July 14: Today on TownHall, Sue Schade, Principal at StarBridge Advisors speaks with Bonnie Goans, RN and Trauma/Emergency Preparedness Coordinator of Rice County District Hospital in Lyons,KS. They talk about how technology that was first implemented at the start of the pandemic has enabled them to broaden the hospital's patient transport reach and how they can quickly coordinate transfer and transport across greater distances.What other services does mission control provide? What were some of the challenges with getting their small 150-person team up and running with the technology?


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So mission control we're able to just answer a few questions, to get the acuity and how fast they need to be transferred.

They start calling hospitals for us in like a circular motion from our hospital out. It's just such a huge benefit for us because that gives one more nurse and/or the doctor time at that patient bedside.

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Hello, I'm Sue shade principal at Starbridge advisors. And one of the hosts for the town hall show today's guest is Bonnie Goins, who has been an RN at rice county district hospital in Lyons, Kansas, for more than 20 years, and also serves as trauma slash emergency preparedness coordinator as a critical access hospital rice county district operates with the lean team of only 150.

In may of:

The hospital knew they needed help. When it came to moving patients, they needed a technology solution for patient move. Today, we're gonna learn about the situation they faced, the solution they implemented and some of their key lessons. Welcome, Bonnie.

Hello. Glad to be here.

Great. I'm looking forward to this conversation and learning about your challenges and what you did.

Let's start by having you describe rice county district hospital who you serve in terms of the community and your specific role.

Yes, our hospital is in the heart of Kansas. We are. 40 miles away from any larger hospital. We service a community of 10,000 people, mostly farmers and industry workers.

Our hospital is a 25 bed critical access hospital. So our role in the big picture is to stabilize and transfer that's our key role in the state of Kansas with giving people to the right. Level of care. Okay. So we typically transfer out probably 40% of our patients.

a little bit more, and then a little bit in terms of your specific role,

my role, I have a, well, a multi. Role, I still work on the floor as a staff nurse when needed mm-hmm and or if there is a crisis I work like in the emergency department labor and delivery, we deliver babies here as well.

And well, and just any, any other thing

so, I understand you also are the trauma slash emergency preparedness coordinator. So what does that mean in terms of your role?

That means I work with the state to come up with specific criteria and a systematic approach to taking care of a trauma patient mm-hmm so that they get the highest level of care.

And the quickest time. And then we that's, our goal is to stabilize them and get them transferred out to a level one trauma center. Okay. And our closest one is 90 miles away.

Okay. So that was something I was gonna ask you to repeat. So, I heard you describe the size of the community and where you are and 90 miles to the closest trauma.

Yeah, well, to the, a level one, we have a level three that is, is like 30 miles away. Okay. Takes 40 minutes by ambulance to get to the level three. Okay. It takes an hour and 15 minutes by ambulance to get to a level one.

Okay. and, and is it by ambulance or is there any air flight?

We do a lot of air flight.

Truthfully, it just depends where that helicopter or that plane is. Mm-hmm to, for their time to get here, pick up the patient and take them to the level one how long that would be versus our EMS driving them. So those times we look at each case to know, are we gonna fly or drive? What's the weather like.

Can we do helicopter or fix wing. And then we also look at, we have a small EMS crew. We do have a full-time crew, one crew for every 24 hours. And then they do have a backup, but in this day and time, paramedics are hard to come by. And so you're not guaranteed to have a paramedic for that second out crew.

Mm-hmm so. The distance is further than 90 miles. Our EMS cannot take the patient. They cannot leave the rest of our community without ambulance care. So that's where flight crews come into play. Okay. And with COVID we have sent patients to seven different states. Wow. Yeah. Oklahoma, Colorado, Nebraska, Iowa, Missouri.

Those are just the ones right off the top of my head. So, yeah, and quite the Ordell we've transferred a lot of patients to Tulsa, Oklahoma. We've transferred some trauma patients to Nebraska. They have a very. Good. Neuro hos for a TBI traumatic brain injury. They have a great hospital for that.

We transferred to Colorado with pediatrics to Aurora, Colorado and all of this has to be arranged and we, I'm not gonna say we have a skeleton crew, but we have a small crew that's very diversified and efficient that works every shift. So we don't have a whole lot of extra runners. We don't have like scribes, we don't have business office, people that are sitting there answering our phone in the ER.

