117: Power of The Podcast: Walking Home From The ICU
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See You Now is a podcast highlighting the innovative and human-centered solutions that nurses are coming up with to solve for today's most challenging health care problems. Created in collaboration with Johnson & Johnson and the American Nurses Association and hosted by nurse economist and health tech specialist, Shawna Butler.

We're making it an equal playing ground for everyone to elevate their care no matter where they are in the world. I want to be the person that answers their question and has no bias. You can feel the human connection from our conversation. Who knew the power of the podcast?

This is a huge change in our perspective, our knowledge and our approach to critical care medicine that does require in-depth education. What if we had patients awake and mobile right away? Let them communicate their needs. Let them connect with their families. Let them know what was going on. They could walk. We would just have to push a ventilator behind them. Many of our patients could really walk home from the ICU. When podcast listeners reach out with questions,

If I can't answer them, I'm going to find someone that can, and we'll do an episode on it. Welcome to See You Now. I'm Shawna Butler. Who doesn't love a great podcast? Obviously, See You Now listeners do.

Podcasts are doing a lot more than entertaining and keeping us company. They're educating us, inspiring us, keeping us up to date on new research, creating community, and filling some very significant gaps in our access to health experts and health education.

In the 2024 annual report from the Commonwealth Fund, researchers compared health system performance in 10 peer countries, including the United States, to glean insights on where the U.S. needs to improve.

The findings, while not unexpected, were nonetheless grim and troubling and detail how Americans face greater barriers to accessing and affording health care than those in our peer nations. Recognizing that podcasts appeal to everyone, nurses are taking their practice to the airwaves, producing and hosting podcasts that share their specialized expertise to reach people where they are,

where they listen, and in doing so, are delighted by how their podcasts are effective in addressing the gaps in access to care, education, community, and professional education. In the second of our three-part series, Power of the Podcast, we meet a critical care nurse practitioner and podcaster from Washington State,

who is bringing her highly specialized expertise to listeners and learners all around the world. Let's listen in. I'm Kaylee Dayton. I'm a critical care nurse practitioner with many years of experience as a critical care nurse. I host the podcast Walking Home from the ICU, and I train ICU teams to become awake and walking ICUs through mastery of the ABCDF bundle.

The ABCDEF Critical Care Bundle. It's an acronym that represents elements of care that help us provide the best care for our patients. It was rolled out by the Society of Critical Care Medicine as the standard of care that we should be implementing or providing these different tools for every patient in the ICU. For example, A means assess and prevent pain.

That's best done when patients are awake and can tell us if they have pain. B is both spontaneous awakening and breathing trials, letting patients wake up and try to take their own breaths on the ventilator. We should be waking them up as soon as they don't have to be sedated. C is choice of sedation and analgesia. So if we do have a need to give sedation, we're going to ask what's the safest kind and how do we

weigh out the risk versus benefits. D is delirium assess and prevent delirium. When someone is really sedated, you don't know what's going on in their brains. So we can best assess delirium if they're awake. We can best prevent delirium if we're not giving medications that cause delirium. And we can implement things like sleep, family engagement, and mobility to prevent delirium. E is early mobility.

getting them awake and mobile as early and soon as possible. And F is family engagement. So the A, B, C, D, E, F bundle is a whole mouthful, but it's a toolbox of tools to help us achieve the goal of keeping patients awake, communicative, autonomous, and mobile. And when we really master all those tools, that's when we have created an awake and walking ICU.

The Walking Home from the ICU podcast is a compilation of stories and interviews with ICU survivors, those that have been sedated into drug or medically induced comas, and those that have been awake and walking while on mechanical ventilation or while on the ventilator in the ICU.

It also has interviews with clinicians, those that have treated patients that are awake and mobile, and those that have sedated their patients and are trying to change the culture and practices in their ICUs. I also interview researchers that have done a lot of investigative work to understand the reality of our normal practices in the ICU and then how to improve those practices to give patients the best chance to survive and thrive.

The podcast provides lots of tools, information, and insights to help ICUs really make this transformation in their culture and care.

So Kaylee, you know, within your podcast, you are talking to people who, the nurses and the people taking care of them met them on possibly the worst day of their lives. Nobody wants to need intensive care. Their life is at risk. A limb is at risk. It is, like I said, it's frequently the worst day of their lives and the worst day of their family's lives. What is the practice and the profession of

of an intensive care, an ICU nurse, a critical care nurse. What does that look like? A critical care nurse has stewardship over patients that are in critical condition, meaning that something is going gravely wrong and their lives are in peril.

