Episode 184: The ICU Revolution at Mercy San Juan Medical Center- Part 3 with Luke Stratigates
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This is the Walking Home from the ICU podcast. I'm Kaylee Dayton, a nurse practitioner and ICU consultant. I help teams create awake and walking ICUs through evidence-based sedation and mobility practices. By hearing from survivors, clinicians, and researchers, we'll explore how to give ICU patients the best chance to walk out of the ICU and go home to survive and thrive. Welcome to the ICU revolution.

Thank you.

I especially enjoyed working collaboratively with Luke Stratagates at Mercy San Juan, and I'm excited for him to share what can happen when a hospital invests in a strong, safe patient handling department and then gives them the opportunity to really lead mobility throughout the hospital. Luke, welcome to the podcast. Thank you so much for coming on. Can you introduce yourself to our listeners?

First off, thank you for having me. Yes, my name is Luke Stratagakis. I am the safe patient handling coordinator at Mercy San Juan Medical Center in Sacramento, California. I'm also a physical therapist. This is really exciting because I haven't had anyone from safe patient handling on yet. So let's back up to the course of your career.

What has been your experience in the ICU prior to this initiative? I got my bachelor's at Cal Poly. I was one of the last people at Cal Poly San Luis Obispo to get a free physical therapy concentration degree at Cal Poly San Luis Obispo. After that, I got my physical therapy degree at University of St. Augustine down in San Diego. Originally, it's interesting. I had wanted to practice neurodegenerative.

I thought I was going to go neuro. And then I ended up going to a school that was very much outpatient ortho. And if you look at kind of different styles of physical therapy, it was almost like an osteopath. Dr. Stanley Paris was the one who put that school together. And we got a lot of very similar training and thought process that some osteopaths and chiros did. I ended up working

orthopedics for between 2013 to 2018. And then I started working inpatient. Through that growth, I got to work in all the different units that our hospital has to offer. We are a level two trauma center, handle everything but burns in the area. Started off working some orthopedics and then every three months we would shift.

I found a home in trauma ICU. You probably heard the statement, it kind of takes a crazy to know a crazy. And some of the stuff that we got to deal with in that unit, you kind of have to have a little bit of a crazy chip on your shoulder to be involved in. It resonated with me when I was working with them. So working in the ICU, that was really where I started to grow. And then I landed there for two or three years because no one really wanted to take the unit. So I would just step in and say, yeah, sure, I'll work trauma.

So I got to see just the ins and outs, some of their organizational things. That's my ICU experience. After that, I went back to just different units. And then I stepped into the safe patient handling role. And for those that aren't familiar with safe patient handling...

What is it and what role does that department play in the hospital? Because not all hospitals have safe patient handling. Well, if we want to back up and you want to look at safe patient handling as a whole, and I will tell you, I'm still a youngster in this. I took over this position in January 23. So January 25 will be two years. I'm currently working on my certification for a safe patient handling professional.

So I will tell you, I'm a youngster. But for people that don't know, say patient handling really came about multiple things. One, it came about through legislation, nursing union groups going to our state legislators. And so they can create laws or at least protection from protection for the staff members is what they were realizing where people were getting hurt at a more alarming rate.

And as I think the legislation grew, hospitals started paying more attention because of more of the involvement of risk management when they deal with these workers' comp injuries in relation to

These type of events, they look at, all right, well, yes, this is a twofold benefit. We get to protect our investment by hiring these people, but also we are state law and policy. So that's the Reader's Digest version from the way I understand it. And so what role does safe patient handling play in patient care in hospitals? A lot. I don't know how much experience you have right now with age-friendly healthcare systems. That's coming down the pipeline. Eventually, it's going to be everything to do with the patient care in the hospital.

We want to keep people moving. If you walked into the hospital, we want to keep you walking out. But ultimately, we have to keep our caregivers safe from that perspective. What I try and preach to the staff is you have to keep yourself safe so you can keep your patients safe. Ultimately, it's about building a team together that looks at every aspect of different types of patient handling injuries that can happen.

formulating policies and also education and also auditing systems to keep everybody safe. I'll tell you one of the things that I really try to advocate for in safe patient handling here at Mercy San Juan is I really want to have the patient do as much as they can during their stay here, right? If they were walking, let's keep them walking. If you are getting to your wheelchair at home, let's

let's make sure you can still get to your wheelchair, right? Old school used to be, all right, let's get three, four people and let's heft them over. But those days have to disappear. And so through the development of different policies, also through relationships with our vendors, we've been able to bring in different pieces of equipment. So

How it plays a piece is knowing what's out there, knowing what your policy is, having relationship with your executive leadership, but also having relationships with the frontline staff to really teach them. This is really here to benefit you. I've now seen a big difference between what equipment is available, how comfortable and competent the staff is with the equipment when hospital has efficient handling versus when they don't.

