Marc Harrison, MD: Hi, this is Dr. Marc Harrison, CEO of Intermountain Healthcare. Today I'm with four of our outstanding caregivers from American Fork Hospital: Dr. Erick Gerday, Wende Prince, Tammy Trapier, and Michelle Harrison. Welcome. Can you tell me a little bit about yourself, your roles? And it sounds like we have a pretty interesting story to talk about today. Erick, you want to start?

Erick Gerday, MD: Yes, I'm Erick Gerday. I'm a neonatologist at Utah Valley, and we cover American Fork Hospital as a team. I've been with Intermountain for 12 years and love my job. I think we have a great team.

Marc Harrison, MD: You've got an amazing newborn ICU, amazing.

Wende Prince: I'm Wende Prince, I'm a neonatal nurse practitioner. I've been with Intermountain for 33 years and started as a staff nurse and went back to school several times. Most recently, I got a doctorate degree at the University of Utah as a nurse practitioner. Our neonatal nurse practitioner group with neonatologist support started staffing the special care nursery at American Fork 24/7 on July 1st, so a couple months now, and it's been great to expand to there.

Marc Harrison, MD: Great. So, you know I'm a pediatric ICU doctor?

Wende Prince: Mm-hmm (affirmative).

Marc Harrison, MD: My experience with NNPs early in my career was they protected the babies from the residents. Is that true?

Wende Prince: Maybe?

Marc Harrison, MD: Maybe just a little bit? Okay. Well, I've had the privilege of working with NNPs for a long time and I really have a lot of respect for what you all do, so thank you. How about our colleagues on the telepresence, do you want to introduce yourselves and talk a little bit about your roles?

Michelle Harrison: Sure, I am Michelle Harrison. I've been with Intermountain for almost 27 years. I've been working in with the babies for 19 years.

Marc Harrison, MD: Great.

Tami Trapier: I'm Tami Trapier. I have been with Intermountain Healthcare for almost 10 years, before that I was an EMT paramedic. And I love what our neonatologists, our nurses, our respiratory, have to offer at Utah Valley and now spreading to American Fork. What we're doing here is just amazing quality work, and I'm excited to be part of it.

Marc Harrison, MD: Thank you, and thank you for your passion. Who wants to tell me the story of this big event?

Wende Prince: Okay, I'll start. I was getting report from my colleague, Jennifer Whitehead, and we got a call for a baby code blue in the ER.

Marc Harrison, MD: You were on service at American Fork at the time?

Wende Prince: That's correct.

Marc Harrison, MD: Okay, thank you.

Wende Prince: As we ran down the hall, we called Dr. Anna Cheatham at Utah Valley to get her on Telehealth. Dr. Minton has set up a great Telehealth presence out there that's been ongoing for years now.

I assumed the baby was going to be in the ER. It was not there when we arrived, it was still en route with EMS. Dr. Cheatham got right on Telehealth and had the foresight to realize that Dr. Gerday was probably en route coming to work at Utah Valley, so she called him and had him come directly to American Fork Hospital.

Marc Harrison, MD: That's good thinking.

Wende Prince: Yeah. So fortunately, he arrived right before the baby came in. Again, me and my colleague, Jennifer Whitehead, had plenty of time to ... Not knowing if Dr. Gerday would get there in time, we had to lineate out the roles between the respiratory therapists, the nurses, who is going to be in charge of helping with medications. We had emergency lines and meds all set up, ready to go, when the baby arrived.

Marc Harrison, MD: Wow. Tell us a little bit about what you all found. Was the baby in fact in full arrest?

Wende Prince: Yeah. They were actively doing chest compressions, and had placed an interosseous, and had given at least one dose of epinephrine.

Marc Harrison, MD: Was this a home birth?

Wende Prince: Yes, it was.

Marc Harrison, MD: Okay, so this is truly a newborn?

Wende Prince: Right. EMS was called at about 20 minutes of age and had actively been doing full code at home and en route.

Marc Harrison, MD: Pretty rough.

Erick Gerday, MD: The thing that I was glad is that we did everything with good planning. On the foresight of Wende and her colleague Jennifer Whitehead were there. They got everything ready. I arrived in the emergency room two minutes before the ambulance. I had been driving on I-15 when I got the phone call. I said, "I'll take the next exit, and I'll be right there."

I arrived before the ambulance, and I had just put gloves on. The line with the tray was there, the person for the medication was ready with the code box to wait for the order, somebody was ready to record. The baby, unfortunately, got accidentally extubated during the movement, and those things happen. We put back an airway, we reestablished her heart rate. We were able to stop chest compression, so we were making progress.