They may have something happening with their lungs, meaning that they're having a really hard time breathing and getting oxygen into their bodies. And they may need to be on a ventilator, a machine that is pushing air in and oxygen in and pulling it out, doing all the work of breathing. They may need medications to keep their blood pressure up to make sure that the rest of their body gets blood flow.

They may need high doses of antibiotics. They may be bleeding so quickly. We're having to quickly replace blood. There are so many different conditions and reasons why someone might be in critical condition when their lives are in danger. So when they come to a critical care nurse, they are trusting that critical care nurse to provide interventions that will save and sustain their lives.

Their lives, their limbs, their function. Yeah, everything, everything. And when we talk about an intensive care unit, you mentioned that there are lots of different reasons why people need to be there, which also means there are different specialties and there are different types of intensive care units. For instance, we will have a neuro unit.

intensive care unit. There will be a surgical intensive care unit. And oftentimes those were planned surgeries. But when you come out of surgery, there is a lot of intensive care and you are still in critical condition. There are medical ICUs where the reason you're there is not some surgical intervention, but system failure or some type of catastrophic event. There are trauma ICUs. So there are lots and lots and lots of different reasons how people end up

in critical condition where their life function limbs are in peril. The one thing that seems to be very similar across all of our critical care is the need for intubation and ventilation. The general public, pretty much everybody, they have the sense of what a critical care and ICU might look like. They've all seen it on TV. They've seen it in a movie.

I don't think I've seen it too many times where it's actually an accurate portrayal. Right. Why don't you set that straight and let's talk about what's going on there, Kaylee. Well, movies often have the wrong equipment to start off with. Oftentimes they will have different tubes that are not relevant to what we use in the ICU. When in reality, you have a fairly stiff and smaller tube, kind of like a straw,

going through the mouth and through the throat and into the lungs. And that is connected to bigger tubing that is then connected to a machine. And that tube in the mouth is then strapped to the face and it's secured. There's a balloon that's inflated at the end of that tube towards the deeper into the lungs that's blocking off airflow so that when the machine delivers that

air and oxygen. It goes through all that tubing and right into the lungs to inflate the lungs. So it does the work of breathing. In the movies, patients are laying there still with their eyes closed, lifeless, comatose. In many ICUs, that actually is accurate. There are so many reasons why patients will need mechanical ventilation.

Sometimes it's neurological. Sometimes their brain's not working well enough, whether from a stroke or a bleed or some complication that they now need a machine to do the work of breathing. For other people,

conditions, their lungs are so sick that they cannot function well enough to provide enough oxygen for the body. There are so many different reasons we could go on and on. But ultimately, in most ICUs, it is like the movies in the sense of no matter why they're on the ventilator, they're going to be in a medically induced coma. We are giving them sedation, which is like sedation that is used in the operating room

We're using a lot of those same medications in the ICU. But the difference from the OR is that in the ICU, it's not just for a few hours. It's now for a few days and a few weeks. So the culture of most ICUs is to automatically put them into a coma as soon as they have that breathing tube placed and almost the entire time that they are connected to the ventilator. During that surgery, that's a great use of these sedatives, including opioids like fentanyl, maybe morphine.

Then sedatives like propofol, there's dexmedetomidine, there's midazolam, which is a benzodiazepine. So there are different kinds and classes of medications.

And those are all used in the OR as well as in the ICU. So intubating someone, that's a very challenging procedure for a human to survive through. You don't want them to fight because you want to safely put that breathing tube down. So you've got to do that quickly and efficiently. So for those reasons, we give these medications to alter their consciousness so they're not aware of the procedure happening and give us time to safely stabilize that endotracheal tube.

And so for a patient, it's usually fine. They usually do not experience anything during that procedural sedation. But what happens after depends on what ICU you're in. Yeah. So let's talk a little bit more about that because until I had seen some of your work, I don't think I've ever seen that depiction or that portrayal of people walking and fully awake while they are intubated and on a ventilator.

To understand why the movies depict the standard comatose for every intubated patient and why that is the process of care in many ICUs, we have to understand the history of critical care medicine. In the 1970s, we did have intubated patients awake and into the 80s. But in the 90s, we started to experiment with how to treat sicker lungs.

especially those lungs that were full of a lot of fluid and inflammation during acute respiratory distress syndrome, also known as ARDS. We heard that phrase a lot during COVID. It's a condition that a lot of patients developed in response to COVID.