I recently trained a team that did not have safe patient handling. And so I looked at their equipment options and I was just shocked because I'd gotten so used to now training so many teams with safe patient handling involved and equipment being there. Nurses had received training at least, but then safe patient handling helps build that bridge even further to say, now that you've taken this training with Kaylee,

Now here's the equipment and let's reinforce and make sure you're using it properly with your patients. Because I've also seen teams that have safe patient handling

We have the equipment and then it just gathers. They don't use it. It just gathers dust. So I had a really good experience teaming up with you to train these five ICUs in your hospital. As you brought in so much of your expertise with the equipment, your role as really the bridge between all the disciplines, looking at ICUs as a whole, as well as the entire hospital.

And that was really nice for me to just bring in my element of now in the ICU, we're going to get them up sooner. We're going to get them awake. And I was really impressed by how much of a leadership role you took throughout all of this, which is what I want to really optimize on. But from your perspective, having worked in the trauma ICU and all the ICUs,

What was the culture like beforehand, before we started this initiative? The culture like at Mercy San Juan, everyone followed orders. And if it was an opportune moment to do a early mobilization following the bundle, people would do it. From my experience in trauma, I see when you came in and you were teaching a kind of, what would you say, a re-clarification of the bundle, right? A re-clarification, a more, a deeper appreciation, a deeper understanding of the bundle.

What I would see before is people would just follow, they would follow doctor's orders, they'd follow order sets. And if it worked out, that was great. One of the things now that I went through your training and also just my experience in trauma was when trauma, you have possibly every body system involved. You can have neuro, you can have ortho, you can have integumentary, you can have GI. So it's really, you learn the

absolute contraindications, you learn the indications, you learn the relative contraindications, and it's about trying to find your way through to apply it to each patient and also say, all right, this is what we can do safely for this patient. And if that means we can just sit the bed up safely, or maybe we just angle the bed up safely, we are thinking about it, right? So from a culture standpoint,

It was always there. People were always moving their patients. But I think we just went from first to probably fourth year after COVID.

The training, right? Yeah. Your patients that were not intubated were oftentimes up in a chair. And when I was training, I saw patients walking around the halls that were not intubated. Not all teams have even that. So you guys had a really great culture, strong teamwork already in place, which made a great foundation. And so I think as I was learning about safe patient handling role, I was just really impressed by how you really stepped in and how did you get

be part of the key leadership of this initiative? Accident? Via my safe patient handling experience, be my relationships. My boss, you met Tom Curry. He is the manager here at our rehab department and we have a strong relationship. He really empowered me to step into projects that I felt comfortable with, right? My first year was really getting to know

what the hospital was doing and trying to make some small common sense changes that I could make effect, gain the trust of the staff a little bit more while building my rapport with the executive leadership team. As I've stepped into the second year, which is where you started coming in,

Actually, Tom invited me to that meeting that he was going to when you were selling the ROI model after you had met with our physician group. And it was more of, hey, this is your current status. This is where your status could be. So Tom got me involved. And Tom and I, our desks are literally 10 feet away from each other. So we have a lot of these conversations. And so...

He lets me build my schedule. He lets me run the safe patient handling day to day, how I see fit, but I also keep him abreast as my direct supervisor. So getting involved in projects like this, I thought, wow, this could be a great way. We're going to, this is mandatory for all of our critical care staff. It already has executive leadership visibility.

I can come into that scenario, obviously get to know this Kaylee Dayton person and figure out what it's all about. Right. But also spread more information to the staff. Right. And I think via your title and via your company title of awake and walking, sometimes staff would get that kind of like, Oh, we're going to walk everyone in. And so I think how many conversations you and I had where staff would start, you could see the wheels start turning. You could see everyone's respiratory rate start to increase and they're getting like anxious and they're like,

Are we going to have to walk everyone? And it was a nice thing that you and I were able to have these conversations and I would just poke my head in there and have them be like, no, no, no, no, no. It's not just walking. It's awake and mobilizing. And we're going to mobilize to their safest level of ability, right? And their highest. To be the trust level, I would say to answer your question about how did I get involved and how I got really into the leadership is trust.

