And I basically did a chest X-ray and she had an apple sized lesion by her heart. And I immediately had my nurse call her mom, said I want her mom here now. I want to talk. I want to get her here before I get my CAT scan. I did a CAT scan. The next day

00:14:13:18 - 00:14:42:18
Kevin Carr, M.D.
I got her in with the hospitals at UW hospital to get a biopsy, and she ultimately had lymphoma. She did take six months in nursing school off and is now cured. Now, to add to that story, three years later she came, wanted to see me and she was somewhat tearful, so I wasn't sure what was going on until she got here and found out she was pregnant. And she was somewhat tearful because she just is finishing school.

00:14:42:20 - 00:15:07:19
Kevin Carr, M.D.
She's not married yet and she's worried, how are my parents going to take this? And we had a long discussion, and I kind of used some old quotes from my former nurse who was outstanding and said, this won't define who you are as a human and won't define who you will be in your lifetime. And she asked if she could give me a big hug and two days later told her parents and her dad was in tears,

00:15:07:19 - 00:15:23:09
Kevin Carr, M.D.
he was so excited. Because three years before that, they're worried they're going to lose their daughter. And now their daughter is bringing a life into this world. And so there's a huge turnaround. And that's why we go into medicine. Now I'm going to add to one step further to that I know this, I know her very, very well.

00:15:23:09 - 00:15:36:01
Kevin Carr, M.D.
I know this family very well. She told me there is nobody else that's going to deliver her baby except for me. Except unfortunately, that few days I was in Canada fishing. So guess who delivered my baby?

00:15:36:02 - 00:15:37:24
Julia Resnick
The other Doc Carr?

00:15:37:26 - 00:15:57:06
Kevin Carr, M.D.
The other Dr. Carr. And so she got to experience the best of both worlds. And now she had her second baby about eight months ago. And so I did deliver that one. So she was thrilled that both of us had an opportunity to care for her. And to be blunt, when I called her and asked if I could use her story today, I could tell she was in tears on the phone.

00:15:57:06 - 00:16:02:27
Kevin Carr, M.D.
She's an outstanding family, just core the earth people from southwest Wisconsin.

00:16:02:28 - 00:16:05:27
Julia Resnick
Amazing. And Melissa, on your end.

00:16:06:00 - 00:16:27:14
Melissa Carr, M.D.
One that comes to my mind is so my very first delivery that I did as a brand new grad or fresh out of residency was a C-section that I did with my dad. It was his patient and she needed a C-section. And so I was the primary surgeon. And then he was my first assist.

00:16:27:14 - 00:16:48:06
Melissa Carr, M.D.
So, you know, looking back, you know, you're just you're eager to do the delivery and, you know, be there for your patients. But at the same time, you know, looking back, it was just such a special cool moment. And now the other really neat thing is that particular patient, she takes care of my kids at daycare. So, you know, I see her every single day when I drop my kids off and, you know, so it's just it comes full circle.

00:16:48:08 - 00:17:07:01
Kevin Carr, M.D.
And to add to that story, the grandmother of that patient was an OB nurse here that I have delivered 500 babies with. And so she was in the operating room. And this is one in the morning, we're doing the C-section. And she thought it was the coolest thing ever, that her granddaughter was in there in the room with both of us.

00:17:07:03 - 00:17:22:00
Julia Resnick
That's amazing. And it's keeping in the family, both your blood family and your community family. So, Doc Carr, Doc Carr, thank you both for the work you do for your communities, for sharing your stories. And Happy Father's Day to all of our listeners out there.

00:17:22:02 - 00:17:24:19
Kevin Carr, M.D.
Thank you. Thank you very much.

00:17:24:21 - 00:17:33:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:23:02
Tom Haederle
Welcome to Advancing Health. In February's Leadership Dialogue podcast, Dr. Marc Boom, president and CEO of Houston Methodist and the 2026 Board chair of the American Hospital Association, speaks with a top rural health care leader about how creativity and excellence can address the unique challenges facing rural providers.

00:00:23:05 - 00:00:44:06
Marc Boom, M.D.
Well, greetings and thank you, everybody for joining me today. I'm Marc Boom. I'm the president and CEO of Houston Methodist, and I'm excited to be the chair of the, American Hospital Association this year. As I mentioned during my first leadership dialog in January, I believe innovation is just a critically important part of ensuring that patient care is absolutely unparalleled.

00:00:44:09 - 00:01:09:02
Marc Boom, M.D.
So my plan to hopefully weave innovation as a theme throughout each of these discussions. And so today we're doing exactly that again, but this time through the lens of a rural hospital leader. I know that all of our colleagues, whether they're leaders of big health systems or small independent hospitals, are committed to innovating to deliver the best possible care to the people they serve and also navigating big changes and challenges in our field.

00:01:09:04 - 00:01:42:03
Marc Boom, M.D.
And we know that when it comes to challenges, the leaders of our rural hospitals, frankly, have a whole extra degree of complexity. I mean, recruiting staff. The administrative and reimbursement challenges, transportation, just to name a few. And I know I'm anticipating our guest today will share that amidst those challenges, many opportunities for growth and innovation. You know, just, two weeks ago, I attended the AHA's Rural Health Care Leadership Conference, and I was totally energized by the sessions and the discussions that were there on building innovative approaches to transformative care delivery.

00:01:42:05 - 00:02:11:15
Marc Boom, M.D.
So today, we have as our guest, Mark Boucot. Mark is the president and chief executive officer of Potomac Valley Hospital in Kaiser, West Virginia. He attended the conference as well. I met and chatted with him there because he was the recipient of the AHA’s Rural Hospital Excellence in Innovation Award. That's an award that recognizes rural hospitals that demonstrate responsiveness, creativity, and excellence in developing or sustaining programs that address the unique challenges that face rural and frontier communities.

00:02:11:15 - 00:02:14:26
Marc Boom, M.D.
So, Mark, welcome today. I'm glad to have you here.

00:02:14:29 - 00:02:17:17
Mark Boucot
Well, thank you for having me. I'm honored to be here.

00:02:17:20 - 00:02:35:24
Marc Boom, M.D.
And we'll keep it nice and confusing with two Marks today. And maybe we'll pronounce them slightly differently. Mine's with the C, yours is with a K, but it is great to have a fellow Mark here for our podcast today. So I want to dive right in. And first off, I know Potomac Valley Hospital, which you lead, is part of WVU medicine.

00:02:35:27 - 00:02:45:03
Marc Boom, M.D.
Which, if I'm not mistaken, you are a 25 bed critical access hospital. So let me start. Tell me a little bit more about the hospital and the community you serve.

00:02:45:03 - 00:03:11:18
Mark Boucot
Yeah that's correct. We're a 25 bed, critical access hospital. Although you'd be very surprised about the amazing array of services that we provide there. The hospital, basically has, general surgery, orthopedics, very strong orthopedics program, along with multiple specialty services. We opened a hematology oncology center there in our geography to serve the patients that we were blessed to take care of.

00:03:11:21 - 00:03:36:28
Mark Boucot
We have, urology. We have along with that. We have colorectal surgery, we have pain management. So there's a there's a pretty vast array of services. We serve a market area of really I think it's a three county area that that comes to the hospital, our community near Potomac Valley Hospital, about 50,000 residents. But we serve a much broader area.

00:03:36:28 - 00:04:06:07
Mark Boucot
People come from about an hour away. And really, I think one of the things that I for me, that is a hallmark of our organization is, is that we have adopted a mission statement that we care for every patient like we would our own family. And so with that as our Northstar, we are able to innovate and develop patient care services for our community, always knowing that we're going to care for them, we're going to include them, we're going to incorporate their needs

00:04:06:07 - 00:04:09:18
Mark Boucot
most importantly, because everything that we do is for them.

00:04:09:20 - 00:04:31:19
Marc Boom, M.D.
I'd love to hear about your technology journey. We believe, and that's why I'm weaving this in these series that, you know, innovating through technology can really transform innovation. And when you talk about that Northstar, which I love of it's all about the patients, right? That's why we're all in health care. I assume when you're looking at technology as a critical access hospital, it's all about the patient, how you do that.

00:04:31:19 - 00:04:39:11
Marc Boom, M.D.
So how do you think about, technology solutions, the infrastructure improvements, care management, all of the above, in that setting?

00:04:39:13 - 00:05:10:16
Mark Boucot
Yeah. Like most organizations, we have a pretty strong governance infrastructure around the development of our technology services. We're blessed to be part of WVU medicine. And because of that, we are able to have advancements in technology that many small organizations that are independent or standalone don't get the opportunity to have. But we've integrated AI into our physician practices and it's one of the most amazing things for them because they're direct face to face care now is much different.

00:05:10:23 - 00:05:33:26
Mark Boucot
So we're serving the patient more than the computer, in that environment. And as we build and grow, we think our way through and develop strategies that would enable us to really provide the academic medical center level of care at our small hospital. And I think that that has been a hallmark of how we decide what we're going to do and how we're going to move forward.

00:05:33:28 - 00:05:55:07
Marc Boom, M.D.
And we'll pull that thread a little bit. So you say, as part of WVU medicine, we have many critical access hospitals out there, as you alluded to, that are standalone on their own. I'm sure you think about that. I know there's pros, I know there's cons, but how would you approach that if you didn't have the WVU medicine as that, as that kind of feeder of some of those technologies?

00:05:55:09 - 00:06:24:28
Mark Boucot
A great example is this program that we were recognized for with the virtual ICU program. Very low cost infrastructure, just with some very simple tablets. We implemented a virtual ICU program where we were able to care for patients. We partnered with a large organization, which is Ruby Memorial, part of our own health system. But you could do that with any other academic medical center that you work with.

00:06:25:00 - 00:06:56:21
Mark Boucot
And basically what we do is we created a partnership where they can monitor our patients. The surgical intensivist in their ICU and critical care intensivist can care for our patients through just a very simple virtual hook up. This, this infrastructure actually, I think cost about $5,400 to implement. So it doesn't have to be rocket science. And it doesn't always have to be complicated in order to be successful.

00:06:56:26 - 00:07:21:12
Mark Boucot
I would also say for me, I've been the independent organization, and we had to make some decisions about making sure that what we provide is as close to the state of the art as we can possibly get. And even so, I would say the most important thing for us is that nothing is going to take away from the face to face care for the patients with our providers.

00:07:21:15 - 00:07:42:14
Mark Boucot
And so we try to enable them to be able to to care. And so even with some when we had antiquated technology or antiquated IT systems, we still were able to utilize Dragon and other scribing techniques that would try to keep the providers as close to the bedside as possible.

00:07:42:17 - 00:08:00:03
Marc Boom, M.D.
So you have 25 beds. You described obviously a lot of very key specialists and talented people there. In those 25, in any given time, how many people are in the ICU? I'm just trying to parse out a little bit more how you know, what you won the award for and exactly what you're doing so it can inspire some others.

00:08:00:05 - 00:08:21:09
Mark Boucot
When I started there, the ICU was closed and all of the equipment was draped with towels or sheets. Basically, the light hadn't been turned on for about 18 months leading up to this. I think we just decided that no matter what, this ICU needs to be open, it needs to be open for this community. And so we're going to figure out a way to make it work.

00:08:21:11 - 00:08:45:15
Mark Boucot
And, we took this pilot program to the health system and said, look, you know, hey, if we're able to partner with you, what that will also help us do is keep our patients local so that we don't have to transfer as many patients out, which would help the health system with overcrowding and very high centers, which is what we are all living through today.

00:08:45:18 - 00:09:10:16
Mark Boucot
We opened up the ICU. Basically, we had to make some investments in equipment, new IV pumps, made sure the beds, everything was working properly. And once we implemented the virtual ICU program with the health system, we found that it created an environment where the hospitalist felt much more safe and secure and supported to be able to admit more patients.

00:09:10:16 - 00:09:22:21
Mark Boucot
And therefore, it drove the census up quite a bit. So when we started, there was an ADC average daily census of two patients who were in the hospital on my first day and in

00:09:22:22 - 00:09:24:21
Marc Boom, M.D.
Hospital overall or in the ICU?