So these lungs are very stiff, very full of fluid and inflammation. And so the theory was in the 1990s was then let's give them lots of volume and lots of pressure. And these were very old ventilators that didn't have the sophisticated sensors like ours do now that can sense a patient's breath and go with their own breaths.

and be comfortable. These old ventilators were just slam air in, pull it out. And they were slamming two and three times the volume. Patients couldn't just hang out and tolerate that while awake. So then they ended up experimenting with bringing these medications up from the operating room. And they realized, wow, they don't fight the ventilator anymore. In fact, they don't move a muscle. And they noticed that they oxygenated better. So their oxygen levels went up. They

rode with the ventilator better. Like they didn't do any of their own work of breathing. So the ventilator could take full control. They noticed that their eyes were closed and they weren't moving. And so the perception on our side of the bed was that they were sleeping. And isn't that nicer? That's more humane. Why would they have to experience the breathing tube and the ventilator and the lines and tubes and the stress and trauma of being on the verge of death?

When we have this alternative option of being asleep, let's just sleep through critical illness. It's so much better. And your body's under so much stress. You're going through so much. Just, quote, rest. Just lay there and rest. Like it was some restorative process that we were granting them. Because we didn't have research to know what actually is happening to the brain during sedation. So this belief really...

resonated with the heart of nurses. So they not only were doing that for ARDS patients, but it spread like wildfire. And it became this hot new thing that we were going to do for every patient on the ventilator, no matter why they were on the ventilator. And here we are in 2024, still doing that in a lot of our ICUs. But we learned a lot since the 1990s. In the research, we looked back and we watched the brain activity. And we saw, wow,

When we give these medications, their brain activity is very disrupted. It's very different. And they actually don't even go into REM cycle three and four. They noticed with those ARDS patients that they were treating that one, a lot of them died because those volumes from the ventilator were very dangerous and lethal. But they also noticed that in the survivors, that though their lungs got better, they had physical, cognitive, and psychological impairments.

These cognitive function levels are like mild Alzheimer's and moderate traumatic brain injury. But that was confusing because what does that have to do with sick lungs? And their lungs were better. So what was wrong with their brain? We thought this is just a weird thing for ARDS. And then we started to look at what they called back then ICU psychosis. They noticed that patients became sick.

psychotic is what they called it in the ICU they became very confused agitated and they were just so dysfunctional and so they started realizing that there was a strong correlation between the meds that we gave and the ICU psychosis that we now call ICU delirium and so over time we realized okay we researched delirium and you realize that's a brain injury it's acute brain failure

But what does that have to do with these lung problems? And we realized it's not the lung causing that, it's our medications that we're giving. So we started to develop a lot of research and awareness. Now, in the 1990s, there was a nurse named Polly Bailey. She was working in a shock trauma ICU in Salt Lake City, Utah, and doing what everyone was doing, putting patients into profound medically induced comas for a long time.

At the time, nurses in the ICU would kind of follow those patients out of the ICU throughout the hospital. And she noticed this patient didn't do very well. Coincidentally, this patient was from her neighborhood. So she went and visited this patient in her home. And it was a mother in her early 30s. And Polly noticed that she could not get out of bed. Her husband was having to help her with a bedpan. She was cognitively destroyed, psychologically damaged.

And she went back to her medical director and said, Dr. Clemmer, why are we working so hard if this is the life that we send our patients off to? And he said, well, what do we know about this? And she scoured the research and there was nothing back in the 1990s. So she went back with her nursing intuition and said, I think it's because of the medications we give and because we leave them in bed. And he said, okay, well, what's the alternative? She searched the research and there was nothing again. And she said, hear me out.

I think if we don't give these medications and if we let them be awake and move and we protect their brains and their muscles, they're going to do better. And he thought it was crazy because it had been many years since they had done that. And these were sicker patients now. But what he said, and I quote, I trusted Polly because I trust nurses and I knew she would keep her patients safe.

So when she was allowed to try this, it transformed these patient outcomes. They could see such a contrast. They got off the ventilator. They were able to walk out of the ICU. Everything was better there.