The baby was stable enough within about an hour to be flown to Utah Valley to go to the newborn ICU. We got the baby stable, we got the neonatal transport team with the helicopter coming there. I left the team as they were loading in the helicopter. I rushed to Utah Valley, I arrived just before they arrived to the ICU.

Marc Harrison, MD: What a remarkable story. It sounds like this baby got just a terrific resuscitation-

Erick Gerday, MD: Yes.

Marc Harrison, MD: ... and got every possible chance to get better.

First of all, thank you to all of you for your dedication. It does take a team. We're kind of useless all by ourselves, aren't we? But as a team we can do pretty remarkable things.

Talk to me a little bit about what this meant to you, to be part of system that is actually acting as a system: the resources that it gave you, the sense of standardization, the ability to provide great care at a smaller place. Talk a little bit about what One Intermountain means in this particular circumstance, and if there's any advice you want to give, I'm very much open to advice as well.

Erick Gerday, MD: We cannot practice at a high level in isolation. It has to be as a team. We all have different job in the team, but the only person more important in the team is the patient, and we have to recognize that. If the patient is really what lead the team effort, then I think we do better as a team, as a unit, as a corporation. It has to be the leading force. We all have different assignments in that team, but it has to be coordinated to have a good outcome or the best outcome possible.

Marc Harrison, MD: In your experience has Telehealth been very helpful in our ability to project excellent care into smaller environments?

Wende Prince: I think so, for sure. Both Erick and I teach neonatal resuscitation, and part of our ... After we do a neonatal resuscitation, it includes a debriefing. And as Dr. Gerday was leaving American Fork Hospital, obviously he needed to get to Utah Valley to care for the baby, but I said, "We need to be able to debrief this at some point. And since we have Telehealth, you could probably do that remotely with our team that was at American Fork, the nurses and therapists."

We scheduled a tentative time that we would do that, and Captain Harding from the EMS group was lingering. His team had all left as well.

Marc Harrison, MD: This must have affected them very personally.

Wende Prince: Yeah. But I invited him to be included in that Telehealth debriefing that we had established the time-

Marc Harrison, MD: Both wise and generous of you, I think.

Wende Prince: Well, thank you. To my surprise, he actually brought his entire team back for the debriefing exercise. But it was a great opportunity for the whole team — EMS and nurses, respiratory therapists, all of us — to go over what things we felt like went well, and questions that we had. Dr. Gerday was able to talk about how the baby was at that point doing, and really reach out for future education for the EMS team.

Marc Harrison, MD: I'd love to hear from our colleagues who are visiting with us over telepresence. Do you have additional reflections around what this means, to be part of a bigger system but still have very personal care at home?

Michelle Harrison: Okay. To me, it's a different concept. I've been at American Fork for all of my years other than one, so I'm very used to the small environment, small community hospital feeling. But I do really like the fact that as I see us turning to this One Intermountain, we have nurses that come over to our facility from Utah Valley. We've been pulled over there to help with care, and I think it's enabled us to be able to provide the same quality of care, no matter what hospital we're at. They're getting the same quality of care. And I also feel like, as far as Wende was saying about the team and how we were all working together during this incident, there are so many people behind the scenes that were involved in the team that we don't really even think about.

Marc Harrison, MD: And you, did you want to make any other comments?

Tami Trapier: I want to say kudos to our Utah Valley NICU, neonatologists, and NNPs, for creating this beautiful environment for not only Utah Valley, but American Fork. They are top-notch. They keep us educated, they keep us debriefed on things. When we have a code, we go through those codes.

Education and staying up on our skillsets is so important, especially at a hospital such as American Fork, where today I've been to two code blues already; a baby and an adult. I need to make sure that my skillset as a respiratory therapist is at a very high-quality so that not only am I doing no harm, but my patient experience and outcome is a positive one. But I want to say kudos to those who have created this environment to just flourish for our valley down here.

Marc Harrison, MD: Thank you. I'm sure you know this, but it actually goes well beyond the valley. So as you know, we actually have tele-neonatology coverage for all of our hospitals, plus now another 11 hospitals, and we're in six Western states at this point. We are taking this expertise and we're sharing it much more broadly, with the hope that babies do well, people stay close to home for their care, and their care is as excellent and affordable as possible.

And I forgot which of you said it ... But the idea, really, around One Intermountain is that regardless of whether you're at Sanpete, or whether you're at American Fork, or whether you're up in Cassia, and something bad happens, you're going to get the same superb care no matter where you are. Because each life has equal value, right? And it has always seemed unfair to me that based on luck of geography, that you may get very sophisticated care in one place and less so in another.

There's a lot of work to do on this, but I'm seeing lots of things move in just the right direction, and it's thanks to people like you. I'm humbled to get the opportunity to speak with you and thank you for your service to Intermountain. Together, we're going to do really great things, so thanks.

Wende Prince: Thank you.