00:09:24:24 - 00:09:26:02
Mark Boucot
Yes, in the entire 25 bed hospital..

00:09:26:02 - 00:09:28:04
Marc Boom, M.D.
Okay. Yeah, that's a small

00:09:28:07 - 00:09:56:14
Mark Boucot
Yeah, there was it was pretty empty. And so now I would say a good 70 to 80 days a year we're at 100% occupancy. The ICU is always full now at this point. And, you know, we combined this implementation for virtual ICU, which is different than an EICU. And we combined it with a pretty rigorous performance improvement in our emergency department.

00:09:56:16 - 00:10:16:25
Mark Boucot
We've got our door to doc time down around ten minutes. And we've got our door to bed time within like four minutes. So basically when you come in, you register, you go right to a bed. And so that requires a pretty significant community of people that are working together to make sure that the rooms are turning over fast.

00:10:16:27 - 00:10:41:29
Mark Boucot
And we went from about 12,000 visits in the emergency department a year, five years ago. We're up now around 22,000 visits in that same emergency department. So obviously we're expanding. We're investing in the community and growing and developing. But we had to create the service that people wanted. And people do want convenience. They want they don't want long wait times in the emergency department.

00:10:42:00 - 00:10:55:26
Mark Boucot
I think that combined with the virtual ICU, meaning that they would then be admissions in a way to create the admissions into the facility, those two things combined were pretty significant change initiatives.

00:10:55:28 - 00:11:03:01
Marc Boom, M.D.
So you must have gotten really positive feedback from the community, I would imagine, in terms of that ability to stay local.

00:11:03:03 - 00:11:37:23
Mark Boucot
Oh my goodness. Yes. The community is rallied around the hospital. When we have events, we just had a ribbon cutting for a new building. Honestly, it was standing room only. The community has been wonderful and I think every like every community, our community just desire to have a great hospital and one that they could rely on. And I think that this program and our service and our] caring toward really wanting to just do the right thing and always be that that organization that would care for every patient, like your own family.

00:11:37:25 - 00:12:09:03
Mark Boucot
That is our North Star. So those things resonate with people. They resonate with the employees that work here and our reputation built. I didn't have to do a lot of advertising. It really happened by word of mouth, just by the fact that we were a different organization. And it's funny, Mark, I'll tell you, one of the things that was really interesting is just renovating and putting in new flooring and painting walls and making the place look different also created a lot of excitement in the community that they knew a new day was coming.

00:12:09:06 - 00:12:13:17
Mark Boucot
There was going to be care and investment back in the local hospital.

00:12:13:19 - 00:12:38:17
Marc Boom, M.D.
So this is really a win for everybody. The community loves it. The patients get really top notch care. The doctors there feel more comfortable taking care of somebody sicker, knowing they have probably pretty immediate back up to make decisions and manage critical patients. And it decompresses some of the referral center that. So when you do have somebody you need to move or other places need to move somebody because they still need that referral center, it's more likely to get them in there, I suspect.

00:12:38:17 - 00:12:41:05
Marc Boom, M.D.
So it's been a it's been a win on all rounds.

00:12:41:07 - 00:13:01:26
Mark Boucot
It's a win win all the way around. And I'll tell you, one of the one of the unique things is, is that our physicians, who were the hospitalist team, once they really started admitting patients and they started to feel more secure by having that safety net with a virtual ICU, because if the patient ever then decompensated, they could just go right into the virtual ICU.

00:13:01:26 - 00:13:25:04
Mark Boucot
They'd get additional help in a consult. Once that happened, it's interesting - there began to be mutual learning in both directions. And our health system is so awesome in that, there's a great deal of humility on both sides of our organizations that they actually learn some things from our hospitalists and our hospitals learned a lot from them.

00:13:25:04 - 00:13:34:15
Mark Boucot
So it was a great mutual learning opportunity and just a really wonderful partnership of working together in a really positive way.

00:13:34:17 - 00:13:52:18
Marc Boom, M.D.
Hospitals always, I think, are pillars in their community. But in a rural environment, when you have a hospital that the people can be proud of, I mean, they rally around and it's such a core part as an employer, as a caregiver, I mean, so critical to the United States that we have amazing rural hospitals like yours.

00:13:52:20 - 00:14:11:13
Mark Boucot
Oh, thank you for saying that. And I would say it's very important that we continue to support our rural hospitals and our local hospitals. This hospital, just by simply growing and having a Northstar of caring for patients and opening practices and bringing a lot of different specialists in. Again, that list I gave you is just a short list.

00:14:11:15 - 00:14:41:08
Mark Boucot
Those things are really important. Also for the economic engine of the community, this hospital created 300 jobs in the town of in Mineral County and in the town of Kaiser. So that we, you know, we have a bigger tax base. As an organization, we have come a long way. And I think this is an important part of the American Hospital Association with the work that the hospital association is doing to really help hospitals be strong and be healthy,

00:14:41:11 - 00:14:59:25
Mark Boucot
it's just amazing work. And like you said on the stage, it's God's work to make sure that we're caring for patients and that we're really doing the work that is healing and helping people. And so I've never actually worked a day in my life, to be honest with you, because I was doing what I was called to do in my life.

00:14:59:28 - 00:15:13:16
Marc Boom, M.D.
That's great. That's amazing. Well, you know, let me ask you this then, for the next aspiring rural hospital leader who wants to implement some of these, any lessons learned? And then what's next? I mean, where are you going next from an innovation standpoint?

00:15:13:18 - 00:15:33:21
Mark Boucot
Yeah. Thank you. I think from a lessons learned perspective, I think that one of the things that I would say for me is just making sure that I always approach things with an open heart and an open ear and an open mind, the way that I conceive things as a leader doesn't always mean that's the right way to do things.

00:15:33:23 - 00:15:58:27
Mark Boucot
We had some big lessons learned, I think, also around technology, what we expected for it to cost and what it had to be. No, actually, it didn't need to be like $1 million price tag on this. And we actually were able to implement this just by opening various portions of EPIC and then also utilizing simple tablets.

00:15:58:29 - 00:16:20:17
Mark Boucot
And I think that, you know, sometimes we think it's a much bigger obstacle to jump than it actually is. And I think once we believed we could do it, we could. There was nothing that could stop us. So I think as soon as we had the faith in ourselves and that we learned that we can do it.

00:16:20:20 - 00:16:46:10
Mark Boucot
We did do it and we did accomplish it. I think for our future, we're going to continue to grow the utilization of AI and to really try to keep the documentation work that's being done through AI and through a bridge. And the technology that we have today keeps that physicians much more happy and satisfied with their care, because they're really spending time with their patients now versus serving a computer.

00:16:46:13 - 00:16:57:19
Mark Boucot
I think that's been a wonderful thing for us. And I would say that making the investment in technology is really paramount to where to success in today's world.

00:16:57:21 - 00:17:15:15
Marc Boom, M.D.
You're working towards that NorthStar. You're seeing it as never working a day in your life. This is a very impressive program. I see 100% even more in detail now why you've won this award, and I think it's an inspiration in many other hospitals. So thank you for your time today. Thank you for your perspective and your commitment.

00:17:15:15 - 00:17:33:03
Marc Boom, M.D.
I really appreciate you being here. And as I close, I want to amplify a comment that I made at the Rural Conference. I was glad you were listening when you said the God's word part. And that's really we need to work together as hospital leaders to be defined not by the challenges we face, but instead by how we overcome them.

00:17:33:03 - 00:17:46:04
Marc Boom, M.D.
And that's precisely what you have done. And congratulations to you and you and your team. Thank you, everybody, for finding some time today to listen. We'll be back next month for another Leadership Dialog conversation. Thanks so much.

00:17:46:06 - 00:17:54:17
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:18:15
Tom Haederle
Welcome to Advancing Health. In the second of a two part conversation, we take a deeper dive into what hospitals and health systems can learn from an initiative from Georgia that's made tremendous progress in improving access to pediatric care closer to home.

00:00:18:18 - 00:00:46:15
Elisa Arespacochaga
Hi, I'm Elisa Arespacochaga from the American Hospital Association. And welcome back to part two of our conversation with Dr. Jean Sumner, dean of the Mercer University School of Medicine, and Marc Welsh from Children's Health Care of Atlanta. We're here talking about the partnership they have made to support health care in rural Georgia. We're going to dive a little bit deeper today on how they're supporting the care of today, the pipeline for the future, and some advice for you on how you might create one of these in your community.

00:00:46:17 - 00:01:13:17
Elisa Arespacochaga
Let me ask you, Marc, to then tell us a little bit about you guys have both hinted at the work that you're doing to build scholarships. We know that obviously supporting clinician training is amazing and absolutely necessary, but also takes time, right? You know, you don't grow a physician overnight. So can you tell me a little bit about how you've started prioritizing which of those roles you're focused on and how you're supplementing that pipeline of clinicians and again, that full team across rural areas.

00:01:18:21 - 00:01:45:01
Marc Welsh
There are a number of young people who are from rural communities who are receiving their medical education and are in many cases, the best candidates to return home to truly return home, to communities. And so we have in the pipeline right now 27 scholars. The first two will be in community this year. And so later this year, we will have our first two scholars who've completed residency and will return to rural communities to provide pediatric care.

00:01:45:03 - 00:02:05:07
Marc Welsh
And we're excited about that. I think this is what we look for in terms of a sustainable solution. When we thought about this at the beginning, it would have been easy for Children's to swoop into the community, do some work and then leave. And that community would have been, you know, better for it in the moment, but in the long run, that would not have created the change across the state that I think both myself and Doctor Sumner hoped to see. And so this opportunity presented us, this avenue for us to really build a sustainable workforce across the state. And these pediatricians will be exactly that. We started out with young people that were at all different years of their training, and that was a goal to accelerate how quickly we could get folks into community.

00:02:27:18 - 00:02:43:09
Marc Welsh
And now that pipeline is really strong, and we will introduce a next set of scholars in the coming months to continue that. So it's a really an exciting opportunity for us to ensure that those over 60 counties without a pediatrician will have one in the future.

00:02:43:12 - 00:03:09:19
Elisa Arespacochaga
That's amazing. Dr. Sumner, can you talk a little bit about the impact those scholarships have had on your classes and your students to be able to really accelerate that return back to to home? I know in so many states. The work that has really helped is when they've recruited from those rural areas to go back to those rural areas, because if you never lived there, it may be intimidating to move to a rural area.

00:03:09:21 - 00:03:36:09
Jean Sumner, M.D.
I think the scholarships are critically important, but I think it is even more important to pick the right student and then give the scholarship. You want a happy doctor, you want a doctor who feels called to that. I think there's no better job in the world in being a small town doctor. I spent my life there, and these young people that are carefully selected, interviewed by committee proved ... and we track them for years. They have opportunity through their school, through their years here to visit children's, develop alliances with subspecialists and people who may support them ten years from now, or who may be able to answer a call and have a relationship with them. So we give them incredible opportunities, but we pick the right student. The scholarship makes it possible because they very commonly come from people of lower socioeconomic status or lower income.

00:04:10:02 - 00:04:33:24
Jean Sumner, M.D.
The first one of the scholars this year, when he finishes, we'll go back to his home county that I believe never had a pediatrician -- and still doesn't. He will be the first pediatrician. So I think that that's the shining light. As time goes on, there's an army behind him that will come. And the second scholar that we named has not made up her mind finally, but I suspect she will be in an area of great need. But they commit willingly at something they won't. And all we do is try to make it easier for them.

00:04:43:15 - 00:05:06:11
Elisa Arespacochaga
I imagine that, yeah, they are. They want to see the community they grew up in just be better and have more access to care. And I love that connection. Marc, can you talk a little bit about what it's like for your clinicians at Children's to now have this network of folks that they are communicating with and supporting and being able to keep those kids not having to.

00:05:06:11 - 00:05:16:20
Elisa Arespacochaga
And I've driven in Atlanta traffic, man, I don't want to go back. So how do you keep those kids in their communities and keep that connection going and feeling supported there?