So they really tried to get this to be normal in the ICU. That hospital started a new ICU, a respiratory ICU. And it essentially was kind of a step down. They would take the patients from the shock trauma ICU that couldn't get off the ventilator. Usually they couldn't get off the ventilator because they were too weak to breathe independently. And I think a lot of this, we've learned a lot about people in space. You know, they come back and it's like,

you haven't been bearing any weight. So there's a lot that we're learning out of space medicine where there is an enormous, when you don't have the effects of gravity and weight, weight bearing. Yes. And that research was coming out in the late eighties and into the nineties as well. But it took a long time for those scientific discoveries to merge. But exactly. We learned a lot about bedrest is anti-gravity. They lay in bed. It's like being in space. And so it's,

They were taking these patients from the ICU that were now too weak to breathe. They couldn't walk. They couldn't sit. They were in ICU psychosis. And Polly hired nursing home nurses who didn't know critical care medicine. And she said, I'll teach you the rest, but here we keep patients awake and mobile. And that's how she got it to be normalized because they didn't know better. And they would rehabilitate these patients. And it was a lot of work, but they had great outcomes. And then physicians noticed and they started sending Polly home.

patients straight from the emergency department and they would send them to her right away as new ICU patients. And so she had this thought, what if we had them awake and mobile right away? And that's when they noticed that it was so much easier to date them for the procedure of putting the breathing tube in, then let them wake up.

Give them a pen and paper. Let them communicate their needs. Treat their needs. Let them connect with their families. Let them know what was going on and mobilize them right away. They could get their own bodies going. They could sit themselves at the side of the bed. They could walk. We would just have to push a ventilator behind them. And that's when that awake and walking approach became standardized. So I came into critical care medicine in 2012. So they'd already been doing that for over a decade. They'd already published a study on it.

I knew nothing else. That was my first critical care job. The nurse manager asked me in the interview, would you be willing to walk patients on ventilators? And I was so naive. I didn't even really know what that meant. And I said, yes, of course. I would love to do that, whatever that is. I will do that. But you have to teach me. And everyone treated it so normal, just as normal and optional as giving an antibiotic.

So I never questioned it. It made sense to me. My patients are human. They're going to be awake during the day, communicating, making decisions, moving their bodies, sitting up in a chair, texting, watching a movie, connecting with their loved ones and sleeping at night. It made sense to me. What is an awake and walking ICU? Because again, I think the vast majority of people, unless they follow you on LinkedIn and in your social channels, they have never seen what an awake and walking ICU is.

So the focus in an awake and walk-in ICU is about preservation, rehabilitation, preventing the brain injury from delirium and the muscle loss that can happen in the ICU. So I defined an awake and walk-in ICU as an ICU that only gives sedation when there is an indication for sedation. Mechanical ventilation, being on a ventilator, that alone is not a medical reason to be sedated, especially to be comatose.

But there are certain exceptions like high pressures in the brain, maybe during a bleed, that if you cough, you could cause your brain to herniate into your spinal column. That, we have to stop all movement there. That is an indication for sedation. If someone cannot keep their oxygen levels up or their blood pressure up when they move, we have to sedate them and stop the movement.

If they're having seizures, we have to sedate them. Now, if there is a reason to be sedated, then we're going to be looking at, well, what's the safest sedative we can give? What's the lowest dose we can give? And then every day we'll be thinking, do they still have that indication? You know, are the pressures in the brain still high? If not, let's see if we can take it off today. We're going to really try to make that duration of sedation as short as possible and get them back on their feet as soon as possible.

And if there's no reason to be sedated and there's no reason to not be mobile, then they're going to promptly be doing their highest level of mobility. So if they could walk yesterday, now they're intubated, let's walk them today, unless there's a medical reason not to. And then there's open family visitation. Families are a key part of the ICU team, and they're welcome and encouraged to be there and to be a part of the team.

compared to very restrictive visitation that exists in many ICUs. That really brings me to the Walking Home from the ICU podcast. How did that come to life? I launched the podcast in March of 2020. I had started recording in January of 2020. So if you can imagine releasing this kind of information... Right when the world was just changing, yes. When the world was exploding. I mean, I have one of my episodes, it's like 15 minutes, I'm just saying...

Everybody just stop and think about it. We don't have enough staff. We don't have enough ventilators. We need a process of care that gets patients out off of the ventilator and out of the ICU as soon as possible. And as healthy as possible, we can't sustain this workload that's about to hit us if we have this process of care that now creates a lot more complications. It keeps them under our care so much longer. But it was so new. It was so overwhelming for people to even digest.

And so I felt very divinely guided to start the podcast Walking Home from the ICU. And I named it that because I wanted that to be the goal of critical care medicine, to have patients go back to their lives that they lived before, whatever that looked like. But many of our patients could really walk home from the ICU. And so I started with, here's what happened in the 90s.