So it does take a lot of effort and time to get that patient where they need to be, and then try to make phone calls to. Doctor hospital acceptance and then get a bed that becomes very tricky if we're trying to do that by ourself.

Okay, this is fascinating. And just hearing you describe the reality for critical access hospital and the distance.

I'd love to just talk about that in general, because why, but we're not gonna my work experience in health. It has been primarily. At academic medical centers and the level one trauma, so on the receiving end of it. So it's really fascinating to hear you talk about your situation, what it's like moving patients out and getting them to those centers.

So, let's talk specifically about the situation that you faced During the pandemic during the height of the pandemic, let's say, and the patient movement tool that you ended up implementing. So let's get into that. Go ahead on that,

so when COVID first started, it did not hit the Midwest yet.

it took a few months for it to really take hold in our community. And when it first did, we had a patient. Was significantly sick with COVID. We do not have the ability to put a patient on a vent This patient, we happened to put on a bipap that's the highest level we can go for breathing and he was not maintaining.

We did the plasma with this gentleman trying to do anything that we could for him. And then our doctor and. Nurses took turns, calling, and calling and calling hospitals. We finally were able to find one, three hours away and we worked well already with the flight crew in our area.

So we called one, they sent a fixed wing in and took that patient to where they needed to go. Then the state of Kansas introduced us to mission control. And that is a company that supports us and arranges transportation and hospital acceptance for us. So now they are actually a key player in our trauma team.

And not only trauma, it's our emergent team. They play a significant role. They help us do the legwork that we really don't have time to do. Our job needs to be at that bedside. Getting blood in that patient, getting them intubated, getting them ready to be transferred, not on the phone, trying to find an acceptance.

And the thing that really was just. Blew my mind is we have two level, one trauma centers in Wichita, Kansas. That's where we send them how they were on diversion for everything they were at capacity. Couldn't take trauma patients couldn't take cardiacs. We don't do surgery here at all. I mean, we do like.

Colonoscopies, just minimal. But we don't have a surgeon on staff. We don't have a doctor in house most of the time. This is a nurse ran hospital with doctors supporting us. So if somebody comes in from a trauma by private car, the RN is the one that is the first contact with that patient.

So our staff is very strenuously trained to where they can manage that patient until they get a doctor on the phone or they get the doctor here. So that's what our staff focuses on and does. And so mission control with their service, we're able to just answer a few questions, get. In their program to get the acuity and how fast they need to be transferred.

They take over from that point and they start calling hospitals for us in like a circular motion from our hospital out. Okay. And they don't just stop at the borders of Kansas. They keep going. And they're the ones that have actually helped arrange most of these transfers to the different states. And it's just such a huge benefit for us because that gives one more nurse and/or the doctor time at that patient bedside.

So that they're not on the phone or. Trying to negotiate. The other thing that mission control does for us is if we have a patient that we can't find a room for, they have consultants, they have pulmonology, they have cardiology, they have neuro. So if at any point we have a patient that.

Obviously needs a higher level of care, but we can't get them to that place. We ask for a consult and within my experiences within seconds, they have that consult doctor on the phone

telehealth kind of visit.

Yes. Yes. And they, I mean, it's extremely quick. The first time I used it, I was like, oh wow.

Because it never happens that point, you gotta wait for them to call them and then they call back, not with mission control. Excellent. They are. Available right. Then they worked with our doctors make a plan of care for our situation. We've had. I am, oh, this COVID has been horrible for our community.

We have had several patients that need to go to a higher level of care, but we could not find placement or we couldn't find transportation through everybody's. Efforts. And so we've worked with the consultants, the consulting physicians to try to provide the best care that we can for that person, until we can get them transferred.

Sometimes we have succeeded other times we have not. So it's been a very up and down roller coaster. But with mission control, they help us through that journey. Right. And they don't stop and they don't give up. They, what they were doing is about every four hours they would call and give us an update on, just a general what areas they've called.

Mm-hmm, what the bed placement, is like how long, that sort of thing, they keep us up to date. And then they keep trying, okay. The thing I love about their website is you can, it's very easy to maneuver through it. You can go back and look at your information. And if that patient has progressed on whatever's going on with them, you can change that information to upgrade their acuity mm-hmm

And so that helps with, getting that process rolling. More. But they also, have a chat feature to where you can type and chat back and forth with the people that are hunting. You can give them specifics about the patient. If something has changed, you can let them know. And they also call typically when we do a mission control.

