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Welcome to the Swallow Your Pride podcast. I'm

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your host, Theresa Richard. I'm a board certified

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specialist in swallowing and swallowing disorders

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and founder of the MedSLP Collective and MedSLP

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Education.

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This podcast is dedicated to delivering the latest

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evidence-based practice to medical SLPs everywhere while

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also recognizing that medical SLPs everywhere are doing

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the best with what they've got. Whether you

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are a new clinician seeking tangible tools for

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therapy or a seasoned vet stuck in a

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rut, my goal is simple, to help you

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advance your practice practice without feeling overwhelmed or

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underappreciated.

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This means that together, we'll build confidence, broaden

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your knowledge, and reignite your passion for our

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fields. So if you're listening, I encourage you

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to swallow your pride and be open to

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new ideas because at the end of the

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day, you and your patients deserve that kind

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of support. Just a quick disclaimer that all

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statements and opinions expressed in this episode do

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not reflect on the organizations associated with the

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speakers and are their own opinions solely. With

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that, let's dive in.

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Welcome to the swallow your pride podcast. I

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am so excited for today's guest. This conversation

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has been a long time coming. I know

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there's a lot of questions that SLPs have

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about this.

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I have a lot of questions myself, and

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I'm so excited to dive in. So today,

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we have Christoph Schmitz with us and Laura

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McWilliams,

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and they are a really interesting dynamic duo.

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They've both been on the podcast previously

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for

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various different reasons, but today coming together for

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a really cool reason that we will talk

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about in just a bit. So Christoph is

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an experienced med device expert, entrepreneur, and inventor.

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He's driven by the desire to help clinicians

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provide best patient care. He takes pride in

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creating innovative device solutions in the field of

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speech language pathology.

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As the CEO of PatCom Medical, his goals

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include giving more patients access to instrumental swallow

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assessments and raising the customer service experience for

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SLPs to a new level.

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I love that bio, Christoph. That's great.

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Yes. I deliver it every day. Yeah. And

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Laura McWilliams is an SLP and board certified

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specialist in swallowing with a passion for change

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management, safety, quality, informatics,

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team development, and workplace culture. She's a leader,

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mentor, supervisor, and consultant,

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and still isn't sure what she wants to

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be when she grows up. She's a mom

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to three kiddos under the age of five

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and has a deep appreciation for innovation, elevating

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others, and finding courage in our daily practice.

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Awesome. Welcome to the show, you guys. I

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feel like those are, like, the best bios

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ever, so I love them both.

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Christoph, without further ado, tell the people a

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little bit more about yourself.

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Yes. Sure. Yeah. Absolutely.

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So I've been,

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in the medical,

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and medical device world, for almost twenty years

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now. I was thinking like

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back in preparation of this. How long has

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it been? Twenty years almost, coming up to

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twenty years. And then,

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you know, seven out of the twenty years,

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lucky enough to,

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to be running PatCom Medical,

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for the reasons that you've mentioned already.

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And, yeah, I'm very excited to to be

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here. This this topic that we're gonna talk

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about is

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really probably,

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you know, I'll say the thing that I'm

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most proud of in a way, because it's

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it's, you know, truly where I,

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you know, was able to invent something that,

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hopefully will, you know, help many, many patients,

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feel better,

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be more comfortable,

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and here and there, maybe even save a

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life. So that's why I'm so excited to

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be talking about that with you. Yeah. Yep.

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I love that, Christoph. And I think one

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of my most favorite sayings is, like, every

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overnight success story has twenty years of experience

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that you never heard about. And I think

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that describes you perfectly. I think people are

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like that that don't know you are like,

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who's Christoph? What does he have to do

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with speech pathology? And it's like, no. He's

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been around a while, you guys. Like, he

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knows this stuff.

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Yeah. So

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thank you for being here. And, Laura,

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tell us what you've been up to because

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I know you've had some really exciting career

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changes.

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Yeah. So I,

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yeah, so my bio's, you know, definitely changed

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a little bit. So I'm now moving into

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more patient safety,

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health care innovation. I'm pursuing an executive MBA

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now. But I also really love just the

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science of

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how humans and technology

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and especially the development of products can better

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serve

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not only the patient but also the clinician

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providing care.