And then here's the survivor side of it. Here's what they actually experienced. And then I interviewed my colleagues in the Awaken Walking ICU to say, as a respiratory therapist, here's my role in helping this process of care be possible. As a physical therapist, here's what I do. And then I interviewed survivors from my ICU as well to say,

I walked in the ICU. I was extremely sick, and I'm so grateful I did. And now here are my outcomes. Here are the things that helped me cope with having this breathing tube. Here's why I valued being able to connect with my family. And here's what my life is like now. And then I started to interview researchers to say, here's what we do know about this. And it's just turned into now

over 179 episodes. I didn't realize that there was so much to explore, but this is a huge change in our perspective, our knowledge, and our approach to critical care medicine that does require in-depth education.

So little by little, it has grown throughout ICU clinicians of all disciplines. So I don't even have to be at some of these conferences and they'll be talking about awake and walking ICUs and sharing podcast episodes. I've been surprised to find that ICU survivors have listened and have found a lot of validation. There's very little support out there for them. So I've had survivors that have found my podcast and finally they have a name, a diagnosis, post-ICU syndrome. And there are others that have experienced this as well. And now they...

They have a will to live. When you do the intro to your podcast, I love how you introduce it. Do you remember it off the top of your head by any chance?

You're listening to the podcast, Walking Home from the ICU. 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. Yeah, that's the part that I love when you talk about welcome to the ICU revolution. Let's take a listen to one of your early episodes where you're interviewing Susan East.

She's a three-time ARDS survivor, and you talk with her about her ICU experiences. And in this clip, she tells you what it was like being sedated while intubated and why she never wants to be sedated again. I was in a medically induced coma for probably six days. And while that transpired,

The strangest of things happened. That's when I experienced delusions. It's a terrible, terrible dream that I will never forget as long as I live. And that's why I never want to be sedated again the rest of my life. There's other reasons too, but that's a lot of it. And not only that.

Pardon me? So you weren't sleeping under the sedation? I was asleep, but I was awake. It's really hard for me to explain. I could hear what was going on in the room. I mean, I was sedated.

But I was having, like, my father-in-law was diagnosed with cancer. And my husband and my daughter were talking about it in front of me because they thought, well, she's in a, you know, a medically induced coma. She can't hear what we're saying. I heard every single thing that was said. Oh, wow. Yeah.

And when they brought me out of it, my daughter was there. My husband wasn't at that time. And I asked her, I said, what kind of cancer does your grandfather have? And she looked at me like she had seen a ghost. And she said, Mom, you were on some strong drugs. He doesn't have cancer. Well, I knew that was as far as I was going to get with her. So I let it go. When my husband got there, you know,

I asked him, I said, look, I heard y'all talking and he told me the truth. And so they were, everybody was blown away. And there were other things I heard too. And I could feel my husband. I told him, I said, you kissed me right here every day, didn't you? And he said, yes. And so, you know, and that's why I tell people now, maybe everybody doesn't hear, but you don't know what people are hearing. So please be cautious. Yeah.

Right. What you talked about. And could you understand what was going on? You said you were having delusions and hallucinations. Yes. And my daughter said my blood pressure would go up and down, up and down. And I said, I can only imagine because of what I was going through. And, you know, when I, when I, and nobody, you know, at first, like nobody would believe me. My daughter did and my family did, but nobody else would.

And I have it in my chart to never be sedated unless it is absolutely 100% necessary. Wow. No matter what. I am not afraid to be on a ventilator, but do not sedate me. You know, do not sedate me. The sedation is what I'm afraid of. Wow. That's a compelling story. And you have so many powerful episodes like that.

Tell me about the other podcasts that you are hosting and why you're hosting them, what you're doing with them. So throughout my journey, as I've been

discovering these things, putting out these podcast episodes, really learning a lot about this care in the ICU. Ironically, I became a family member in the ICU myself when my daughter was admitted during her own critical illness. And even though I was a critical care clinician, I'd worked in the ICU for, I think at that point, nine years, I was overwhelmed. I was traumatized. I was panicked. And I just kept thinking, how do people cope with this when they're not familiar with the environment?