00:05:16:23 - 00:05:41:05
Marc Welsh
You know, I would say that the feedback here has been amazing. When we announced this work and began to share with our physicians across the system the excitement and energy and desire to participate and contribute to the work, was just overwhelming. And because I think for every one of our physicians, for every physician that goes, I would argue, into pediatrics, they go into it for a very specific reason. And that desire is purely to make an impact on the lives of kids, and for them to be able to be connected to impact communities across our state who otherwise are not having those resources, it fills their cup and it makes them better physicians. And they want to be connected to these young people who will return to community.

00:06:02:03 - 00:06:18:27
Marc Welsh
When those young people come to Children's for their rotations to learn, we have a long line of folks who want to engage them and want to be supportive of them. When we go to the Scholars Luncheon every year. It is the most amazing feeling to see those young people and to really energize us in the work that we do.

00:06:18:29 - 00:06:36:20
Marc Welsh
And so I will tell you that it has been a huge, huge win for us in respect to just morale amongst our physicians and employees, to know that we are committed to making this impact. And for us at Children's, it really allows us to fulfill our mission, ensuring that kids across the state have access to the best possible care.

00:06:36:22 - 00:06:52:15
Elisa Arespacochaga
I'm going to ask you both and Dr. Sumner, I'll start with you. The organizations that are listening to this aren't going to replicate exactly what you did, because they're not in your shoes, but they're going to hear something that's going to spark, a line of thought or a person they may not have thought to reach out to. So I'd ask, what advice would you have for an organization? In your case, Doctor Sumner, a medical school, and in your it a children's hospital. Subspecialty programs. What advice would you have for those listening if they want to create something like this?

00:07:08:27 - 00:07:32:18
Jean Sumner, M.D.
Well, first and foremost, understand the problem you're trying to solve. Understand the need. Understand the complexity of it if it's rural health, understand the complexity. It's not simple. And we say children are not little adults; well, rural communities aren't little cities. And there's a different it's a different place. People would come and they would run a clinic for three months and it was great and then they disappear, or they had a grant and they came and did research. And the community never heard from the research, but they see it written up somewhere. And so a lot of trust has been lost. And I honestly think part of that is academia, that we want them, that change the world. But we don't realize we're taking people who are human like us, and they want to be part of it, and they want to build trust with their providers.

00:07:57:00 - 00:08:17:21
Jean Sumner, M.D.
So we usually go when we go out to a community that has a need, we find out what they want, what they need, how can we help you and we say, "If we're going to commit to something in that community, you can't run us off unless you want us to leave. We're here. We'll find a way. We'll bring in partners to help."

00:08:17:23 - 00:08:41:04
Jean Sumner, M.D.
What we heard on all our counties is they have to have health care. They have to have care for their families because you don't have industry or economic development or education without good health care. So I would encourage anybody to do a little work in knowing the problem and knowing ... don't take the community as an equal part of that.

00:08:41:06 - 00:09:03:27
Jean Sumner, M.D.
This is an effort with Children's Healthcare Atlanta and Mercer University and then every county that we serve in a little different way, we're a little different in every county. We base it on need. They don't need something, we don't bring it to them. If they want something, we try to find it. Even if we can't provide it ourselves, we get a partner who can provide it.

00:09:03:29 - 00:09:31:08
Jean Sumner, M.D.
But having a physician in a rural community is important. Having colleagues who answer the phone at 2 a.m. when you've got a child dying in your E.R., is equally important. And it allows that young person to go there. Those communities want to have trust in their health system and yet many of them have lost trust. So it takes us time to convince them that we're there to stay.
And once we become true partners, the needle moves and that's the magic of it. We do what we say. We don't let them down. If we find that we can't do something, we tell them. But we value that third partner in this, and that is the community and being true to our word. So I would say, if you're the institution and you want to solve this problem, find out exactly what the problem is, understand it fully, go down and talk to the human beings you're going to be dealing with. Find out what they need, what their priorities are, and start there.

00:10:04:14 - 00:10:05:15
Elisa Arespacochaga
I love that. Marc?

00:10:05:17 - 00:10:26:27
Marc Welsh
Yeah, I mean Doctor Sumner said it so well, and I think I would sum that up for us is humility. I mean, it is the willingness to see folks who are collaborating as equal partners in advancing this work, of seeking to understand the needs of those communities and letting them guide you, letting them invite you in, and not assuming that you know better.

00:10:27:00 - 00:10:54:07
Marc Welsh
I think what I've learned more than anything else through this journey is that we have a lot of expertise here at children's, but there's a lot of things we can learn and have learned from our rural communities. From the way that, you know, health care has to be approached from what folks know on the ground. And so having that humility -- coupling that humility with trust and trust and empowerment of others to carry out the work. For us at Children's, we came into this with really two things: We said, "We want to lend our expertise and we want to lend the resources needed for this to work. But beyond that, we have to trust our partners to carry out the work that is important to them and entrust these communities to know what is best for their community." That is vitally important. We cannot look at these things through a city lens. I think we fail if we go into it with that mindset. And so I would implore anyone who's interested in this type of work to enter it with humility, to enter it with a desire to empower others to carry out what is best for their communities.

00:11:29:04 - 00:11:54:26
Elisa Arespacochaga
I love that this is about you have some expertise that can help support that community. let them guide you to what it is that they most need and how best to employ it. Well, thank you both for both the work that you've done and the humility and trust you brought to it. And I can't wait to hear about the hundreds of pediatricians across Georgia that will be serving in the next decade.

00:11:54:29 - 00:12:04:23
Jean Sumner, M.D.
I've worked in rural health my whole life, and I am so excited that if we can affect these families and these kids, we're going to have a healthier, rural Georgia.

00:12:04:25 - 00:12:13:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:17:10
Tom Haederle
Welcome to Advancing Health. When a heart attack strikes, every minute counts. Today we hear about a new cutting edge communication platform that sends patient to EKGs directly from the ambulance to the cardiologist in real time.

00:00:17:12 - 00:00:40:09
Tom Haederle
I'm Tom Haederle, senior communications specialist with the American Hospital Association. Glad you can join us. And I'm also really pleased that Josh Neff could join us. Josh is president of Mercy Hospital in Durango, Colorado, an area of the state known as the Four Corners region, and is here today to talk about how Mercy is using a cutting edge communications tool called Pulsara to assist patients who are dealing with cardiac issues.

00:00:40:12 - 00:00:44:12
Tom Haederle
Josh, thank you so much for joining me on Advancing Health today. Really appreciate you being here.

00:00:44:14 - 00:00:50:14
Josh Neff
Yeah Tom it's a pleasure. It's a it's a great opportunity to talk about some really great things we're doing in southern Colorado for cardiac care.

00:00:50:16 - 00:00:54:27
Tom Haederle
Well let's start with the basics. What is Pulsara? And how is Mercy Hospital using it?

00:00:54:29 - 00:01:32:27
Josh Neff
So Pulsara is ultimately a field to hospital communication tool. And we've got a large and remote area. And sometimes our response times are lengthy in southern Colorado, especially in the Four Corners area we've got a lot of mountain passes. When it's snowy, it creates some really delayed times getting critical patients to the hospital. And so Pulsara is really a way for us to connect and communicate with our pre-hospital providers across our seven counties that we serve in southern Colorado and northern New Mexico, where for patients who are having chest pain and cardiac related issues, EMS has progressed over the last decade or two, and we've now got paramedics and other folks that

00:01:32:27 - 00:01:58:07
Josh Neff
are doing 12 lead EKGs in the field as soon as they arrive at the patient. And that's a really important thing for us to know and understand. How do we get that EKG to a cardiologist that's in a hospital, 20 or 30 miles away, or maybe more? And so, Pulsara really bridges that gap for us. It allows those pre-hospital teams to transmit that EKG and a HIPAA compliant manner directly to the cardiologist on call.

00:01:58:09 - 00:02:20:29
Josh Neff
And that cardiologist then is able to help the pre-hospital team manage that patient clinically. It also allows us to be more prepared if that patient is actually having a STEMI or a heart attack. It allows us to have our teams ready and prepared so that that patient goes directly to the cath lab and undergoes cardiac treatment, in a shorter period of time.

00:02:21:01 - 00:02:39:13
Tom Haederle
Take us inside the ambulance itself if you would for a minute. So you've got a patient in there who's having a cardiac issue enroute to the hospital. Could be a long drive ahead. What is happening in the ambulance itself and how EKG and other vital signs - how is that all being monitored and transmitted? How does that happen?

00:02:39:16 - 00:03:06:05
Josh Neff
There's both Bluetooth and direct wire technology and capability between. Basically it's transmitted over cell service. And even in the remote areas where cell service is a little bit patchy, the Pulsara system is accumulating this data in the background. And then as soon as it hits a signal, it automatically transmits which allows that pre-hospital team, that those paramedics and EMTs to be focused on working on that patient and providing care. As a former pre-hospital guy -

00:03:06:05 - 00:03:22:14
Josh Neff
so as a ground paramedic and a flight paramedic way back in the day - we didn't have this technology and and it's it's really comforting for the team to be able to know that they've got, a group of specialists just, at their fingertips that can help us and help them care for that patient. And so basically, they get the machines hooked up.

00:03:22:14 - 00:03:38:20
Josh Neff
Pulsara can connect directly to their cardiac monitors. And so it feeds through that system and and electronically can transmit a wide amount of data to us and to our caregivers that are at Mercy Hospital ready and waiting for that patient to come in.

00:03:38:22 - 00:03:44:06
Tom Haederle
And so what do they do with that information, once it is transmitted? That helps with treatment plans.

00:03:44:06 - 00:04:01:10
Josh Neff
It does. So during the day, we've got our cath lab. We have two cath labs at Mercy Hospital. We're the only cath lab program in the southern part of the state and serving northern New Mexico. And so we've got folks on call or in the department every day. However, if it's after 5 or 6:00 at night, we've got an on-call team.

00:04:01:13 - 00:04:21:17
Josh Neff
The goal is really with this to reduce the amount of time from first medical contact to device. And device is kind of that reperfusion or the treatment time that's tracked by all of the accrediting agencies. We know that the earlier we perfuse an artery, it leads to better outcomes. And that's both in-hospital mortality as well as long term recovery.

00:04:21:17 - 00:04:55:15
Josh Neff
And so what it allows us to do specifically at Mercy - before implementing Pulsara, we had about 130 minutes from first medical contact to reperfusion times. I mean, our cardiology team has worked with Los Pinos CMS, Pagosa Springs Hospital, Upper Piney EMS, all Durango Fire Department, and a number of other agencies. This year, since we've implemented Pulsara, we've been able to reduce that time from first medical contact to perfusion from 130 minutes to 84 minutes.

00:04:55:15 - 00:05:23:18
Josh Neff
So we've seen a 35% decrease in time Because typically what would happen is that patient would come to the ER, they'd have a repeat EKG, yes, you're having a STEMI. We should have the cardiac team here. You need to go to the cath lab. They'd have to, you know, drive in from where they were. And so what this has allowed us to do is our cardiologist directly receives this EKG on a cell phone, is able to interpret the EKG, and he or she makes the call in real time.

00:05:23:21 - 00:05:33:23
Josh Neff
This patient's having a STEMI. Hits the button, alerts our cardiac teams. And so that patient can come directly to the cath lab and undergo treatment immediately.

00:05:33:26 - 00:05:45:03
Tom Haederle
That's remarkable. And being able to shave that much time off from the older way of doing things prior to Pulsara, what kind of results has that yielded so far in terms of patient outcomes?

00:05:45:05 - 00:06:05:03
Josh Neff
So we know that that time is tissue. We are in the process of tracking the official data. What I can tell you anecdotally is we're seeing patients with shorter hospital stays getting back home and back to work and back to play in a shorter amount of time. And we're seeing better outcomes clinically for them as well.

00:06:05:11 - 00:06:17:10
Tom Haederle
That's just amazing. What kind of training is involved in using the Pulsara system, both for Mercy Hospital, ambulance employees, EMS people...is it a complicated thing to get the hang of, or not really?

00:06:17:12 - 00:06:37:25
Josh Neff
It is not. If you can operate your social media apps on your cell phone, you can understand and operate Pulsara. It is that simple. It's intuitive. It knows how to store the information, what to send. And so when those pre-hospital folks hit that send button, it just automatically alerts the team that's on the receiving end of it.