One, the freedom of my boss to be like, hey, just do your thing. This is what I expect of you. Do your thing. Right. As long as you're within this kind of parameter, do what you got to do. And so stepping into that role.

it was a leadership growth opportunity for me because now it wasn't just me having these quick meetings. It was me meeting with our director of respiratory, me meeting with the director of rehab, me meeting with our executive leadership to discuss different options and how we can make this better. It was a massive learning curve for myself too. I would say it helped my leadership growth because one of the things that I'm getting better at is listening. Not necessarily, I might know the answer already,

From my perspective, there's always that saying of there's my truth, their truth and the truth. Right. And so my learning has been through this process and leadership is listening, listening to their truth, listening to objective findings and then figuring out what works for everybody. And it was a tricky endeavor because you have five very different ICUs, different patient populations.

different ecosystems, different personalities, different barriers. And you were really trying to navigate what each unit needed to achieve their own goals. Neuro patients are not going to be walking on the ventilator as a norm. If they're vented, it's because they have some neurological catastrophe that's going to prevent them from being able to walk and many indications for sedation. So you were really key player in supporting them to

make sure that this is feasible for their own patients. Also bringing in the equipment to say, okay, this patient obviously cannot walk independently, but you have equipment.

to get them up to accomplish this highest level of mobility. Here's the equipment to help you get there. That was really helpful. It was really nice too, because one of the reasons, and again, back to the leadership thing is you listen. And sometimes I don't have the answer. And sometimes it's not appropriate for me to even relay the proper answer to them. Right. And I think really you as an advanced care practitioner in your position are

You're optimally positioned to have these conversations. You've been there at bedside. You can also function at a doctor level, right? And so some of those, if you have to have a clinical conversation, you come with authority, but also experience, right? And you have to play the chameleon when you're dealing with this many personalities. One of the things in safe patient handling they talk about is,

marketing and how do you market your message? And a lot of the time, certain programs have had more success when it is nursing. So it

First off, safe patient handling and safe patient handling coordinator positions can be held by PT, OT, risk management, nursing. If you're looking at research type things, if you're trying to relay messaging to nursing, it comes best from a nurse or packaged with a group that has nursing included. Because if it's just rehab, and we've really figured this out here at San Juan, it's like if it's just me going out there and educating, even if I have the full support of ELT and all the nurse managers, if

If it's me out there telling them, it's bouncing off people's foreheads and in the other ear. There's some people I might catch, but most of the time it's like, oh, it's not my manager telling me. Okay, thank you for your time. And that's still one of the reasons why I bring with me on site a respiratory therapist and a physical or occupational therapist, because I appreciate that a respiratory therapist may not want to hear it from a nurse practitioner. Right. I don't understand their workflow. I've learned a lot throughout this journey, but

Be able to speak personally to that. I would be a fraud to say that I understand all the little nuances that have to happen in order to make your workflow possible and all the things. So it is important to have everyone represented in speaking each other's language to each other. Also, it's one of my objectives in that training process to break down some of those walls so that it wouldn't be so shocking to have a physical therapist asking about sedation.

Do you feel like any headway was made or how are you saying that there was resistance and saying, Luke, you're a physical therapist. Don't talk to me about sedation. Was that the standard or how has that been evolving?

So without devolving too much information, just because I know in this type of situation, I don't want to say keep the cards close. But at the same time, that type of situation has been interesting. I think familiarity, just due to my consistency of being present, helped allow that and also figuring out how I can package things.

the question to that staff member, right? You have to let them explain their thought process before you delve into all the like nitpicky questions, right? And so instead of just directly like, hey, why are they on so much sedation? You know what I mean? Figuring out a different way to package it has definitely helped.