I knew how to advocate for her. But what about so many family members that understandably really trust the ICU community to provide the best care, but they may be in an environment and in a hospital that's not prepared to advocate for this approach to critical care medicine. So I created the podcast, Walking You Through the ICU, to provide simple, basic knowledge about what the ICU is,

who all these people are in the ICU that are caring for their loved ones, some of the equipment. There was a lot of fear that came out about ventilators during COVID. So talking about what ventilators are, why we shouldn't be afraid of them, but also being honest about the risks that are involved with some of the management or some of the care that we provide while patients are on the ventilator and how they can advocate for their loved ones. I also interview families that have advocated for their loved ones, showing that

Families can advocate and they can make a difference when they are there and involved in their loved one's care. I understand how busy the ICU is. We are focused on keeping them alive in that moment. And it's really hard as clinicians to take the time to thoroughly provide the education that these families need in order to be really, really effective contributors and advocates.

and to know what their role is. I've seen so many times family members be just overwhelmed by the situation and they sit in the back and try to stay out of everyone's way, which is helpful in some circumstances. But if their loved one is sedated and or having delirium, they need to know what to do and they can have such a big impact. So I was hoping that the podcast would also be a tool for clinicians to use to say, hey, just listen to these podcast episodes. It'll get you up to date on who we are, what we're doing, delirium. They'll circle back and talk about this when you've listened. Yeah.

So it's been very interesting to see how nurses use this as a teaching tool for the families that they're caring for. I'm going to talk specifically about podcasts. There's this huge generational shift of where people are going to get their information and who they trust to get their information from. Why do you think that taking your knowledge and sharing it through a podcast is helpful and important in

in getting really good, credible information out to people. When I started to explore the research, I was astounded by how much there was. I was currently in my doctorate program, so I was learning a lot about how to dissect and apply research. I was realizing that my perspective and my capacity was shifting in that program. I learned a lot of information that I wished that I had known

when I was a newer nurse with my associates and then my bachelors. And so I really could see it from the perspective of our bedside clinicians that don't have the time, the bandwidth or the stewardship of pouring over research for hours. And so one of my main motivators was to make that research accessible, not just to bedside clinicians in my country, but throughout the world.

Do other clinicians have access to PubMed and open medical journals? And then, though there was lots of research, it wasn't necessarily tied in together. A lot of the research talks about the problem. 80% of ICU patients suffered from delirium. Okay, then what's the solution? So we needed a lot of connecting the dots when it comes to understanding the problem and what are the interventions that will be best for our patients. So

That has been my mission is to make this research accessible, also applicable, and make it practical for ICU clinicians. So if you want to prevent delirium and you want patients to be awake and you want them to be mobile, so what do you do after intubation? So I've had the honor of interviewing a lot of experts throughout the world to bring in those elements to answer those questions. When podcast listeners reach out with questions, if I can't answer them, I'm going to find someone that can, and we'll do an episode on it.

So for me, it's kind of been investigative research because there's a lot that I did that I didn't understand why I did it. So in order to teach it better, I've had to dig in and figure out why, have other people teach it to me, and then share that information. I provide transcripts with citations on my website. I want to point them towards peer-reviewed, evidence-based research. I wanted them to be able to go to my website and put in the search engine information.

keywords and they could find multiple episodes that address that topic in different ways. So maybe it's something very deep into the research and then a survivor talking about their perspective and then a clinician talking about their perspective to reinforce and make the research come alive. The podcast is a little bit more organic where we can have a conversation.

And you can really get these intimate perspectives. And so the podcast for me has been able to provide that kind of intimate insight in a very casual way. So on your podcast listening forums, you wouldn't see when a new podcast episode pops up.

So it becomes kind of an easy, ongoing resource. I think the other part, too, about a public-facing podcast is, and you mentioned this, your ability to reach a whole lot of folks that may not have access to this type of information, information.

The and being the inspiration for change and the revolution of the ICU. Remember in one of your episodes, it wasn't too long ago where you were talking with nursing leaders, the nursing leader that you had on this. She said a group of nurses went to a conference where you were speaking. They came back to me on fire. This is you know, we need to be doing this. So I started listening to your podcast. I would listen while I was going into work. I will listen when I was coming back to work.

And I realized we could be delivering better care. She was so open and embracing to change. And I'm thinking that one listener is

And that change of mind impacts thousands of lives and thousands of clinicians where they're now open to, wow, there are better ways to do things. And so the ability to influence people's thinking, openness to new ideas and to trying ways of doing better things, I think that's pretty powerful that a podcast can do that, that an article that was produced and released in some of our most credible publications

academic journals might not have. The more I found research, I thought, is anyone even reading this? Right. And are those financial decision makers? Are those actual clinicians that are doing it? Yeah. And are they tying it in together? Like, do they know how to apply this? And so I have listeners from all over the world. I've been reached out to by people in Iran, Saudi Arabia. I actually just did a podcast interview with a physician in Bangladesh.

