In Part 1, Dr. Creese speaks of the empathic physician, “An empathic provider communicates a plan of treatment back to the patient and family with awareness of the impact.”
Part 2 gives us an idea of how empathy for the patient started very close to home for Dr. Creese.
Part 3 0f 3
As an EMT, Andre’ Creese had struggled to keep a patient alive. An ER doctor, speaking over the radio, guided him well past the point of where his training ended. Later, he visited the patient at the hospital. “Al, the toughest part of all this for me was when he grabbed my hand… so firmly and he wouldn’t loosen his grip. I am getting uncomfortable, trying to let go… to let him know that I was just doing what was expected of me. His eyes, they just fixed on me. I couldn’t look away. The raw appreciation in his grip and watery eyes, they just wouldn’t let me go.” Soon after, Dr. Creese changed his college major from nursing to pre-medicine.
From his residency, 1994-1998, to his current position as CEO of OPYS, Dr. Creese, maintains that, “Great skill, great hands, and great compassion” are needed for success. I have worked around his schedule over the past few weeks. I would add great endurance. And there is, of course, the physician’s need accurate and concise information to compliment great hands, great skills, and even the expression of compassion. People and equipment/systems provide this information. Our focus is on equipment/systems (hardware and/or software).
In that discussion, Dr. Creese states, “The ER is dependent upon the systems that can be managed in part or fully by other departments.” These are all related to the outcome of the patient.
I ask, “What about a system like 12-lead electrocardiography, ECG, transmitted from an ambulance to the Emergency Room?”
Dr. Creese’s verbal meter increases interval and becomes determined. “The goal of the 12-Lead ECG transmission is to reduce the time it takes for a patient to receive treatment to reopen an artery. It has become an essential part of pre-hospital medicine. Time is tissue! The Standard of Care is 90 minutes door to balloon insertion to open the artery. This time is calculated from ER door to the balloon insertion performed in the catherization lab. Ambulance transport time is not included in the calculation. The 90 minute standard of care should include transport time decreasing the overall time to reopen the artery.
With 12-lead ECG transmitted by trained technicians, the 90 minute goal is calculated as time from the incident scene to the catherization lab. The patient goes from the ambulance straight to the catherization lab without further triage. The appropriate teams are prepared to act. Treatment time is shortened, saving heart muscle.” This isn’t just a matter of life and death but mental capacity or other severe chronic conditions. “Yet, hospitals can struggle with acquiring the technology.”
Essential yet struggle, those were Dr. Creese’s words. Having experienced such a deployment, I understand the struggle. It’s not just expense Dr. Creese implicates as part of the struggle.
There are clinical, state policy, and operational concerns:
- A cardiologist must read the transmitted ECG to determine if the patient has suffered a heart attack and where the damage is located. Onsite or off-site cardiology must be considered
- Understanding the clinical changes and requirements during the decision making process
- State approval of who in the pre-hospital environment may perform a 12-lead ECG
- Coordinating a program for geographical response with other services requires other parties to agree, train, and prepare.
There are equipment considerations:
- Mobile Phones
- The wireless service carriers
- Hardware and software maintenance
- Connectivity from the ambulance through the continuum of data storage and retrieval
- Whether or not the system increases or decrease net revenue
And there is more, most of which are dumped heedlessly into the laps of Department Heads or Clinical Mangers to drive and coordinate. Time and pressure ingrain detrimental assumptions at every level. The capital committee scrutinizes the attempt then kicks it back because information is missing or some part of the coordination fell apart. If the project is ever approved, purchased, and deployed, a project manager has already been set up not to meet the timeline requirements.
One take away in regards to context is a simple reminder about medicine. Dr. Creese’s path reflects that medicine is often both a profession and a passion, a lifelong dream come to fruition. This aspiration of heart may be motivated by an incident or what may best be described as a calling. In the ER, all of this passion and skill manifests daily while dealing with the uncertainty of who, in what condition, enters into their care (hands, skill, and compassion).
Their patients - crime victims, heart attack sufferers, infected, those tittering on the edge of whatever concept of the afterlife held dear… they require and deserve more than “this is our process” or the easy command to “cut everything across the board” without even allowing the thought that something else is possible. Process is important. Expense control is important. Sometimes… asset managers just have to challenge every assumed limitation. We have to figure out how to overcome and persevere in helping clinical requirements fit into the financial reality.
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