00:06:37:26 - 00:06:50:14
Josh Neff
Those folks who have the same Pulsara on their communication devices. They get an alert, they can go right in and tap the picture, look at the EKG. They can look at vital signs, a number of different things. So it is very easy to use.

00:06:50:21 - 00:06:57:00
Tom Haederle
What about the cost involved? Is that something that is within the budget, would you say, of many hospitals or health systems?

00:06:57:02 - 00:07:12:12
Josh Neff
Yeah, it is, it is not an overtly expensive investment. And it's an investment in clinical care and quality outcomes. So it made all the sense in the world for us to do it. We know that if we can save one life over the course of a period of time, then those investments are well worth it.

00:07:12:12 - 00:07:22:05
Josh Neff
But, I would say to any hospital CEO as well as the EMS programs are out there, it is an affordable program that you can and you can easily integrate.

00:07:22:07 - 00:07:30:27
Tom Haederle
Would it be as helpful, do you think, for hospitals in more urban areas that really aren't looking at the same transport times, you know, with that patient in the ambulance?

00:07:30:29 - 00:07:48:06
Josh Neff
I think it could be used widely across all markets. I mean, I was in on the Denver Front Range before I moved to Durango. And, you know, it may take you 45 minutes to go 6 or 7 miles if you hit traffic wrong or there's a wreck. And so time is still tissue, and it's still important for those patients to receive timely care as well.

00:07:48:06 - 00:08:06:00
Josh Neff
And so it extends our ability for our cardiac specialists to have eyes and ears in the field, in the ambulance and understand what's going on with the patient. It allows our clinical teams to be thinking about, you know, what kind of STEMI does this look like? What should we be prepared for when this patient comes in the door?

00:08:06:02 - 00:08:31:27
Josh Neff
You can have a heart attack and still have pretty stable vital signs. You can also have a heart attack and be really, really sick with unstable vital signs. And so being able to communicate that to our team just allows them to mentally prepare for what's about to come through the door. You know, listen, I was doing pre-hospital care in the early and mid 90s, and we didn't have this technology and we serviced some real markets. And, this would have been a game changer back then.

00:08:31:27 - 00:08:52:23
Josh Neff
I know for sure that this technology is saving lives and impacting the people who live and work in my community, and that's important to me. That's why I'm passionate about being the CEO of this hospital. That's our role in this world, is to make sure that we're taking great care of our community in a way that's meaningful, and this is just another tool in our toolbox that allows us to do that.

00:08:52:25 - 00:09:02:29
Tom Haederle
Well, thank you so much for your description of what it offers and how you're putting it to use. And,thank you for the great care that you're offering your patients every single day. Really appreciate you being on Advancing Health today.

00:09:03:01 - 00:09:06:21
Josh Neff
Yeah, it's a pleasure. Thanks for asking us to talk about this.

00:09:06:23 - 00:09:15:05
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:06 - 00:00:31:02
Tom Haederle
Welcome to Advancing Health. Being your best at anything usually boils down to practice, practice and practice. All across rural Iowa, first responders and other health care professionals are getting in that critical practice to improve patient outcomes, and the training that makes it possible is delivered right to their doorstep.

00:00:31:05 - 00:01:07:29
Tom Haederle
I'm Tom Haederle senior communications specialist with the American Hospital Association, and I'm delighted today to welcome two health care professionals to introduce us to Simulation in Motion, Iowa. That's a mobile clinical education initiative that delivers on-site simulation training to EMS providers and others who provide care to the about 43% of Iowans who live in rural areas. Joining me today to talk about this are Dr. Jacinda Bunch, an assistant professor at the Iowa College of Nursing, and senior advisor to the SIM in Motion Iowa program, and Tina Eden, who is CEO of Virginia Gay Hospital in Vinton, Iowa.

00:01:08:02 - 00:01:11:18
Tom Haederle
Tina and Jacinta, thank you so much for joining me on Advancing Health today.

00:01:11:21 - 00:01:12:27
Jacinda Bunch, Ph.D., R.N.
Thank you for having us.

00:01:12:29 - 00:01:13:23
Tina Eden, R.N.
Thank you.

00:01:13:25 - 00:01:27:01
Tom Haederle
Well, let me start with you, Jacinda. Maybe you could take a whack at this first. I'm sure that my introduction did not do full justice to this wonderful program. So what needs was it designed to meet? And what kinds of medical scenarios do the care teams get to practice?

00:01:27:03 - 00:01:59:26
Jacinda Bunch, Ph.D., R.N.
So Simulation in Motion Iowa or SIM Iowa, is a mobile simulation program where we have three trucks that we take across the entire state. We allow health care providers to practice to take care of our simulated patients. They can provide care for patients they don't see very often. They can take care of patients in new settings. It's a way to test new protocols and really just to refine the care that they're providing, across the state to really improve patient outcomes.

00:02:00:02 - 00:02:33:28
Jacinda Bunch, Ph.D., R.N.
And we really designed this because in rural Iowa, access to simulation education is a challenge. It's expensive. It requires special training to really do it well. And we all know that resources are somewhat limited in our rural areas. So this provides both EMS providers and hospitals with the opportunity to have their staff go through simulation education to really enhance the care that they're providing across the entire state, regardless of where they live.

00:02:34:00 - 00:02:36:05
Tom Haederle
How realistic are the scenarios?

00:02:36:08 - 00:02:59:28
Jacinda Bunch, Ph.D., R.N.
So we work together with both the hospitals and the EMS providers to really design the scenarios to best fit their location, what they're seeing and the things that they feel that they need to work on the most. We can do medical scenarios. We can do trauma scenarios. We have simulators that are adult, pediatric, infant and then a neonate, a 25 week premature baby.

00:03:00:00 - 00:03:24:19
Jacinda Bunch, Ph.D., R.N.
So we can really do almost any type of medical or trauma scenario. And then we also work to make sure that the scenarios match the local protocols. So we're going to ask you to use the same medications that you have access to, the same equipment, and really follow your protocols rather than having you do something if you travel to a mobile SIM center that might not match what you do locally.

00:03:24:21 - 00:03:35:29
Tom Haederle
And I guess in some cases, the EMS teams or the people that are getting the training or working on - I don't want to call them crash test dummies because I know they're not - but they're human bodies in a sense, right, that they get to do some of these things on?

00:03:36:01 - 00:04:03:17
Jacinda Bunch, Ph.D., R.N.
Yes. So our simulators are basically mini-computers. So they're little robots. They have heart sounds. They have lung sounds. You can take pulses, you can give them medications. We can amputate an arm and have arterial bleeding that they need to control. We can change heart rhythms based on medications that are given. So we really can create almost any medical or trauma scenario.

00:04:03:21 - 00:04:14:25
Jacinda Bunch, Ph.D., R.N.
We try to make it as realistic as possible. Again, we want to put the learner in that environment that they would be caring for a live patient and really try to recreate as much of that as we can.

00:04:14:28 - 00:04:25:17
Tom Haederle
Wow, that's really impressive. Tina, if I could get your thoughts as the CEO of a hospital and boss of some of the care teams that have received this training, how did it work out for your folks?

00:04:25:19 - 00:04:51:09
Tina Eden, R.N.
Really, with any simulation, muscle memory is so important to build confidence in our staff. Some of the experiences they have with the simulation mannequins are those that it would take a year in their training to receive that same experience. And so it's really invaluable. It does provide a lot of confidence and just creates more of a teamwork environment.

00:04:51:09 - 00:04:56:05
Tina Eden, R.N.
They do work with a group of other individuals when they go through their simulations.

00:04:56:07 - 00:05:13:20
Tom Haederle
Sort of circling back to some of the most valuable services that the program offers, I understand that, 32 of Iowa's counties are considered maternal care deserts, meaning they lack adequate labor delivery, postpartum care services. How has Sim-Iowa helped in that particular sphere?

00:05:13:23 - 00:05:40:12
Tina Eden, R.N.
At Virginia Gay hospital, we did actually have a maternal child simulation lab come as well as SIM-Iowa. In working with those pediatric patients, it's really important our staff just don't have the pediatric experience. And working in a critical access E.R., you can see anything on any given day. So it's really important to have that in lab experience to handle those situations,

00:05:40:12 - 00:05:43:06
Tina Eden, R.N.
everything from a burn to a crush injury.

00:05:43:08 - 00:06:07:10
Tom Haederle
SIM-Iowa, as I understand it, has now visited, I believe, all 99 counties in Iowa. I think some of the most important lessons learned in the field have not necessarily been hands on operations and emergency response, but more having to do with emergency protocols and things like that. Can you both speak to that aspect of the training and maybe not, you know, if it's not treating a patient who is up on a stretcher

00:06:07:15 - 00:06:14:18
Tom Haederle
what are some of the other big lessons and takeaways that that the care teams have benefited from as the program goes around the state?

00:06:14:20 - 00:06:34:26
Jacinda Bunch, Ph.D., R.N.
I know a couple of things that we have experienced with our educators is when we go into a either an EMS agency or a hospital and we're working with scenarios that they don't see very often, they may have read those protocols multiple times, but to really pull them out and go through the steps, do we really have this medication in stock?

00:06:34:26 - 00:06:58:10
Jacinda Bunch, Ph.D., R.N.
Does everyone know where it is? How do we access it? What about this piece of equipment that we don't pull out very often? Have we really had the chance to use it hands on? Does everyone know how to work it well? Tina mentioned that muscle memory...to actually get your hands on it and do the tasks and provide the care and use the equipment, especially when it's something that we may not see as often.

00:06:58:13 - 00:07:20:01
Jacinda Bunch, Ph.D., R.N.
So that has been a huge piece. Our EMS folks bring their bags in so they are going through their own jump bags and finding their equipment and pulling out those things that maybe they don't see very often. And we also are able to take our mannequins inside the hospital so that they are also providing care in the same location that they will be with a live patient.

00:07:20:03 - 00:07:50:16
Tina Eden, R.N.
We were able to do an onsite airway training with SIM-Iowa where they actually came into our emergency department and worked on difficult innovations with our E.R. staff, including our physicians and physician assistants, as well as our nursing staff. We were also able to do emergency procedures in their unit, and that's something that we would only use in an extreme emergency, and our staff weren't comfortable.

00:07:50:19 - 00:08:06:23
Tom Haederle
The program was recently gifted with, I think, more than $5 million in investment by the Wellmark Foundation to expand the reach and frequency of the training. I wonder if you both could speak to what the plans are for this funding. How do you see it helping and benefiting patients around the state?

00:08:06:26 - 00:08:32:06
Jacinda Bunch, Ph.D., R.N.
Well, the focus of this particular gift from the Wellmark Foundation is really has a focus on our rural hospitals and EMS providers. So what this gift is able to provide is two trainings every year for our rural and mixed urban rural counties. So those are our emergency departments' primary focus. So it's maybe a medical scenario in the E.R., like sepsis.

00:08:32:06 - 00:08:57:21
Jacinda Bunch, Ph.D., R.N.
It might be a trauma like a motor vehicle accident. But they will receive two of these trainings. And those costs are covered by the gift from the Wellmark Foundation. And then in addition, the maternal care desert counties are also provided one obstetric emergency training. And that is delivered in partnership with the IPQCC, which is the Iowa Perinatal Quality Care Collaborative.

00:08:57:23 - 00:09:11:08
Jacinda Bunch, Ph.D., R.N.
And so our educators are working together. We go out jointly and provide this education in the maternal care deserts. And the Wellmark Foundation is paying for these trainings to occur over five years.

00:09:11:11 - 00:09:27:07
Tom Haederle
That's fantastic. Is it your sense that there's a great appetite for this? Maybe, Tina, you can speak to that because you're one of the hospitals who have benefited from the training. Do you have the sense from your own folks that, wow, this was fantastic. You know, a great, great use of our time, and we'd love to see them come back and do more of this kind of work?

00:09:27:09 - 00:09:49:02
Tina Eden, R.N.
Absolutely. It's very engaging for the staff. They get to do those hands on skills that they may not necessarily do. And a lot of the apprehension that new staff will have working in the emergency department is they just haven't seen something before. So it really provides that access to think through, talk through, and work through an emergency situation.