who was talking about the journey that he's led his team on the last year after listening to the podcast, reading the research himself. He's like, well, no one around here knows how to do it. So we're just going to go in and I'm going to help you. And we're just going to figure this out. And now their team mobilizes their patients three times a day. And he doesn't have to

push and compel everyone to do it, it's now part of the culture. And now they're becoming experts on it. And I just think, how else would this physician in Bangladesh have had access to experts throughout dozens of podcast episodes that could teach him how to do this? So

So when we put something like a podcast into places where they are readily and freely available, we are democratizing and creating equity around access to really good information. We've talked about the health outcomes and improved lives of folks. There is a huge financial benefit to an awake and walking ICU in terms of length of stay, not having pressure ulcers, other hospitalizations.

Hospital-acquired infections, depression, there's just so many other things. So I know you've got the data on this. When we institute these improved evidence-based practices in our ICU care, what is the financial impact? So I always look back to the research, right? We had this huge study published in 2019 with 68 different hospitals involved, over 15,000 patients.

And if you can understand, when they first did these quick little trainings with these few leaders from these 68 hospitals, they sent them to Vanderbilt. They gave them some really great education for a few days and then said, go convert your team. And if you don't work in the ICU, you have to understand this is like telling them the world is flat. It is doing the exact opposite of what they've ever known. And so it's a process of evolution. They

took this education and they made some progress. So they were not giving as much sedation, maybe some safer sedatives. They really weren't mobilizing them yet. Only 8% of those patients were actually out of bed standing. So fairly low compliance with this approach. Like they were inching their way towards an awake and walking ICU. But any little improvement makes a difference. For every 10% improvement in complying with this approach, there's a 15% improvement in survival.

So going from very deep sedation to lighter sedation where patients are a little bit more responsive, that already starts to save lives. But even with that incremental improvement without achieving the full awake and walking approach, they found that seven-day death decreased by 68%. Patients were 68% more likely to be alive in a week. Coma and delirium decreased by 50%. Now understand that delirium, this isosycosis, this brain injury,

That increases costs by 39%. It increases time in the ICU by almost five days. They decreased readmission to the hospital, so coming back to the hospital, by 46%. Do you hear the cha-ching? Oh, I was saying, when people start to realize that an average ICU stay, I think in the States, it's $38,000 to $50,000 to be in an ICU. Mm-hmm.

So when you reduce that even half a day, you know, that is a huge savings. And then there are so many savings that come after that. Right, like where you end up after the ICU. Because we're just looking at the hospital cost. And it greatly impacts where they end up leaving after the hospital. So they found with this huge study that patients were 36% more likely to go home.

rather than to a care facility. And remember that these weren't necessarily really awake and walking patients. Yeah, they just weren't as heavily sedated and having all the high risks of that deep sedation. And so they found in that study that it was dose dependent. The closer care got to being awake and walking ICU approach, the better their outcomes were. So these are big numbers. They're very impressive, but it's an average among a fairly low compliance. So in a similar study where they implemented this approach,

And they weren't totally there yet. But with the improvements that they made, hospitalization cost decreased by 30%. We know that for every 10 additional minutes of mobility in the ICU, time in the hospital decreases by 1.2 days. For every time you get a patient out of bed on the ventilator, time on the ventilator decreases by 10 to 22%.

So hospitals are financially strapped. They say, we don't have the resources to do this. Now think in Bangladesh, they have less staff, less equipment, less technology. So when they were sedating their patients, it was very, very normal to have a pressure sore, a bed sore. Their skin would break down because they're just laying there. So it was amazing if someone didn't have a bed sore, if they ended up on a ventilator, it was just par for the course, just assumed.

Now that their patients are awake and mobile, they barely have any ever. They didn't switch beds. They didn't make this huge investment in equipment. They changed their practices. And initially, it took a lot of people to mobilize these patients. They're scared. They don't know how to do it. Now, because they're doing it so frequently, patients are so strong. The clinicians know how to do it. It doesn't take as many people. So upfront, when we apply this, we need to have the right equipment, the right staff supporting this.

but it's not going to be the huge investment that people think it's going to be. I've trained teams and one hospital had two ICUs within the first three months, just from going from that deep, heavy sedation to lighter, they saved $500,000 in the first three months. And now they're almost a full awake and walking ICU. And so once they hit that year mark, we'll know the whole year savings, but

It's all money. And that's the language we can talk to advocate for better staffing, better work environment for the nurses, better training, education, and overall better care and outcomes for our patients. So did you ever, when you started this out, did you ever have any idea or imagining that a podcast would have this much interest and impact and devotion, I would say? No. If you could have told me five years ago that I'd be sitting here talking to you about this, I would not have believed it.