One of the barriers that we found was we were doing the rounds very beginning. And it's like you talked about that other advanced care practitioner that would come in at 4 a.m. and staff would already have those people up because they just expected it, right? We have some of these units where after we had brought the mobility techs in that we had another unit where our mobility techs, Marlon, he's been coming in at 6 a.m. and helping staff get patients up out of bed for breakfast. So we have these other units that have been clamoring, well, we want our own at 6 a.m.,

But then I go in there and Marlon's been telling me, he's like, yeah, they're already getting the patients up. And so I told the manager, I was like, just via the fact that we've gone through this and Marlon is doing this in other units, your staff are already doing it, right? So to circle back to your question about how I've been empowered to ask these questions, it's really just the team aspect, right? Our team decided to call them smart rounds. What does that stand for?

mobility and rehab team or respiratory team. Something I, the naming part of it, I tried to stay out of it. The team got really excited and I was like, guys, let's, we're spending 20 minutes talking about an acronym. Let's move this process forward. It doesn't matter what it's called. It's what we get done. But the team aspect of it, right? And so we had an experience of, we had increasing returns and then we hit a point of diminishing returns where staff were like, we got it.

let's just move forward right and let's back it up so we did webinars one team at a time and i would do webinars customized for that team's needs patient population and then we would come on site say for three or four days the simulation training with almost every single member of the team and then after we train those five teams everyone's at different levels of progress right you've got

Surgical ICU was trained in January. Now medical ICU is now finally trained in May. So everyone's at different points, but the training was done. So then the question was, how do we make sure that there is accountability, continued progress and the support? Because there's a lot of things that they kept saying is we don't, we need more leadership support. We need more leadership support. So this smart team was created to ensure that leadership was involved, that each nurse was heard.

that they were prompted to think through these things, do these things and a hands-on help to actually get patients up. But the reception kind of varied by individual, by patient, maybe by unit. Correct. So initially, because they needed so much help,

Do you feel like that rounding process was beneficial? 100%. I think it really helped them. It provided a sounding board for some of those kind of lingering questions, right? We learned X, Y, Z, but now I need to get to A, B, C. How do I get there? And it was us being available to them.

Like you said, we provided the support and also we've hired two, three actually mobility techs. She starts in about a week now, our third one. So we're working through that process. And those mobility techs were part of the ROI. The ROI and also the support.

People need people wanted support. And that's one of the things that they identified with was having mobility techs who have a great idea of the whole program and they're ready to support whatever the nursing staff need. And so as those mobility techs got on board and probably as well, the team getting more comfortable with the process, getting their skill set built up, they didn't need you as much to come around the room and guide them through that. Correct. Correct.

Correct. Yeah. Yes. They don't need as much guidance. It's more along the lines of little tweaks, but we are seeing some sort of a little bit of regression and some of the thought process behavior into mobility techs round. And it's just a quick like boom, boom, boom, boom, boom with the NSM. And afterwards they get a little bit of a professional blow off. Oh yeah. We'll try and do that today. Yeah. Well, I'll do it with rehab instead of

hey, this is a reason why we're not, the professional conversation needs to continue. Still, there's just some, we're trying to fine tune this to keep it working because over and all,

We've experienced, we have obviously increased participation, increased mobility sessions, decreased vent days, and also decreased time to trach. Those are some of the measurements that I know Gina, or excuse me, Ginger has been measuring. I don't have our current length of stay data. That was our big one. Like, hey, can we get people up and out faster? But I think that's a symptom of a bigger problem as far as being able to discharge people at a faster rate. And this needs to floor involved as well. Yeah.

which we are currently working because I'll tell you right now, we've had a couple of days this week where our neuro ICU is half empty, surgical ICU got closed.

cardiac ICU got closed just because we just didn't have the caseload, but that was for three days and now it's ramped up again. So one of the things that we've done is trained our mobility techs up. They go upstairs too. So they've been reaching out to some of our higher functioning patients upstairs just to keep the process moving. We've got them involved in our cardiac telemetry. So post open heart, post cabbage, post mitral valve replacement, stuff like that. They're helping those staff members telling these patients that you need to walk six times a day

And patients can do it. Staff are busy. So we just have a quick check-in mechanism and then they can go and walk some of those patients in the times when ICU is not the focus. And when we...

we're proposing this mobility tech position with the staff, I could really feel like people are like, okay, so when we get this mobility tech, then we will start. They will help us with everyone. It will be all on them. If you've been listening to this podcast, you're likely convinced that sedation and mobility practices in the ICU need to change. The ICU community is facing incredible difficulty with the trauma from the pandemic, staffing crisis, and burnout.

We cannot afford to continue practices that result in poor patient outcomes, more time in the ICU, higher healthcare costs, and greater workload for the ICU team. Yet the prospect of changing decades of beliefs, practices, and culture across all disciplines of the ICU is a daunting task. How does this transformation start?