00:09:49:05 - 00:10:04:24
Tom Haederle
I don't know this for sure, but this is the only program that I'm aware of in Iowa that is set up to do what it does and organized like this. If another state is considering doing something similar, what advice would both of you have in terms of what you've learned so far and what you know works?

00:10:04:26 - 00:10:30:19
Jacinda Bunch, Ph.D., R.N.
I would say from launching this program, some of the things that we learned and actually did were to partner with a state that was already doing something similar. The Helmsley Foundation, Helmsley Charitable Trust, provided the initial start-up funding for this program, and they have done so in four other states. Each of us run our programs just a little bit differently, but we collaborated with them and we learned from them.

00:10:30:19 - 00:10:54:12
Jacinda Bunch, Ph.D., R.N.
We learned the mistakes they made and also the things that they did well. And then really just getting out and talking to providers across the state to hospitals, to EMS agencies and finding out what their needs specifically are. We don't want to come in and say, you need A, B, and C, we want to know what you need, and then we can provide that for you.

00:10:54:14 - 00:10:56:21
Tom Haederle
Got it. Tina, any final thoughts?

00:10:56:23 - 00:11:07:21
Tina Eden, R.N.
If there are other facilities that haven't used SIM-Iowa, I would recommend it. It's been very time valuable and well worth the cost of training your staff.

00:11:07:24 - 00:11:17:21
Tom Haederle
It sounds like a marvelous program and really impressive. Thank you so much for spending some time with me on Advancing Health today to talk about this and share your insights and your knowledge.

00:11:17:23 - 00:11:18:14
Tina Eden, R.N.
Thank you.

00:11:18:17 - 00:11:20:02
Jacinda Bunch, Ph.D., R.N.
Thank you.

00:11:20:04 - 00:11:28:15
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:00 - 00:00:28:18
Tom Haederle
Welcome to Advancing Health. Western Wisconsin Health recently put a lot of care, planning and resources into expanding its maternal care services for the rural population it serves. Was it successful? Well, the hospital CEO jokes that she took on a little bit of market research herself by having her own child at the hospital and checking out the experience from a patient's point of view.

00:00:28:20 - 00:00:54:01
Julia Resnick
Hi, I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. I'm so excited to be here today with Eilidh Pederson CEO of Western Wisconsin Health. Today we're going to discuss rural maternal health. As many rural hospitals are shutting their labor and delivery services, some are doubling down. Eilidh’s hospital is one of the ones that's expanding their maternity care for their community and for their patients.

00:00:54:03 - 00:01:06:15
Julia Resnick
And Eilidh has a special connection to share. So let's get right into it. Eilidh thank you so much for joining me for this conversation. To kick things off, can you tell me more about your hospital and the community that you serve?

00:01:06:17 - 00:01:35:06
Eilidh Pederson
Yes. Thank you, Julia, for having me. Thank you to the AHA. My name is Eilidh Pederson. I'm the CEO with Western Wisconsin Health, and we are Critical Access Hospital in Baldwin, Wisconsin. We serve a rural community and we serve as a safety net hospital to both our community and to our region. We employ about 500 people and offer a full breadth of service, focusing on a holistic approach to health care and meeting patients where they are.

00:01:35:08 - 00:01:39:15
Julia Resnick
Fantastic. And tell me more about your family and raising your family in Baldwin.

00:01:39:18 - 00:02:11:19
Eilidh Pederson
So now I have four kids. Very excited to share my pregnancy journey with you with my most recent baby. She was the latest addition to four kids. Two boys, two girls. And I absolutely love raising a family in Baldwin. I think there's nothing better than raising your children in a rural community. Having an opportunity to really get to deeply know people, both people with whom you're raising children at the same time, but also meeting and getting to know people who use and benefit from your hospital services.

00:02:11:21 - 00:02:37:27
Eilidh Pederson
I personally love that opportunity to meet patients in the grocery store, at the local football game, or my family at our hockey games, or big hockey players. And so that opportunity to get to know people outside of just when they're sick and when they're in the hospital, when they're feeling their best out in the community, I think is the absolute best thing about serving as a leader in a rural hospital and living in a rural community.

00:02:38:00 - 00:02:43:29
Julia Resnick
That's so special that you get to see your patients when they're healthy and out of the hospital and back to their day to day lives.

00:02:44:02 - 00:03:07:22
Eilidh Pederson
Yes, yes. I think it also is really what contributes to the quality of medicine and rural communities. There's nowhere to hide if something doesn't go well, if there is displeasure about a service, you're going to hear about it again at the grocery store, at the football game, at church, at the hockey game. And that high level of accountability translates into quality outcomes.

00:03:07:22 - 00:03:13:06
Eilidh Pederson
So it makes a difference to, to live and work in the same community.

00:03:13:08 - 00:03:20:20
Julia Resnick
Absolutely. So tell me about what maternity care is like in your community, all the way from prenatal care through postpartum care.

00:03:20:22 - 00:03:50:12
Eilidh Pederson
So all things encompassing, maternal and child health are really a staple in our hospital. We've made a conscious decision that these are foundational programs to us. So we offer prenatal care, through midwives, certified nurse midwives, obstetricians and family medicine physicians with obstetrical care as part of their training and their service. So the prenatal journey starts there. Patients have an option to see any of those providers.

00:03:50:12 - 00:04:12:28
Eilidh Pederson
It's their choice. Part of our very focused approach to medicine here. Patients are in control. They lead their own show. We're here to support and care for them. So the prenatal care journey starts there, and we see patients through anti-partum visits, and we see for them through their ultrasounds. All of their lab work is done within our hospital.

00:04:13:00 - 00:04:36:10
Eilidh Pederson
And then there's the birth experience that happens in our labor and delivery unit. We are now a seven bed obstetrical care unit where we deliver patients, either vaginally or through C-section. And then once those patients are born, we're there to be serve as their medical home. So on the pediatric side, we have two pediatricians. One specializes in developmental pediatrics.

00:04:36:10 - 00:05:00:23
Eilidh Pederson
So for our patients who have developmental needs, we have onsite pediatric care for patients in need of those services. We have a pediatric nurse practitioner. And then we have family medicine providers who also meet the needs of our pediatric patients. And we really want to be that wraparound service for a patient's life span. So through the birth through childhood and all the way throughout all stages of life, we want to be here for our patients.

00:05:00:28 - 00:05:11:18
Julia Resnick
And it's one thing to talk about pregnancy care in the abstract. It's another when you are the hospital CEO who's getting your pregnancy care at your own hospital. So can you talk about that experience?

00:05:11:21 - 00:05:35:27
Eilidh Pederson
It is just an absolute joy to have my own child at this hospital. One of the things that we do here for all patients is we sign kind of a quasi birth certificate. It's not an official birth certificate, but it's a welcome to the world. We put the baby's footprint on it. It's one of my favorite parts of the job is I get to personally sign all of those welcome to the world, through our hospital.

00:05:35:28 - 00:05:58:01
Eilidh Pederson
And so it was really special and fun too. I had my own baby, and I got my own certificate that I signed welcoming my baby into the world. Being able to experience prenatal care here, I went the midwifery route and had an absolute wonderful experience through prenatal care, sharing and the joys of practice with that personalized approach of a nurse midwife.

00:05:58:04 - 00:06:22:09
Eilidh Pederson
Then, through the labor experience to a nurse midwife by my side, we expanded our hospital a year and a half ago, and to be able to be in a room that we worked hard to bring on site for patients in need. Was great to see every aspect of that design come to life as a patient, to see firsthand why we built it that way.

00:06:22:12 - 00:06:38:11
Eilidh Pederson
All of the funds that we raised to bring that to life. Again, just to experience that firsthand was great. And nothing beats the joy of welcoming a child into the world. And to get to do it in my hospital is beyond words, how special that was.

00:06:38:13 - 00:06:42:26
Julia Resnick
Being a patient in your hospital, how did it make you think about care differently?

00:06:42:28 - 00:07:14:10
Eilidh Pederson
You know you have more vision as an administrator on what you think that care journey should look like. Of course you do that in partnership with physicians, providers, nurses, all of the, caretakers who are closest to the work. And that vision you hope you plan, you prepare that that aligns with reality. And so I joke that this was one way to do market research to determine, okay, did all of that planning go according to plan and a real life experience?

00:07:14:10 - 00:07:33:16
Eilidh Pederson
And I will say, for the most part, it did. It went exactly as we planned and prepared that it should, with few exceptions, and I'm happy to share those exceptions. But it was great to see that vision that we had, that plan of care come to life and to experience that as a patient. I'm thinking, you know, okay, this is what should happen next.

00:07:33:17 - 00:07:41:25
Eilidh Pederson
This is what we plan for. This is what it should look like. And really in every aspect, it it basically did, which was wonderful to experience firsthand as a patient.

00:07:41:28 - 00:07:47:13
Julia Resnick
Yeah. What were those exceptions and how are you thinking about changing things based on those?

00:07:47:15 - 00:08:05:22
Eilidh Pederson
You know, you can't predict some of these things, but I was glad to see how it played out. So this was a unique birth experience and that there was a storm coming when I went into labor. And, my midwife who is as great of a midwife as she is, storm tracker said, “okay, Allie, I need you to be prepared.

00:08:05:24 - 00:08:21:27
Eilidh Pederson
There's a storm coming. I think it's going to hit about 10 p.m..”And that's right around the time when your baby is going to be born. And I said, Sarah, how do you know this? I know you're a great midwife, but how do you also track storms? And she said, “in my spare time, I track the weather and I know there's a storm coming.

00:08:21:27 - 00:08:41:23
Eilidh Pederson
And so we need to prepare you.” Sure enough, I was ready to push at 10 p.m., right? At that time, all of the power went out in the hospital. We had a huge storm. Indeed. Power went out. We were on backup generator power. And so it was this dual thought, I need to have this baby right now.

00:08:41:23 - 00:09:03:00
Eilidh Pederson
And I'm also very curious to see how our emergency preparedness planning is going to work in this moment. Minutes before the power went out, the team moved everything to the red outlets, which are the outlets that make sure that when generator power comes on, all of the monitors and equipment still works the way that it should. They did this quietly, discreetly.

00:09:03:00 - 00:09:32:17
Eilidh Pederson
I, of course, knew what they were doing. My husband had no idea, which is what you want. It happened seamlessly. It was clear that our emergency preparedness planning went the way that it should. Everything functioned. Indeed, when the power went out a few minutes later and was able to safely and healthily deliver my baby girl in the midst of a storm with no power, only operating on generator power, the team knew the emergency preparedness policies training was effective.

00:09:32:20 - 00:10:03:21
Eilidh Pederson
The power was out until the next morning at 7 a.m., so we had a full evening of without, regular power. The hospital was still able to deliver many babies that night. The other unique thing about the experience that I thought about differently as a patient is when our OB rooms are full, which they often are because of the need in the community, we have to move patients to either a triage room or, to, a postpartum care room.

00:10:03:23 - 00:10:30:20
Eilidh Pederson
And we do this routinely. And as we plan for this, you know, I thought, okay, well, this won't be a big deal to families. They'll understand. We've got a patient coming in who needs a labor and delivery room. But as I experience that as a patient, I saw firsthand the challenges of moving everything. You know, the new baby, the partner, all of the mountains of things you have, and doing that at 3 a.m., was not an ideal time.

00:10:30:22 - 00:10:41:00
Eilidh Pederson
And so I saw firsthand that we can probably do that in a better way. So the market research continued with how do we interact with our patients better when those needs arise?

00:10:41:03 - 00:10:57:03
Julia Resnick
That is such a helpful learning that I think you can only realize by being in it. So I want to talk about rural maternal health generally. So many rural hospitals are being forced to close their labor and delivery services. While you all seem to be expanding, how do you do that?

00:10:57:05 - 00:11:27:07
Eilidh Pederson
We've made an investment and a commitment to sustaining rural obstetrical care. Despite all odds. We've really taken it as our personal mission that when others close, we have to be there for those communities in need. How do we do that? Number one, quality of care. That's the foundational aspect of this training, making sure that we know our patients needs because of that relationship, to be there to deliver the best care possible.