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And as a speech therapist, I'm always things

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that gets me excited

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are stories like the first therapist that asked

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for a pistol grip scope

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compared to the overhead scope and how ergonomically

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that saves our arms and shoulders.

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And I naturally gravitate towards innovators like Christoph.

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And so when I was, introduced

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to the introducer

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product, it just really aligned with my core

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values of supporting the clinician patients,

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and also that that growing interest of human

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factors engineering and human factors health care. How

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to do things easier, kinder, and better for

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our patients.

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I love that. This aligns with

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I had some shower thoughts this morning. And

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I was like, you know what? I really

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love where we are right now

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in business and in health care because it's

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fun. Like, there's so much cool technology

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and AI coming and, you know, people are

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intimidated by that, but it's either you've got

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either

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run away from it or embrace it. Right?

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And those are the kind of things that

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get me so excited. Like, we're just trying

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so many new things in the collective right

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now with AI and just really advanced technology,

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but there's also we all know that human

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element that can never be replaced. So I

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just I think it's a really cool time

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for innovators and people that are willing to

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step outside the box and use these technologies

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to our advantage to help patients and to

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help SLPs. So,

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Christoph, tell us why we're here today and

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what we're gonna talk about.

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Yes. We're here today to talk about the

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Patcom

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Introducer,

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a product that,

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assists the placement

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of

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catheters

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that otherwise would be placed blindly

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into the gut system. System. So,

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We make use of, the flexible endoscopes

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that so many of you already know from

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doing fees, for example.

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That's the visualization

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aspect that we benefit from. And then,

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the Introducer is what,

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gets placed into the esophagus. And then,

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once the endoscope is extracted,

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we can place a catheter

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through the Introducer,

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being guided by that channel,

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and really just helps with

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the safe and more comfortable placement of

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any catheters,

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into the esophagus.

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Okay. So, Christoph,

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everybody's number one question is why are we

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as SLPs doing this? Is this within our

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scope of practice?

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What in the world were you thinking here?

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Okay. Yes. Alright. So that,

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  that's, like, the final very,

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very No. We're going we're going right into

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it. We're going right into it. Totally. Absolutely.

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So let me start by saying this. When

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you register a medical device with the food

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and drug Administration,

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it is a long process. It's a very

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difficult process. You have to prove a lot

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of things before you're allowed to market

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your product to, you know, the health care

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world and to patients, etcetera. There's a lot

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of bench testing. It's about material compatibility

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that you have to show. You know, this

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does not cause harm to

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the human body.

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You

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have to do a lot of things.

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Of course, the, you know, the manufacturer that

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that's making this has to be certified.

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So, like, a long, long journey to get

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something,

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FDA approved. Now as part of that,

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what you do is you tell your intended

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use.

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OK. So what is this device for? And

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that is actually a fairly brief typically paragraph

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where you just say, okay. What what does

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this device do?

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And

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that is part of your submission to FDA,

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and that is part of what they look

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at, and they will accept what you say

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or they will not accept what you say.

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So for example, if your medical device,

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you know, is,

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a surgical device where you,

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cut the body open,

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it probably has to be a surgeon, a

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physician, a trained surgeon who is allowed to

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do this. Right? Can't be an allied

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health professional probably cutting the the body open,

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as an extreme example.

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Now,

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 from the industry perspective, if you 

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try to market your product, of course, you

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want this to be,

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you know, sort of as broad as

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possible because you don't want to limit,

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your product,

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unnecessarily

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to only a very specific

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group of people. Now talking about the Introducer,

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our initially,

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suggested intended use

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did get accepted. Actually, we never had to

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change it. And it simply says that,

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the Introducer is to be used

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by trained

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health care professionals.

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So that is a very important,

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you know, regulatory,

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even legal, if you wanna call it that,

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aspect of it. Because if this said

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has to be used by a gastroenterologist,

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 then that's it. Scope of practice

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answered. It's a GI. If it's, you

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know,

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some other device and a specific,

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type of, doctor, then it would be that.

