To whom it may concern,
I would like to nominate the ER team, both night shift, and day shift, for Team DAISY. Not only does this team operate in chaos most shifts, but they work so in sync that to the average person it would seem every move is choreographed. This team does extraordinary things on a daily/nightly basis and seldom sees themselves in need of recognition, because the mentality in this department has always been: "It's my job, my responsibility to my patient/s, to work as a team". I know my writing or description of this story will do my team no justice, but I had to try to help others see, feel, and understand a glimpse of our life in the ER and the extraordinary teamwork that takes place here. Please bear with me, close your eyes, and try to place yourself on our unit on this night, under these circumstances:
On this night I was with Salim, RN in RME; the shift was winding down and Charge Nurse Andrew Bueno was planning on down-staffing. It had been an overall "quiet" night in the ER (a rarity). Andrew had already called us and told us to start thinking about who was going to get to go home early and to prepare, clean, and stock the area for the next day. All of our patients were settled and waiting for "dispo" when a call came in overhead summoning Salim to the front nurse station. Salim and I looked at one another and smiled; we figured Andrew had some last request (task) for us to complete before one of us was released for the night. I figured Salim would return with the news but after some time passed- no Salim... Then the overhead calls started "Trauma 1, ER Doc, Respiratory".... Shortly thereafter, "ER Doc to another room, x-ray.....". I figured a patient arrived and their room was not ready, or the announcement was done in error, so it was corrected to room.
Our patients were settled, so I decided to go see what I could help with. As I made my way to the front nurses' station there was a lot of traffic in and out, lots of police officers, the OA, and a few other faces I did not recognize. Andrew was shuffling back and forth from person to person answering questions, clarifying protocol, managing the ER flow all while managing delegation and making all the calls (risk management, directors, managers, etc). Looking into the room I saw Samantha and Mark at the computer entering orders, charting, and tasking, as Dr. Kutsen was finishing placement of a chest tube- assessing and reassessing the patient, while simultaneously calling out orders, requesting information, exams and communicating with staff.
Salim was in a corner helping with the chest tube setup/ suction. Misty and Melissa were tag-teaming the rapid infuser in another corner, Jordan, and Chad, RN were multitasking and trying to get another IV access- adjusting leads, medicating, amongst other tasks. I ran out to grab additional supplies that Samantha requested and more fluids. Maricela came in anticipating patient needs, physician consults, life flight transport. She called out and confirmed with staff, OA, charge, and Dr. Kutsen; everything that needed to be done. Always amazingly working.
The command center, Maricela transferred calls to a spectra, left the command center, and had face-to­face communication with the whole team to include HPD. She also ensured consults, arrangements, and pertinent information were communicated and confirmed so the physician and the charge could focus on patient care. I made sure Samantha, Mark, and Chad had everything they needed, and I stepped out of the room and waited for additional requests- as there was no space for additional staff inside the room. The patient stabilized and was sent to a stat CT. I caught Salim and asked for a backstory on events and the whole room fiasco.
This is when he told me that the initial call came in as an MVA, single-car accident with a driver and multiple pediatric passengers. Staff was prepped, ready, and waiting to receive a pedi patient- as it was reported they were first en route. Despite vast efforts by the EMS team, Baby was pronounced deceased shortly after his arrival. Moments thereafter a second
EMS team arrived with another patient, the driver of the vehicle, and the transition began for her care. My heart sank as Salim and I stepped into the room past the glass door and green curtain. The room had been cleaned, all equipment and supplies put away, it was quiet, the lights dim as only a single overhead light glowed in the room. This child had been cared for by our team in such a manner that anyone stepping into that room would have only thought they were seeing a child sleeping on that bed.
He had been changed into a pedi hospital gown as his superhero pajamas were removed for assessment and treatment, and a warm blanket was placed over him. Not a single detail was missed in preparation for expected visitation. We stood in silence for a moment (it seemed like time stopped). I whispered a prayer as I softly brushed remnants of grass from his curly black hair. Salim gently folded his soiled and torn pajamas and placed them in a brown bag. Just then, commotion and heavy footsteps could be heard outside the glass door.