00:11:27:10 - 00:11:55:03
Eilidh Pederson
We have a 4% C-section rate. So clearly that foundational level of quality care rings true. Number two is workforce making sure that we have a diverse, sustainable workforce to meet the varied needs of our patients. And that's why we employ certified nurse midwives, obstetricians, family medicine physicians with OB, so we can have a variety and enough caregivers to meet the needs of our patients.

00:11:55:06 - 00:12:19:02
Eilidh Pederson
And then number three is advocacy work that needs to continue so that our government partners, our community partners, know the challenges that we endure and know how they best can support rural hospitals to stay open. And our minds, those are the keys to success. And that's our daily mantra. And how do we do this? How do we keep our doors open and do it well?

00:12:19:05 - 00:12:28:07
Julia Resnick
And as labor and delivery departments around you are closing their services, how are you adapting to meet not just the needs of patients in Baldwin, but in the communities that are around you?

00:12:28:09 - 00:12:48:24
Eilidh Pederson
The thoughts that we have as we work to adapt to the changing landscape and the ever growing needs, goes back to what I shared earlier. Number one workforce. We need more caregivers and providers to do this work. And the number two is increasing our space. Just a year and a half ago, we doubled the size of our labor and delivery unit.

00:12:48:24 - 00:13:10:06
Eilidh Pederson
And we're already pushing up against those limits. I personally had to move as a patient because we had more patients coming in to deliver. We need more space. And that's why as part of our five year strategic plan in this hospital, we intend to add yet again, more space, more clinical space to meet the needs of our growing region.

00:13:10:08 - 00:13:29:01
Eilidh Pederson
I think we do this and can do this well because we're local, we're independent, we're very accountable to our community. And it highlights why it's so important for rural, independent hospitals to stay open, because they keep these things at the heart of their work, keeping labor and delivery open.

00:13:29:03 - 00:13:54:25
Julia Resnick
Absolutely. And it's just such a powerful story for how you can have rural medicine really serving the needs of the community and providing high quality care that even the CEO or be willing to have her baby at. And listeners, I've met that baby and she is adorable. So congratulations on your new little one. Thank you so much for the work that you do every day for your community, and I just really appreciate you sharing your story with our listeners.

00:13:54:27 - 00:13:57:12
Eilidh Pederson
My pleasure. Thank you for having me.

00:13:57:15 - 00:14:05:26
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:01 - 00:00:27:01
Tom Haederle
Welcome to Advancing Health. Behavioral health resources are in especially short supply in many rural areas of the country. Sutter Health in Northern California is committed to dramatically expanding access to behavioral health services for rural residents. And as we hear in this discussion, it's game plan goes beyond just constructing new facilities.

00:00:27:03 - 00:00:54:14
Rebecca Chickey
I'm Rebecca Chickey, the senior director of behavioral health at the American Hospital Association. And it is my honor, truly, today to have two speakers for this podcast. Dan Peterson, who is the CEO of Behavioral Health Services, as well as the CEO for Sutter Center for Psychiatry at Sutter Health; and his colleague, Dr. Matthew White, who is the chair of the behavioral health service line at Sutter Health.

00:00:54:17 - 00:01:26:11
Rebecca Chickey
Welcome to both of you, and thank you for being willing to share your time and expertise on how Sutter is expanding access to behavioral health in rural communities. Before I launch my first question to you, though, I just want to set the stage for the listeners who may not know the severity of accessing services in rural communities. 65% of rural counties do not have a psychiatrist, and 70% of rural counties have no child and adolescent psychiatrist.

00:01:26:13 - 00:01:50:29
Rebecca Chickey
And for nearly two decades now, suicide rates have been consistently higher in rural America compared to urban America. So just to level set, how important it is that Sutter is doing this work. As we start, could you give the listeners a sense of what is Sutter Health, you know, what's its clinical footprint? And, Dan, I'll pitch it to you.

00:01:50:29 - 00:01:53:26
Rebecca Chickey
And, then Dr. White, please weigh in.

00:01:53:29 - 00:02:21:14
Dan Peterson
Yeah. So Sutter Health is a large, integrated health care system. We're really geographically focused in Northern California, but we cover the breadth of services across our footprint in Northern California. We have 23 hospitals. We have 57,000 employees, 6,000 physicians, clinicians, and our medical groups, almost 6,000. And so we're really quite a large health system, but we are also quite geographically diverse, right?

00:02:21:15 - 00:02:41:00
Dan Peterson
We have hospitals and clinics everywhere from downtown San Francisco, right in the middle of the city, all the way up to Crescent City, a small town up on the Oregon border, eight hours north. We have a number of rural hospitals, critical access hospitals and rural health clinics that we're very proud to support.

00:02:41:03 - 00:02:48:02
Rebecca Chickey
And for the listeners who may not be health care experts, per se, can you describe a little bit of your critical access hospital?

00:02:48:09 - 00:03:16:19
Dan Peterson
Yeah. Thank you. A critical access hospital is just a designation for a hospital that is essentially a sole provider in a community. You have to meet certain geographic distance requirements from other hospitals. And really, by definition be in a rural area. I was actually the CEO at Sutter Lakeside Hospital in rural Lake County several years ago, about 8 or 9 years ago, serving in a community living in a town of Lake Park, with just a couple thousand people there.

00:03:16:25 - 00:03:45:24
Dan Peterson
And it's really meaningful care provided in those communities, because you really are the provider that those residents have to depend on. Many of them simply cannot travel. Either can't afford to travel, don't have the means to travel or logistically because of the needs of their care, cannot travel long distances in order to reach another provider. So the communities really depend on these providers in the rural communities to do - not just to be there - but to do a great job for them.

00:03:45:27 - 00:04:03:00
Rebecca Chickey
Well, and I can tell there's a piece of your heart that is clearly committed to rural communities. Sutter has recently made investments to expand behavioral health services in two rural areas in California. Can you tell me about that? Let the listeners know what you're doing and why?

00:04:03:02 - 00:04:27:08
Dan Peterson
Yeah, I'll start with some of our capital investments and then maybe Matt can talk about some of the programs. We have recently announced we're building more infrastructure in these rural communities. That's an important piece of what we have to do. So, we are going to be building some additional office buildings, about 18,000ft² of additional office buildings for primary care and urgent care up in Crescent City on the Oregon border.

00:04:27:10 - 00:04:57:24
Dan Peterson
We're also really excited to announce something called an empath unit, which is a crisis care unit, for individuals in a behavioral health crisis immediately adjacent to our emergency department there in Crescent City. It'll be a 3,000 square foot facility really designated for behavioral health crises. We're also building an additional medical office building on Lake County at our lakeside hospital, another 7,000ft² or so, about a $5.5 million investment in that community.

00:04:57:27 - 00:05:19:03
Dan Peterson
And this coming summer, we'll be opening another rural health clinic in Los Banos actually, just outside of Modesto. We have a rural hospital there, and we're excited to open a new rural health clinic there, which does tie into our behavioral health strategy as well as we're really looking programmatically to embed these services in our primary care offerings at all these communities.

00:05:19:03 - 00:05:26:03
Dan Peterson
And Matt, as a psychiatrist, can probably talk a little bit better about that. The strategy behind that and why that really works well.

00:05:26:05 - 00:05:27:26
Rebecca Chickey
Dr. White, you're up.

00:05:27:28 - 00:05:51:12
Matthew White, M.D.
First to expand, on the Empath unit a little bit and then talk about some other ways in which Sutter is supporting behavioral health in these rural communities. As Dan articulated, Crescent City is up in the far, far north coast of California, and it's really pretty much an island in a very rural community. So if you're in a behavioral crisis, you end up in our emergency room there more often than not.

00:05:51:14 - 00:06:15:10
Matthew White, M.D.
So Sutter recently got some state funds to build a specialized kind of crisis care unit, a crisis stabilization unit. But an empath unit is really a particular type of crisis stabilization unit. It's designed differently in a more therapeutic way. It doesn't have the bright lights of an emergency room. It tends to have chairs rather than gurneys. It's really just a much more soothing environment.

00:06:15:10 - 00:06:31:26
Matthew White, M.D.
And it's shown to have significant reduction in hospitalization rates and reduced length of stay. So we're really fortunate to be able to leverage a state grant opportunity to kind of provide a place for folks in crisis in that area can go to get more therapeutic relief than the current state.

00:06:31:28 - 00:06:52:15
Rebecca Chickey
So it sounds much more patient centered for someone who is in a psychiatric crisis compared to an emergency department, which, as you articulated, can be loud, with lots of lights and lots of activity. You really are being able to deliver patient centered care in a different way. Is there an average length of stay? What is the time period?

00:06:52:15 - 00:07:16:25
Matthew White, M.D.
Usually it's significantly less than 23 hours, so that the average length of stay in an emergency room in these rural communities can be literally days sometimes, because if you need to be in a hospital, there's very few resources around. So people can spend several days sometimes waiting to get a hospital bed and then travel six hours to the nearest hospital. Because empath units are more therapeutic

00:07:16:25 - 00:07:26:15
Matthew White, M.D.
actually, if folks don't end up getting hospitalized quite as frequently and didn't get the care they need right then and there, instead of going a long, long distance after a long stay.

00:07:26:17 - 00:07:36:21
Rebecca Chickey
If that's not patient centered care, I don't know what it is. I know that Sutter has been the driving force behind some of these initiatives, but have you had engagement or worked with community partners?

00:07:36:24 - 00:08:00:03
Matthew White, M.D.
Yeah, the empath unit is a perfect example. It actually started a number of years ago where our community benefits liaison had been working with local behavioral health and local tribal entities, because it's been a long identified problem. And they actually got some early seed grant funding a number of years ago to sort of plan for something like this empath unit.

00:08:00:06 - 00:08:25:03
Matthew White, M.D.
So when this larger grant opportunity came along last year, which was prioritizing projects that were kind of, quote, "shovel ready, ready to go because of the existing kind of groundwork that Sutter had done, working already with the local communities and hoping and planning for one of these empath units. It was a project and a grant application that really rose right to the top and got funded because again, some of that community work that had already been happening.

00:08:25:06 - 00:08:28:21
Rebecca Chickey
Dan, anything you'd like to add about the community partnerships?

00:08:28:24 - 00:08:54:28
Dan Peterson
One of the things that I have loved about working in rural communities is you have an opportunity to truly rally everyone in the community around something, right? Because there just aren't that many people to rally. And so it is logistically possible to bring together all the stakeholders, you know, to bring together multiple interested parties, multiple interested organizations, and get them all physically at the same table and co-develop some of these ideas.

00:08:55:05 - 00:09:16:00
Dan Peterson
It's an ideal scenario in many ways. I think sometimes we think of the rural communities as having challenges and difficulties because that's true. But on the other hand, there are some of these advantages where you truly can bring the whole community together and come up with a dream and a vision as a community in a way that is far more difficult in a metropolitan area.

00:09:16:02 - 00:09:43:10
Rebecca Chickey
I so concur. I grew up in rural Alabama, in a community of about 30 homes, so everyone knew everybody. The local police officer, you know, of the tiny little town seven miles away, used to come on my mother's grass. I mean, her primary care physician was right down the street. And so the support system and the ability to identify needs and then come together and collaborate to meet those needs, it's truly unique in rural communities.

00:09:43:13 - 00:09:50:24
Rebecca Chickey
Beyond the empath unit, can you share how center is working to expand access to care in rural areas in California?

00:09:50:27 - 00:10:11:17
Matthew White, M.D.
There's a couple ways, actually a number of ways. As Dan mentioned earlier, finding a psychiatrist or even a therapist is so challenging in this environment. So one of the initiatives Sutter has been leveraging virtual opportunities and tele-psychiatry, and one such way is through embedding primary care into pay for help using a nationally recognized model called collaborative care.

00:10:11:20 - 00:10:37:13
Matthew White, M.D.
And so we've been able to stand up collaborative care using a virtual provider. So this is where a primary care physician can get support and access to a therapist for the patient and psychiatric support for help medication management through Content Health, our virtual partner. Additionally, in Los Banos, which Dan mentioned earlier, Sutter has recently hired some nurse practitioners to serve patients in their rural health clinic.