Patient. We also put in a phone number for them to contact the person who is communicating with them now during COVID and the hospital, all of our regional hospitals being at capacity. What we ended up doing is having a team of staff members that would be on call. For people that were working in the hospital so that if they had somebody that needed to be transferred, they notified the person that had.

On call phone gave us a brief synopsis of what was going on with that patient. And we would enter the information into mission control because it's a web base and an app. You can do it off your phone. You can do it off a tablet. You can do it off of a laptop. And so we could be anywhere and take over that portion.

Communicate with mission control to get that transfer moving while our staff was at the hospital, working on that patient that worked out very well. Excellent.

So it sounds like it's a service. Yeah. In terms of the work they do to find a bed somewhere with the right level of care, it's a web based app that you log into and enter the information and then get your updates and, can chat with them.

And then they provide also the medical consults. If you need.

They are amazing. The third thing that they provide is transportation. Oh, okay. Yes, because in the beginning I told you about how our EMS works. We have one crew on for 24 hours, right? We can only have one ambulance out of our county at a time, and we cannot have that ambulance outta county for eight, nine hours.

Yeah, it has to be a short transfer go and come back. So mission control actually helps us with that. If we need transportation help, we tell 'em and if that's all we need, that's fine. We can start a case and tell 'em all we need is transportation. This is where they're going. and then they get all of us together.

Whoever the flight crew is, we decide what method is used. And we actually have a say so in what method? So it, we're not just told what's going to happen. We are in that decision. So that is really great. But yeah, we work with. and it's not just one flight company. We work with several flight companies and mission control works with all of these companies so that we get the quickest and the fastest.

Transportation and get 'em outta here. And we have used that significantly over the last two years.

Excellent. Excellent. Any particular challenges that you faced in, once you knew mission control could be , a solution for you getting from no mission control to fully using it, any particular challenges

Yeah, we had a learning curve that went along with this. Initially when we did this, we registered all the RNs. to be able to get in and utilize that had a little issue with getting night shift nurses. To be get registered because the way you register on them, you have a certain amount of time to respond to their email.

And so that timing was off. So we worked out a plan for that. So we got through that challenge. The next challenge that we ran into is once a bed was found. You had to get that transportation going because that bed was not guaranteed to you until the patient was en route. If they were still at your facility and somebody else called and needed that bed, you lost the bed.

So we learned very quickly. To move fast with these we have one patient that we ended up losing three different bed placements over, and it was because of transportation trying to get it. And it was nobody's fault. It was bad weather, just all of that type of stuff. So that was a really sad, sad situation.

but they have come through for us so many times we recently. Had a patient that had a dissecting aneurysm that our regional hospitals were at capacity. We had nowhere to send this patient, so they helped us. They actually got a doctor in Tulsa and he consulted with a doctor in Florida.

They arranged the flight for our patient to go to Tulsa, to that doctor and have surgery. So that patient, if they would've stayed here, they would've died. There was nothing we could do with that. Nothing we could do for them. And mission control understood. The severity of the case and worked so hard to get that patient outta here.

Wow. Are there you talked about some of the challenges in terms of learning curve and the adoption and few other things, any other key lessons that you wanna share for anybody listening, who might be in a similar situation and could benefit from such a service and tool, any other key lessons?

I don't think so. I don't know. I think that's mainly it. It's just learning how to utilize their service with the staff that you have on mm-hmm . And. Through the main part of COVID and it, and actually we're still going through it now it's a nursing shortage. Yeah. So there's no beds available for any type of patient and it's an hour by hour situation that you've gotta check to see if there's beds and again, mission control helps us with that. So yeah, it just became a member of. Our transfer.

Yeah, it sounds like it's not just something that you needed to do during the, during COVID peaks, but ongoing, considering your situation, critical access hospital for all your patient transfers.

That's excellent. Exactly. That's excellent. Well, Bonnie, I so appreciate everything that you have shared with us today and your time. I know you're very busy there and this has been excellent. I just wanna thank you so much for taking the time to share your story. This is.

Thank you.

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