It can begin with a consultation with me to discuss your team's current practices, barriers, and to formulate a plan to help your ICU become an awake and walking ICU. I help teams master the ABCDEF bundle through education, consulting, simulation training, and bedside support. Let's work together to move your team into the future of evidence-based ICU care. Click the link in the show notes of this episode to find out more.

It's really the perception, right? But then there were all these complications with hiring them that they didn't even get hired until the last one now in September. When this is rolled out in January. Right. And yet you guys are already launching this program. Mobility sessions. You've tracked the session numbers, right? What was your kind of starting point and where are you at now? As far as like number per day or just like.

It's interesting. One of the things that we had to do is clear messaging, right? Because when we have involvement with nursing staff, anybody from a safe patient handling standpoint, from a safe patient mobility that doesn't have a clear like therapist role, they almost get viewed as a like lift tech or lift team, right? So it's, oh, hey, come turn this patient, come move this patient, come help me clean this patient, right? And so one of the things that we had to do was repackage our verbiage on how we refer to these patients. And my boss and I really had to clean up

I took what you gave me from a mobility tech layout. We had our job description and then we merged the two and then we've just had to change the verbiage to improve quality of sessions. Right. In California, we have a union friendly environment and we've had to be very careful with verbiage because some of these role, some of these items that they do.

can be viewed as, oh, maybe this was a therapist assistant role, or maybe this should have been done by a CNA.

But none of our ICUs have CNAs. Some of them have unit assistance. They don't have PCTs. So we've had to work on the quality of the messaging, right? I will tell you that rounds have gotten more efficient when we're trying to empower the techs more. They have their verbiage on their little sheet that I've given them. So when they're going through these rounds, they're asking some of these questions, remaining professionally correct, professionally and politically correct in these situations.

I want to say questioning sessions, but helping the nurse guide them through that thought process, kind of like how I was. When the ICUs are busy, I will tell you

numbers go up. When the ICUs are not busy, the numbers go down. Vented sessions are done primarily with therapy. I have not been tracking vented sessions per se. I just wanted to track kind of total mobility sessions, but that kind of gives me a little bit of a, hey, start tracking vented sessions. But I would say it fluctuates with census. It was fluctuating a little bit with certain staff. I could tell like when rotations would roll through, if we had verticalization beds on the unit,

So verticalization sessions would go down with certain staffing groups and then it would ramp back up with certain staffing groups. So just some of the trends that I've noticed. So there's still some culture that needs to be worked out. What role do you feel like accountability plays?

in an initiative like this? It's everything. It's everything. I would say accountability is everything in this point. Facilities like to pride themselves as using HRO or high reliability outcome definitions, statements, forms, audits, stuff like that. But then when it falls into it, some of that stuff, I feel like falls short. It's actually one of the things that

I hold myself very accountable, probably a little bit too accountable. Sometimes people are like, hey, dude, calm down. It's not that big of a deal. But I also think that if I can hold myself... How can I expect other people to hold themselves accountable if I can't hold myself accountable? Pretty much every meeting we talk about accountability. I think that when you have... Start from the very beginning after, let's say, an ELT group agrees to bring on your consulting service. And I think...

That actually might be something that you might add to your questioning or when you're interviewing or just getting this set up. Like, hey, what are your tools for accountability through this process? What are your tools of accountability going to be? That is so variable by hospital. Oh, it's a huge challenge. Right. And one of the things I wanted to make sure and some of the staff did feel this way sometimes was brought in the consulting service. ELT was all excited about it.

And it was like, all right, go. And I've had meetings with some of the managers and like, hey, your staff feel like you're backing out on them. I know you might be busy with other things, but if you expect them to do this, you better be present and ready to go and help out where you can in the leadership role. Absolutely. It's not just a light switch that you turn on. I think sometimes people that are not at the bedside, not clinical thinks, OK, so I'll have my return on investment by this time. No. Much of that depends on how well the staff is supported.

Right.

Each room doing exactly what you did, but just alone and helping people get them up. And now she doesn't have to do that anymore. So something I really learned from your team is the importance of making sure that there is a team, whether it's SOAP, SMART, whatever you want to call it. Leadership comes in a very standardized process. So everyone's anticipating leadership.

Certain questions, certain accountability so that every patient, every clinician is being prompted to think through patient delirium mobility management. And do you feel like things are a little bit, it's only been five months now for some of your teams, right? So this is also really new, but what changes have you seen?