When I started the podcast, it was really just because I felt very compelled to do it, like spiritually. Started a podcast. I didn't think anyone would listen to it. When I was asking my colleagues to be interviewed, they said, no one's going to listen to this. No one cares about this. I was like, I agree.

I'm totally with you, but I have to get it done because the big guy upstairs is not letting me sleep at night. So I just need to get this off my checklist and then be done with it. So I thought I had to do 30 some odd episodes by the beginning of March. Didn't know why I just dumped all these episodes really fast. Then COVID hit and I thought, well, now it's all about COVID. No one's going to care about this. And I had this spiritual awakening saying, after all that research you did, you don't understand millions of people are going to be on ventilators. And so it's just been little by little. This has developed. I've

gotten a lot of hope for the future. I've had opportunities to help lead this. So sometimes I do get frustrated with how slow these changes are, how long it takes. But when I really look back at where I started, barricading my door for my toddler in my closet, I could not have imagined that I would be then interviewing someone in Bangladesh that transformed his ICU from listening to the podcast.

Would you like to comment on using a podcast to address our issues of access, affordability, and equity? My first critical care conference was as a fairly new nurse in that Awaken Walking ICU because they encouraged us to go to critical care conferences. Now, especially after COVID, that's not the norm. They're not encouraging nurses to go get higher education and go meet with other critical care nurses and be exposed to new ideas. And that's not within the budget of most hospitals now.

So then you become very isolated in your ICU and very victim to culture and outdated practices. So then how are nurses going to know what is best practice? What is possible? What are other people doing elsewhere? And so if they're not in an academic hospital where they have conferences happening locally or educators, they don't have access to this information. So for me as a nurse, it's been really exciting to reach nurses that are all over the country and the world

that are being inspired to look into the research themselves, to bring these changes, knowing that they as a nurse can bring evidence-based quality improvement into their hospitals, rural or academic, and everything in between. We have monthly revolutionist meetings on Zoom. So we've got someone in Canada, in Bangladesh, in Brazil, in Germany, everyone's sharing their ideas and what's worked for them in their units and saying, oh, that's not available here, but what we have here and can we get access there? Like we're making it

an equal playing ground for everyone to elevate their care no matter where they are in the world and to really protect those more vulnerable populations, our geriatric patients, our disabled patients, our minorities. Who knew the power of the podcast? Not me. I really don't feel like it was my idea, but I'm just here for the ride.

Special thanks to critical care nurse practitioner and host of the podcast, Walking Home from the ICU, Kaylee Dayton. In our third and final episode in our Power of the Podcast series, we're introducing you to nurse, educator, advocate, and host of the This is Getting Old podcast, Melissa Batchelor.

By 2030, the boomers will finish turning 65. So that means we're going to have more Americans over the age of 65 than when we have under the age of 18 for the first time in human history. They will be about 23% of the U.S. population. We have more working adults that are providing care for an older adult than our parents of children under the age of five. So that also hasn't happened before. When you turn 50, you're like the youngest of the older adults.

So you're like in the freshman class. But unlike when you're a freshman in high school and college where you get an orientation, there is no orientation to turning 50 or beyond. With the podcast, this is getting old. What I've done is created a digital hub and it's called Age Wise U. So it's the University of Becoming Wise About Aging.

What I'm trying to do is help people get their bearings around aging, caring for an aging parent, being a caregiver to an older adult living with any type of chronic illness, that there's a place that they can go to get trustworthy, reliable, evidence-based answers. People are going to the internet, they're turning to YouTube, and with the podcast, I want to be the person that they find

that answers their question and has no bias. And so that's really what the podcast is about, is that all of this stuff is not in place and that is what's getting old. For See You Now, I'm Shawna Butler. Keep listening.

Nurses are transforming healthcare through innovation, compassion, and leadership. And Johnson & Johnson is proud to continue its 125-year commitment to champion nurses through recognition, skill building, leadership development, and more. The American Nurses Association is dedicated to building a culture of innovation

Nurses improve the lives of patients and communities through innovative thinking, empathetic connection, scientific rigor, and sheer determination. ANA is proud to support and advocate for our nation's most valuable healthcare resource, our nurses. For more information on See You Now and to listen to any of the earlier episodes in our library, visit seeyounowpodcast.com.