00:10:37:15 - 00:11:05:19
Dan Peterson
One of the reasons that this model is so successful - at Sutter Health we've embraced this collaborative care model - is because it really allows our clinicians to work at the top of their license, and it allows us to maximize our clinician workforce, right? There are only so many psychiatrists out there, and there are only so many psychiatric nurse practitioners and advanced practice clinicians, it's like clinical workforce especially in rural areas is difficult to come by.

00:11:05:21 - 00:11:34:15
Dan Peterson
Recruitment is difficult. There are many rural communities that you just can't find a dedicated psychiatrist to come move to that rural community, but by embracing other care models that sort of allow these clinicians to come in and consult on the care of the patient and allow the primary care doctor to continue to be the prescribing clinician but with the support of a psychiatrist, those models really lend themselves towards virtual support, which is very helpful in the rural communities.

00:11:34:17 - 00:12:06:22
Dan Peterson
And second of all, it helps you sort of maximize the impact of the workforce that you do have available. And so then, you know, we look at places like Los Banos where we haven't been able to bring in a psychiatrist for that model, but we have had success in recruiting a psychiatric nurse practitioner or some of the other areas where we're able to find some therapists and they just need some support, or we have a strong core of primary care doctors, but they just need some support from a psychiatrist. Embracing different types of models like that really just helps logistically embrace the challenge of recruitment in those areas.

00:12:06:25 - 00:12:32:15
Rebecca Chickey
So it sounds like from this approach, you are meeting the patients where they are, you're better supporting the staff, the clinicians that you do recruit practicing at the top of their license. I've seen some studies in integration that show that integrated care or collaborative care not only improves patient satisfaction, but workforce satisfaction. It can reduce stigma, which can be great in rural communities.

00:12:32:17 - 00:12:56:26
Rebecca Chickey
It has just an abundance of positive outcomes. So thank you for taking it there. Dan, Matthew, thank you so much for being here with us today. And for sharing your experiences and your innovative ideas on how you're improving access to behavioral health services in rural communities. And before I go, I'd like to remind everyone that November 20th is National Rural Health Day.

00:12:56:29 - 00:13:06:01
Rebecca Chickey
Be sure to check out the links in the show notes below for a wide variety of resources that'll allow you to participate in this important awareness day.

00:13:06:03 - 00:13:14:09
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:02 - 00:00:23:23
Tom Haederle
Welcome to Advancing Health. Philanthropy supporting hospitals and health systems doesn't spring out of nowhere. It's nurtured and sustained by building a culture of giving. In today's podcast, we learn more about how to create that culture and why it's so important to get employee engagement and buy in.

00:00:23:25 - 00:00:56:22
Sue Ellen Wagner
Hi everyone. Welcome to Advancing Health. I'm Sue Ellen Wagner, vice president of trustee engagement and strategy with the American Hospital Association. I'm very happy to have leadership from Sanford Health with me for this podcast, and I'm pleased to be speaking with Bill Gassen, president and chief executive officer, and Deb Koski, chief philanthropy officer. Philanthropy, as you know, can have a huge impact in helping a hospital or a health system achieve its mission of caring for patients while supporting operations.

00:00:56:24 - 00:01:06:12
Sue Ellen Wagner
What role is philanthropy playing right now in health care? And if you could also include the role that its playing in Sanford Health, that would be great. Bill, let's start with you.

00:01:06:14 - 00:01:23:14
Bill Gassen
Sounds great. Well, thank you for the opportunity to meet with you. It's a pleasure to be here with my colleague, Deb Koski, as we have the opportunity to really share the power of philanthropy and really, especially what that means for us in health care across this country, but really specifically what it means for us in Sanford Health.

00:01:23:16 - 00:01:55:29
Bill Gassen
And I'll start with this. Philanthropy is a really critical lever that gives us a distinct advantage in living out our mission. At Sanford Health our mission is to care, comfort, and cure. And we do that through a variety of different capabilities and characteristics. But a major way in which we fuel those characteristics and those different capabilities of Sanford Health is really by bringing alongside philanthropy. And philanthropy does a whole lot more than just help fuel it from a financial perspective.

00:01:56:02 - 00:02:29:05
Bill Gassen
But as Deb leads the foundation for us at Sanford Health, and she knows best, it also helps galvanize our communities. Community based, not for profits. Our constituents are our patients and the communities that we have the privilege of serving. And philanthropy allows everybody to be a part of that mission. So even if you're not one of the individuals who's been called to serve at the bedside, that you're not one of the individuals that's providing direct patient care, you can be a part of fulfilling that mission in the community by giving philanthropically.

00:02:29:05 - 00:02:53:04
Bill Gassen
And as Deb knows best, whether it's $1 or whether it's many, many more dollars, you're making a difference with those dollars and you're helping us meet our patients where they are at. And it's a critical part of allowing us to be able to do the things that we do, especially on a limited budget. We always say for us at Sanford Health and really for the entire field, for our hospitals and our health systems,

00:02:53:11 - 00:03:17:24
Bill Gassen
the needs are infinite, but the resources are finite. And one of the ways that we're able to do more with what we have is because of philanthropy. And the opportunity, again, to be able to mobilize communities, to be able to bring people inside the mission is something that not only helps us meet the needs from a financial perspective, but it also makes a big difference for our caregivers as well, too.

00:03:17:27 - 00:03:29:00
Bill Gassen
When our caregivers know that community leaders are behind them and they're giving with their time, they're giving with their talents, and they're giving with their earthly treasures, that makes a difference for them as well, too.

00:03:29:03 - 00:03:58:13
Deb Koski
Really well said, Bill. I think one of the things that I'm most proud of is how we have engaged our communities. We really have patients and community leaders and businesses really rally around Sanford Health in every community that we are in. And that's everything from, you know, guardian angel type gratitude that's expressed by patients to attending our events, listening to radio or video on our social channels.

00:03:58:13 - 00:04:22:27
Deb Koski
So we just have amazing engagement by our communities. And Bill is right. We have about 20,000 active donors who are giving every year from, you know, a dollar per pay period to seven figure gifts. So we just really have the spectrum of people who support us and I think, you know, rallying around our mission of to care comfort and cure, has been a real, a real rallying cry for people.

00:04:23:02 - 00:04:42:07
Deb Koski
They resonate with that. And they're really proud to be affiliated with Sanford Health and helping us accelerate all those great things and the, frankly, the access they have to health care. We're very rural, but we have access to amazing health care here in the Midwest, in the Sanford footprint. And people are grateful for that and they want to support it.

00:04:42:09 - 00:05:13:24
Bill Gassen
Deb, maybe one other thing I would add to that is, the other thing that philanthropy allows us to do is to really tell the story. And this day and age we know how critically important it is to make sure that we're getting the message out to the people in our communities, to our patients, to the individuals who are part of our care teams that are working with us day in and day out and really across this country. So people know and understand how important the work of our hospitals and our health systems really are as part of that critical infrastructure to this country.

00:05:13:26 - 00:05:39:07
Sue Ellen Wagner
I think it's great that you talked about telling the hospital story and how it's important for everyone who gives to see themselves as part of that story. So thank you so much for sharing that. Let's move on and let's talk about the culture of giving. Why is it important to support the culture of giving? And how does the board and leadership really begin this kind of culture?

00:05:39:09 - 00:05:42:04
Sue Ellen Wagner
Bill, if we start with you again, that would be great.

00:05:42:07 - 00:06:14:15
Bill Gassen
Yeah. So I would say this: from a cultural perspective, it's vital that our leadership, that our board members, whether they're local board of directors, whether it's our, board of trustees that oversees the entirety of our organization. For them to be able to set that example - which I am so grateful that they do - that so many of our leaders across this organization not only lead with their voices, but they lead with their actions.

00:06:14:17 - 00:06:31:27
Bill Gassen
And they're at the front lines of a lot of that giving. And an important part of that, again, is that it helps everybody know and understand that they get to be a part of that mission, that they get to be a part of making a difference and allowing us to be able to do more with the resources that we have today.

00:06:32:00 - 00:06:58:12
Bill Gassen
It again, it's, a real strong - and we say this oftentimes at Sanford Health - that it helps us all come together to drive that common culture that says that we know how important the work is, and everybody gets to be a part of that work whether you are somebody who's caring for a patient or whether you're somebody who's caring for those who care for our patients. And by joining in and being a part of philanthropy, you get to be a part of that.

00:06:58:15 - 00:07:26:03
Bill Gassen
And we believe that when that happens, there's a level of fulfillment that happens for the individual. We know that it makes a difference to be able to give. We know that that helps change hearts and it changes minds. Giving begets giving, which is another really important principle. Deb talks about this, better than anybody that as we see individuals in our community step up to make major financial contributions, that that doesn't quiet other giving.

00:07:26:05 - 00:07:40:17
Bill Gassen
We don't see community members say, well, I'm not going to give because Deb's giving and she's taking care of those needs. But instead we really see it as a mobilizing force where more individuals start to give as well, because they want to be a part of that.

00:07:40:19 - 00:07:44:16
Sue Ellen Wagner
Deb, would you like to elaborate a little more from your perspective?

00:07:44:19 - 00:08:02:15
Deb Koski
Yes, I would, I'm really excited to talk about this, frankly, because I think Sanford Health does this really well. Our leaders just incredible in the support that they provide. And Bill is too humble to say this, but one of his first acts when he became our CEO five years ago was to make a gift himself, he and his family.

00:08:02:17 - 00:08:28:05
Deb Koski
I've been here about over 20 years, and so I can say with sincerity that that kind of leadership has completely changed the culture of giving that Sanford Health. Currently today, the C-suite - so all of Bill's direct reports - 100% of them are giving. They do that because they want to. They attend almost every signature event. We have an organization which is quite a feat because we are spread out geographically.

00:08:28:07 - 00:08:50:27
Deb Koski
They have to travel to go to signature events in all of our markets, but they go, and they give proudly. That has cascaded now to where we have 90% of our VP's and above giving. Also influenced our physicians. We have almost 50% of our physicians giving, which I think is incredible. And I know in the industry that that's, that's a pretty impressive number.

00:08:51:00 - 00:09:05:10
Deb Koski
Over 30% of our employees are giving, including our good Sam facilities. So we just have incredible engagement. We've also seen, ironically, our NPS scores rise. And I really believe that that's because they feel like they're part of something.

00:09:05:12 - 00:09:31:08
Bill Gassen
You know, one of the things that Deb has done so well over the last 20 years is that she has made sure that she's leveraging philanthropy to really connect people to the mission. Whether you're part of the organization and you're one of the non-clinical members who is connecting into that mission, whether you're a patient, we have many of our patients and their lives have been transformed by the care that's been delivered, and they want to be a part of that moving forward.

00:09:31:10 - 00:09:49:07
Bill Gassen
And then we have members of the community that know how critically important it is, the work that we do, and how important it is to have our hospitals and our health systems there 24 by seven, 365 days out of the year. But I think one of the ways that Deb has probably done this best is her team is embedded in our operational teams.

00:09:49:09 - 00:10:26:20
Bill Gassen
And so the giving that happens, the initiatives that are underway and those campaigns are all connected right into those operational priorities. So there's no daylight between the priorities for what we're doing at the Sanford Health Foundation and what's happening in each one of our medical centers. Each one of our clinics, our long term care facilities. And to have that seamless connection not only creates the best results for the hospitals and the health systems themselves, but it also makes sure that there's a great level of connectivity to the mission, and that the individuals in the community really do feel that they're a part of those care teams.

00:10:26:22 - 00:10:44:06
Sue Ellen Wagner
Any final thoughts that either of you would like to share to give our listeners, you know, any additional information to help them either begin a philanthropy strategy or enhance their own philanthropy strategy? You've given a lot of information, but I'm sure there's a couple of things that both of you can add.

00:10:44:08 - 00:11:11:17
Deb Koski
Like I said, it really has to start from the top in my opinion. So you have to embrace philanthropy. You have to talk about it. Our chief financial officer talks about philanthropy being one of the three legs of the stool in terms of revenue to the organization and the bottom line. And while that's a lot of pressure to be, you know, lifted up like that, it also validates the importance of it.