We stepped out as the patient was rushed past from CT and back into her room. She was awake voicing pain and had no idea that her child had died and was lying in the room next to her behind that tattered green curtain. Almost immediately after arriving back in the room, the patient began deteriorating, stats steadily declining, and the patient became more and more lethargic. Dr. Kutsen and staff were feverishly trying to cover every scenario, communicating, questioning, assessing, and treating. Lena and Alexandria could be seen running down the hall with ice chests filled with RBCs from the lab as the unit emergent supply had been depleted. Life Flight arrived and jumped into the mix trying to help stabilize the patient for transport to the Medical Center. Shift change arrived, day shift- moving with purpose, comes around the corner, no questions asked- they just move right into the room, relieving mentally and physically exhausted staff, continuing care so seamlessly. It was a remarkable sight. Katie Evers, RN, Kendall Fox, RN, James, RN, Taryn, RN, and techs Susie and Marta had already received reports from their Charge Nurse, Courtney Windham, and were ready to take over. The patients were left in their care and the mother made it safely to the Med Center and straight to the OR. We have heard she has made a full recovery.
Many things were in play here and happening simultaneously during patient care/treatment­ many not mentioned. Between Samantha and Maricela's investigative/assessment skills- they were able to track identity/medical info for both patients- facilitating patient care and identity/transport/status information for the third patient that the Medical Center received. This was crucial- as staff had already suffered a traumatic situation with Baby. Finding out that the second pediatric patient was transferred safely with no life-threatening trauma, and was awake and asking for his mom, I believe, helped staff transition from the devastating loss of a child to the fight in saving their mother.
The quick-thinking, delegation and coordination efforts of Andrew Bueno contributed to prepared and focused care for this trauma patient and the smooth operation of the ER. His communication/report to Courtney ensured that proper staff was in place to relieve night shifters and continued care/transport for the trauma patient along with care for multiple patients occupying front trauma rooms were in place. He ensured that all tasks completed were relayed- so that the transition was smooth, and no questions were left that could hinder continued care. The unit banded together and helped care for all patients in order to free Gary, RN, Ryan, RN, Melissa, RN, and Misty, RN from their assignments to assist with the trauma case. X-ray, respiratory, and CT staff were all on standby; waiting and stepping in during care, moving swiftly and effectively to complete their role/tasks, and expediting results to the physician and nurses. Dr. Kutsen communicating clearly, receiving and requesting staff input- working as a team and not as separate entities with titles.
We regularly work fast-paced, back-to-back cases involving trauma, post-arrest, and CPR- in­ progress. We can't save them all, but we give it our all every time. This one was hard. The circumstances surrounding the cases as well as the details confirmed the next day when the story made headlines were crushing: wrong-way driver, driver suspected of being under the influence, young children in the car ejected and possibly not properly restrained, no patient info or medical history upon arrival, death before we had a chance to make a difference, saving mom, praying circumstances changed for the surviving child. The list continues and will be different for every staff member involved. The scenario not ending but continuing full circle, affecting each individual differently, the heaviness at the end of the shift when you can react, feel, and reflect on the circumstances surrounding the death of a patient; the hurt and sorrow felt after the death of a child knowing you just helped save the person who contributed or caused his death. Maintaining composure and mindset to function effectively, making a positive difference in the outcome for the next patient- with no personal recovery time between cases­ is crucial, and in my mind a marked distinction of this team.
Watching this team operate without hesitation- feelings, beliefs, and opinions set aside- always working toward the best patient outcome for every patient, no matter their story, is a reminder to me- I am working with the best team. I hope I was able to paint a picture, even if a small one, of the amazing team that makes up our Memorial Hermann Southeast Emergency Center.
Thank you so much for your undivided attention and time, A proud-of-her-team ER nurse.