I think people are more willing to ask some of those more difficult questions of me too. One of the things that I've found is we did the rounds, me, senior director for nursing, director of RT or supervisor for RT, NSM, manager of the unit, right? And so it's, I don't want to say heavy hitters. That's a weird statement, but leadership positions. And sometimes the frontline staff aren't as...

first and they can get a little when it comes to those conversations or I don't want to say standoffish, but they're like, hey, I'm a bedside nurse. I know what I'm doing. So it's almost like, do you really think I don't know what I'm doing? Those type of conversations. Like it feels more, it feels too intrusive. Too intrusive, very intrusive, very like, hey, what are you doing? Why aren't you doing it this way? And so one of the things that I found successful is after the rounds and stuff like that, going back at the end of the day or the middle of the day and like, how's it going? What support do you need?

And then some of those other conversations have opened up like, oh, there's been a couple of times where it's like, well, we don't feel supported. If something was to go wrong, if something was to go wrong, we felt like we wouldn't be supported. And I was like, that's interesting. Tell me more. And it's just from some of the experiences some of the staff have had. And so listening to that and then being a sounding board and then taking that directly to their leadership and saying, hey, you have staff members that don't feel supported in X, Y and Z region. Right.

And I know sometimes a lot of fear can come from inexperience, right? And so it's the probing questions. It's the open-ended questions. And it's just sitting there of like, do you not feel comfortable touching the patient? Do you not feel comfortable using this piece of equipment? What don't you feel comfortable? If you were to have a magic wand and say, perfect scenario, right? What would that be for you? And just listening to them and helping them through that process. Because I feel like if you can get that one or two or three people that are like, yeah, we can do this. We got this. That'll just start to spread.

And also go back to accountability because if they're doing it and other people on the unit, and if you can get more people that are doing it and there's still those outliers that don't, that'll eventually work itself out. So when you find, especially at the beginning, certain people that were hesitant, they're scared, almost everybody attended the training. So by then they knew the why, but the application to their specific patient at the time may need more support. And if they're hesitant,

You were able to provide hands-on support, go in and be like, we're here. We're going to help you get your patient up. What did you learn during that process? Because again, this is probably a lot earlier and more aggressive than what you're used to. Oh, 100%. I learned a lot more just for me personally, a lot because I had my basic, I had my rancho level education.

And it was either they're agitated or not agitated. That is just, that could mean so many different, do they need to poop or are they starting to lose it? Right. And so I learned a lot about RAS and CAM. I learned a lot more about that for me personally, a lot more about vent settings. That would be me as the physical therapist. For me as the safe patient handling coordinator for Mercy San Juan, I learned

I learned a lot more about what type of educational level these people have from a mobility perspective, from a therapy perspective, but also just from like an equipment perspective. They might be trained. They might have done their annual training, but it's so surface level.

And you know what, they can pass a test. They might be able to know what it looks like. But when the metal meets the meat, some of them are really still lacking from that type of educational level. And so for me, it's given me insight on how I can better train the staff. And so I've made some kind of tweaks from there.

And also learning for me, too, is learning from a leadership role, too, of a lot of leadership is just listening. Leadership, it's listening and removing barriers and almost getting out of your own way. I think the ADF bundle has been rolled out in such a way usually that it put these requirements in the HR, might make a checklist to go through in rounds, and we call it good.

And then we don't see an impact in the data. And then it becomes a punitive thing to say, why aren't you guys doing your awakening trials instead of like what you guys have done is what do you need to be successful? What do we need to help this patient be awake, mobile, communicative and autonomous, someone consistently helping everyone refocus and keep the objective and the why in sight.

And almost push the team to the point where they actually do it. It's interesting what you just said, right? And obviously you sent me the SoBrown form. If you looked at the Dayton consulting kind of like almost like motto, right? If you were to package it into a statement, like what you just said was perfect.

What do you need to get this patient moving? What do you need to get this patient awake? What do you need to get this patient communicative and autonomous? What do you need? Right. And it's like that right there would be, gosh, I'm going to, I'm going to put that on something. And so I can give that to my mobility tax because it might not necessarily be something that they can do personally for that staff member, but it also might help that staff member have a little aha moment. I need to talk to this person. Boom. Right.

True servant leadership, right? Yeah. And then it got to a point where they're like, Luke, we don't need so much of you. Yeah. And I was like, perfect. I can go do my other job. Because that was never the net purpose was never to have a permanent routine of these rounds. No. The purpose was to help the culture shift, support the team to develop the skill set, get the successes and then wean off.