00:11:11:17 - 00:11:31:09
Deb Koski
And it has really, frankly, motivated my team to work harder, do everything they can to bring in dollars to the organization. We have been made to feel like we make a difference. The work we do truly is helping us provide a better level of care to our patients, and our employees.

00:11:31:12 - 00:12:00:24
Bill Gassen
As hospitals and health systems, we can't forget that one of the most significant advantages that we have on our side, especially when it comes to philanthropy, is that we have an unassailable cause: to be there for every individual, regardless of their ability to pay, no matter whether they are living in some of our most densely populated urban communities, or whether they are in some of the most rural or frontier communities that are geographically isolated,

00:12:00:27 - 00:12:32:01
Bill Gassen
hospitals and health systems like Sanford Health are here to meet their needs. And I would be remiss, any time we at Sanford Health have the opportunity to talk about philanthropy, to not lift up health care's greatest philanthropist: our namesake and our most significant benefactor, Mr. Danny Sanford. As we sit here today in 2025, Mr. Sanford has already given $1.5 billion to Sanford Health to help do exactly what Deb's talked about.

00:12:32:03 - 00:13:10:16
Bill Gassen
It's been a catalyst allowing us to advance care in communities that we could have never done that in. So for us, we always talked about at Sanford Health that giving begets other giving. And we have seen that happen. And so to know that when we have the ability to go to philanthropists or potential philanthropists to say, we want you to be a part of our mission, to know that we're asking for them to come alongside in a partner in some of the most rewarding work that could possibly exist is something that should embolden us to go out, to be able to engage other people.

00:13:10:18 - 00:13:24:21
Bill Gassen
And Deb knows this as well as anybody. Time and time and time again, we have our donors come back to us and say, thank you. Thank you for giving me the opportunity to be a part of the mission at Sanford Health.

00:13:24:23 - 00:13:44:27
Sue Ellen Wagner
Thank you, Bill and Deb, for being with us today. Clearly, Sanford Health is a leading practice in philanthropy and I think a lot of what you shared, leveraging the philanthropy to connect to your mission involving the leadership and your employees, has gone such a long way to your successes. Thank you again for being with us.

00:13:45:03 - 00:13:45:23
Bill Gassen
Thank you.

00:13:45:26 - 00:13:47:06
Deb Koski
Thank you so much.

00:13:47:09 - 00:13:55:20
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:00 - 00:00:26:07
Tom Haederle
Welcome to Advancing Health. Here is a health statistic that hasn't changed in an amazing 75 years. Since 1950, cardiac issues, specifically heart disease, have remained the leading cause of death in the United States. But in Colorado, one hospital is using an innovative new tool to chip away at that stubborn reality.

00:00:26:10 - 00:00:49:06
Tom Haederle
I'm Tom Haederle, senior communications specialist with the American Hospital Association. Glad you can join us. And I'm also really pleased that Josh Neff could join us. Josh is president of Mercy Hospital in Durango, Colorado, an area of the state known as the Four Corners region, and is here today to talk about how Mercy is using a cutting edge communications tool called Pulsara to assist patients who are dealing with cardiac issues.

00:00:49:08 - 00:00:53:09
Tom Haederle
Josh, thank you so much for joining me on Advancing Health today. Really appreciate you being here.

00:00:53:12 - 00:00:59:11
Josh Neff
Yeah. Tom. it's a pleasure. It's a great opportunity to talk about some really great things we're doing in southern Colorado for cardiac care.

00:00:59:13 - 00:01:03:23
Tom Haederle
Well, let's start with the basics. What is Pulsara? And how is Mercy Hospital using it?

00:01:03:26 - 00:01:41:12
Josh Neff
So Pulsara is ultimately a field to hospital communication tool. And we've got a large and remote area. Sometimes our response times are lengthy in southern Colorado, especially in the Four Corners area we've got a lot of mountain passes. When it's, when it's snowy, it creates some really delayed times getting critical patients to the hospital. And so Pulsara is really a way for us to connect and communicate with our pre-hospital providers across our seven counties that we serve in southern Colorado and northern New Mexico, where for patients who are having chest pain and cardiac related issues, EMS has progressed over the last decade or two, and we've now got paramedics and other

00:01:41:12 - 00:01:58:10
Josh Neff
folks that are doing 12 lead EKGs in the field, as soon as they arrive at the patient. And that's a really important thing for us to know and understand. How do we get that EKG to a cardiologist that's at a hospital 20 or 30 miles away, or maybe more? And so Pulsara really bridges that gap for us.

00:01:58:13 - 00:02:29:26
Josh Neff
It allows those pre-hospital teams to transmit that EKG in a HIPAA compliant manner directly to the cardiologist on call. And that cardiologist then is able to help the pre-hospital team manage that patient clinically. That also allows us to be more prepared if that patient is actually having a STEMI or a heart attack. It allows us to have our teams ready and prepared so that that patient goes directly to the cath lab and undergoes cardiac treatment in a shorter period of time.

00:02:29:29 - 00:02:48:11
Tom Haederle
Take us inside the ambulance itself if you would for a minute. So you've got a patient in there who's having a cardiac issue enroute to the hospital. Could be a long drive ahead. What is happening in the ambulance itself and how are EKG and other vital signs - how is that all being monitored and transmitted? How does that happen?

00:02:48:13 - 00:03:13:21
Josh Neff
There's both Bluetooth and direct wired technology capability between. Basically it's transmitted over cell service. And even in the remote areas where cell service is a little bit patchy, the Pulsara system is accumulating this data in the background. And as soon as it hits a signal, it automatically transmits which allows that pre-hospital team, those paramedics and EMTs to be focused on working on that patient and providing care.

00:03:13:21 - 00:03:28:23
Josh Neff
As a former pre-hospital guy - so as a ground paramedic and a flight paramedic way back in the day - we didn't have this technology and it's really comforting for the team to be able to know that they've got a group of specialists just at their fingertips that can help us and help them care for that patient.

00:03:28:23 - 00:03:47:17
Josh Neff
And so basically, they get the machines hooked up. Pulsara can connect directly to their cardiac monitors. And so it feeds through that system and electronically can transmit a wide amount of data to us and to our caregivers that are that are at Mercy Hospital ready and waiting for that patient to come in.

00:03:47:20 - 00:03:53:03
Tom Haederle
And so what do they do with that information? Once it is transmitted? That helps with treatment plans?

00:03:53:03 - 00:04:10:08
Josh Neff
It does. So during the day, we've got our cath lab. We have two cath labs at Mercy Hospital. We're the only cath lab program in the southern part of the state and serving northern New Mexico. And so we've got folks on call or in the department every day. However, if it's after 5 or 6:00 at night, we've got an on call team.

00:04:10:10 - 00:04:30:13
Josh Neff
The goal is really with this to reduce the amount of time from first medical contact to device. And device is kind of that reperfusion or the treatment time that's tracked by all of the accrediting agencies. We know that the earlier we perfuse an artery, it leads to better outcomes. And that's both in-hospital mortality as well as long term recovery.

00:04:30:13 - 00:05:04:12
Josh Neff
And so what it allows us to do specifically at Mercy - before implementing Pulsara are we had about 130 minutes from first medical contact to reperfusion times. I mean, our cardiology team has worked with Los Pinos CMS, Pagosa Springs Hospital, Upper Piney EMS, all Durango Fire Department, and a number of other agencies. This year, since we've implemented Pulsara, we've been able to reduce that time from first medical contact to perfusion from 130 minutes to 84 minutes.

00:05:04:12 - 00:05:32:15
Josh Neff
So we've seen a 35% decrease in time, because typically what would happen is that patient would come to the ER, they'd have a repeat EKG, yes, you're having a STEMI. We should have the cardiac team here. You need to go to the cath lab. They'd have to, you know, drive in from where they were. And so what this has allowed us to do is our cardiologist directly receives this EKG on a cell phone, is able to interpret the EKG, and he or she makes the call in real time.

00:05:32:17 - 00:05:42:20
Josh Neff
This patient's having a STEMI. Hits the button, alerts our cardiac teams. And so that patient can come directly to the cath lab and undergo treatment immediately.

00:05:42:22 - 00:05:54:00
Tom Haederle
That's remarkable. And being able to shave that much time off from the older way of doing things prior to Pulsara, what kind of results has that yielded so far in terms of patient outcomes?

00:05:54:02 - 00:06:14:01
Josh Neff
So we know that that time is tissue. We are in the process of tracking the official data. What I can tell you anecdotally is we're seeing patients with shorter hospital stays getting back home and back to work and back to play in a shorter amount of time. And we're seeing better outcomes clinically for them as well.

00:06:14:06 - 00:06:26:07
Tom Haederle
That's just amazing. What kind of training is involved in using the Pulsara system, both for Mercy Hospital, ambulance employees, EMS people...is it a complicated thing to get the hang of, or not really?

00:06:26:10 - 00:06:46:21
Josh Neff
It is not. If you can operate your social media apps on your cell phone, you can understand and operate Pulsara. It is that simple. It's intuitive. It knows how to store the information, what to send. And so when those pre-hospital folks hit that send button, it just automatically alerts the team that's on the receiving end of it.

00:06:46:21 - 00:06:59:16
Josh Neff
So those folks who have the same Pulsara on their communication devices. They get an alert, they can go right in and tap the picture, look at the EKG. They can look at vital signs, a number of different things. So it is very easy to use.

00:06:59:19 - 00:07:05:26
Tom Haederle
What about the cost involved? Is that something that is within the budget, would you say, of many hospitals or health systems?

00:07:05:29 - 00:07:21:09
Josh Neff
Yeah, it is, it is not an overtly expensive investment. And it's an investment in clinical care and quality outcomes. So it made all the sense in the world for us to do it. We know that if we can save one life over the course of a period of time, then those investments are well worth it.

00:07:21:09 - 00:07:31:01
Josh Neff
But, I would say to any hospital CEO as well as the EMS programs that are out there, it is an affordable program that you can and you can easily integrate.

00:07:31:04 - 00:07:39:23
Tom Haederle
Would it be as helpful, do you think, for hospitals in more urban areas that really aren't looking at the same transport times, you know, with that patient in the ambulance?

00:07:39:26 - 00:07:57:02
Josh Neff
I think it could be used widely across all markets. I mean, I was in on the Denver Front Range before I moved to Durango. And, you know, it may take you 45 minutes to go 6 or 7 miles if you hit traffic wrong or there's a wreck. And so time is still tissue, and it's still important for those patients to receive timely care as well.

00:07:57:02 - 00:08:14:27
Josh Neff
And so it extends our ability for our cardiac specialists to have eyes and ears in the field, in the ambulance and understand what's going on with the patient. It allows our clinical teams to be thinking about, you know, what kind of STEMI does this look like? What should we be prepared for when this patient comes in the door?

00:08:15:00 - 00:08:34:02
Josh Neff
You can have a heart attack and still have pretty stable vital signs. You can also have a heart attack and be really, really sick with unstable vital signs. And so being able to communicate that to our team just allows them to mentally prepare for what's about to come through the door. You know, listen, I was doing pre-hospital care in the early and mid 90s

00:08:34:05 - 00:08:52:27
Josh Neff
And we didn't have this technology and we serviced some real markets. And, this would have been a game changer back then. I know for sure that this technology is saving lives and impacting the people who live and work in my community, and that's important to me. That's why I'm passionate about being the CEO of this hospital.

00:08:52:29 - 00:09:01:19
Josh Neff
That's our role in this world, is to make sure that we're taking great care of our community in a way that's meaningful, and this is just another tool in our toolbox that allows us to do that.

00:09:01:22 - 00:09:11:25
Tom Haederle
Well, thank you so much for your description of what it offers and how you're putting it to use. And, and thank you for the great care that you're offering your patients every single day. Really appreciate you being on Advancing Health today.

00:09:11:28 - 00:09:15:17
Josh Neff
Yeah, it's a pleasure. Thanks for asking us to talk about this.

00:09:15:19 - 00:09:24:01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.