And allow each team continue to have accountability within their team. But it's already part of the process. They're already working towards that. They don't need Luke checking in on them while they're trying to pass meds or whatever. So you feel like the team's momentum's going.

The momentum's going and now we're just doing the fine tuning. We're trying to keep the momentum positive. Like I talked about with our union environment, we have to really watch out for they were hired by this person. Can they do this? Okay. No. What license do they hold? Because CNA, somebody who works in the rehab department, but has a CNA license is kind of a unicorn. And so it's been an interesting process on kind of the role of

progression but yeah going back to the round process it's been nice i i really looked forward to stepping away and getting that was like the last couple of meetings was like pushing nudging the managers being like you need to start like staff has been trained we've given them the support they've told us hey back off we want to run this thing

Now it's time for you guys to work on setting goals and keeping people accountable, right? It's not, hey, you didn't mobilize your patient. Oh, hey, it looks like you needed a little bit more support today. What else could we have done for you during this day to get that patient mobilized? And it sounds like I just noticed throughout my consulting journey that past experiences such as trauma from COVID, any kind of issues a team has had that has left

the team with feeling defeated, low morale, being traumatized, not trusting leadership, whatever it is throughout all the teams I've trained, there's always something. And this kind of massive cultural overhaul brings all of that to the surface. So there's an opportunity to either trigger that trauma or heal it. So making sure that this is not something that is a punitive thing, but it's saying we're all in it together. We're all working towards the same goals. What do you need to be successful? That is different than

You're doing this wrong. And why is your patient sedated? And why is this going wrong? But rather, what do you need? Big time. Big time. What other recommendations would you give to other safe patient handling leaders bringing this kind of change to their hospitals?

Oh man, I think the biggest thing is you have to start with a well-rounded team. You have to really understand the capabilities of your hospital first. I've done the hospital level stuff. I've looked at the division level stuff, but now I'm getting more specific to each unit. Knowing what you need on each unit is going to be very massive from an equipment standpoint, from a training standpoint. Are you a high fall unit? Are you a high injury unit? So really knowing what your builder building blocks are.

Once you have that, go to your executive leadership, get their support, find that one person you're always going to be go to if you need to help hold somebody accountable and bring the heavy hitters to the table, have that person. But then the next part is, and this is something I wanted to talk about, and it helped, if you want to say, heal the trauma, right? Some of those nurses that went through COVID where you can just tell they're just beaten and battered, they're over it, they don't really have a positive view of medicine anymore.

And one of the reasons I enjoy therapy so much sometimes is the look that the patients give you, right? And they always talk about, these therapists are always so happy to go lucky. You're jovial. Maybe not myself, but we get to see some of the more positive aspects in a hospital, right? You get that person out of bed for the first time and they're just so grateful. They might've not done a thing, but the fact that you sat in there, you had a conversation with them, they feel like more of a person.

And so trying to get that into a bottle and package that and sell that to the nurses of like, you get to experience a little bit of this. You get to experience that people that look at you, they start tearing up and you start tearing up and you're like, all right, I remember now why I got back into this. If you can find that and sell that to your team, bring the executive leadership, bring the education. That's really what I would recommend. Do you feel like people have been able to taste that as a whole? Oh, for sure. For sure. Environment feels different.

We had a, we've had a couple of things happen. We've sick. You've actually had some really big wins. And so our surgical ICU was one of the conversations. It was a multi-factor when we had gone through the rounds and somebody in the staff, you could tell they were very apprehensive. So we did the mobility rounds and it was asking questions, just asking the questions. And she was like, yeah, that makes sense. It was a patient who had gotten intubated for airway protection and sedation hadn't gotten turned off.

I was like, why is it? Why are they still on this? Are they still on propofol? She's like, I'm not sure they were on it for intubation. I was like, does it still need to be on? She's like, no. I go, okay. And I was like, what were they doing before they got here? We're walking. Okay. Do you feel comfortable doing this? Yeah. Will you be here? Of course. And it was myself and Naila. And it ended up being on that video that Ginger produced, but it was just one of those experience. And I saw her light go on. I was like, there you go.

That happened. Another win was, it was a rough one. He was a larger gentleman who had a lot of different things going on with him, some chronic, some acute, and he was a very large gentleman. And so we know sometimes in our bariatric caseload, people go, oh, he's big, he can't move. And then coming in and really showing the staff, no, people can move if

To be able to move that kind of weight, you have to be strong. Give them a chance. And we talked about bariatrics in every single simulation training. I think I either talked about it or used one as a case study because it's such an important population. Yeah. Now, overall, there have been so many wins. I think we can really up our game even more. I think I just have to keep thinking positive and keep finding ways to improve. And they might tell me, hey, Luke, slow down a little bit.

But I think now we're really on a maintenance level with more organized checking in as where we need to go for me. Yeah, fine tuning. And you mentioned verticalization beds. Yes. As a safe patient handling expert and being part of this, what role have those played in your...

Making sure everybody, every patient does what they can. Right. It does everything. So we use BMAT in our hospital, right? It's the tool that we have. It's not a great tool. It's really just meant, tells you what piece of equipment you technically should be using, right? It doesn't talk about quality of movement. It doesn't talk about a lot of different things that therapists look at or some of those other units look at. So one of the things that we have is BMAT one is total lift, right? BMAT two, Howard's hit the stand, BMAT three, Walker, et cetera, et cetera.

But people's always question, what do we do? What do we do for the BMAT one and below? Right. And that was we have these options. Right. And so it has given us another tool to use just even after we've instituted it here. We're still getting some pushback and it's a comfort level thing. It's a time thing. I think that's actually one of the things are looking at improving is how can we better use that tool?

with our staffing levels, or do we need a little bit more staffing to consider more of that? Because it is a one-on-one. If you have a two-on-one situation and you verticalize your patient, you're one-to-one. They're trying to figure out ways to make that more effective. One of the things that I've been looking at is trying to use it for people who are minimally conscious because they talk about, and I'm not a neurocritical care specialist, I'm not even a neuro specialist in physical therapy, but through my research, look,

People have better recovery times if you can get them out of the minimally conscious or vegetative state. They can recover faster. Movement will help get people out of minimally conscious vegetative state via all the reasons that you've listed on your podcast before.

So why aren't we using it? Even if you're going to take them, even if you take them to 45 degrees, oh, they don't have head control. You don't lose head control on that thing until about 60 degrees. So even if you got them to 45 degrees in a minimally conscious state, minimally vegetative state, you're going to get fluid shift. You're going to get diaphragm drop. Why aren't you using this? And so

Answer your question about how we can use them is I really think that's where we can go to our quote unquote sicker patients. Absolutely. And that's always something that comes up in simulation training is what about X, Y, and Z? What about these patients? And so it's nice to have a tool to say there's still equipment available that's going to help you achieve these goals. How would you feel like the training impacted your ability to help lead this initiative? Would you be able to have these conversations without the training beforehand? Yeah.

From a mobility perspective, yes. From everything else that we learned about sedation, agitation scores, I still would just be viewed as the mobility specialist or the safe patient handling coach, right? So if I was just a treating therapist on there, unless I had gone to all this kind of post-school education, right? If I had gone to an A through F bundle CEU course and been like brought it back, which I know some people have tried to do.

I wouldn't have had that experience to be able to have those conversations. Would you have been received well? No, no. If your team didn't understand the why, could you help them find the how? No, if you don't have, if you can't, if you don't have the why, you don't have the financial why, the medical why, I wouldn't have been able to come to the table as well as I did in my opinion.

Absolutely. And I'm always learning from each team that I train how to do this better, but it makes such a huge difference to have strong leaders there and to have experts like with safe patient handling. I've come to really appreciate your specialty and the whole field of safe patient handling.

I get to go to your conference. Are you going to go to Atlanta? I'll be in Atlanta. Very cool. Are you talking or are you just going to go? I'll be speaking and I'll be helping lead a class. So it's going to be a really good time. I wish I could go. I was hoping that you would go because I feel like... I'll talk with my boss. My boss here and my boss at home. Right.

But thank you so much for everything. We'll definitely keep Luke as a great resource moving forward because he's- If anybody wants to reach out to me, I'm not sure if I'm allowed to leave my email on this. You've done it before.

Okay, so my email is luke.stratagakis at commonspirit.org. And my last name is spelled S-T-R-A-T-I-G-A-K-E-S. Or you can reach out to Kaylee and she can give you my information. Luke, thank you so much. No problem. Have a wonderful weekend. Thank you.

To schedule a consultation for your ICU, as well as find supportive resources such as the free ebook, case studies, episode citations, and transcripts, please check out the website, www.daytonicuconsulting.com.