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But it says trained health care professional. So

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when you say, like, is scope of practice

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for SLP? Because my first question would be,

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is

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an SLP a health care professional,

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and can they be trained

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in using this device?

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And I would assume that, you know,

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the two of you and many others

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would say yes to both of these questions.

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Right? So from that perspective,

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SLPs are already within, for us, our scope

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of people that we can work with for

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this device.

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Right? Now,

272
00:10:28,745 --> 00:10:31,545
why do we, work with SLPs also? Of

273
00:10:31,545 --> 00:10:34,264
course, the history of the company, right, is

274
00:10:34,264 --> 00:10:36,985
that we are very, very focused on working

275
00:10:36,985 --> 00:10:38,445
with speech language pathologists.

276
00:10:38,970 --> 00:10:41,149
And, we know about SLPs

277
00:10:41,529 --> 00:10:42,269
that there

278
00:10:42,570 --> 00:10:44,490
a lot of them are very, very good

279
00:10:44,490 --> 00:10:47,610
with flexible endoscopes because you're already doing FEEs.

280
00:10:47,610 --> 00:10:49,309
So you already have

281
00:10:49,690 --> 00:10:50,190
experience

282
00:10:50,570 --> 00:10:53,149
using the instrument that is also quite crucial

283
00:10:53,209 --> 00:10:56,085
for using the Introducer. You know, another group

284
00:10:56,085 --> 00:10:58,725
would be an ENT physician. They're naturally using

285
00:10:58,725 --> 00:11:00,425
the same type of endoscope,

286
00:11:01,205 --> 00:11:03,845
as well. So the benefit of working with

287
00:11:03,845 --> 00:11:04,585
speech pathologists,

288
00:11:05,764 --> 00:11:08,019
part of it is that, you know, you

289
00:11:08,019 --> 00:11:10,679
are already trained in using the endoscope. So

290
00:11:10,899 --> 00:11:13,220
just makes sense to also work with

291
00:11:13,220 --> 00:11:13,879
the Introducer.

292
00:11:14,899 --> 00:11:16,500
And then of course, you know, if you

293
00:11:16,500 --> 00:11:18,759
work with dysphagia and you're working with swallowing,

294
00:11:20,535 --> 00:11:21,995
then it comes to be,

295
00:11:22,455 --> 00:11:24,075
you know, you're dealing with,

296
00:11:25,335 --> 00:11:25,835
recommending,

297
00:11:27,095 --> 00:11:29,495
you know, source of nutrition for patients. So

298
00:11:29,495 --> 00:11:32,149
now the question is because we now

299
00:11:32,149 --> 00:11:33,930
know that, you know, nasogastric

300
00:11:34,309 --> 00:11:36,550
tubes and g tubes are in a really

301
00:11:36,550 --> 00:11:38,550
way we probably benefit the most from the

302
00:11:38,550 --> 00:11:39,050
Introducer.

303
00:11:39,590 --> 00:11:41,750
So the recommendation whether or not one of

304
00:11:41,750 --> 00:11:44,009
those tubes is actually necessary also,

305
00:11:44,754 --> 00:11:46,754
you know, is something that SLPs, of course,

306
00:11:46,754 --> 00:11:48,054
are involved with.

307
00:11:48,514 --> 00:11:50,674
And those are the reason from my

308
00:11:50,674 --> 00:11:52,214
perspective, and maybe,

309
00:11:52,714 --> 00:11:54,454
you know, Laura can add to it why

310
00:11:54,674 --> 00:11:57,414
it does absolutely make sense to have SLPs

311
00:11:57,475 --> 00:11:58,294
look at this.

312
00:11:59,429 --> 00:12:00,250
Yep. Awesome.

313
00:12:00,949 --> 00:12:02,549
I have so many more questions, but I

314
00:12:02,549 --> 00:12:04,549
want to bring Laura in on this for

315
00:12:04,549 --> 00:12:07,029
for a minute. Laura, tell the people

316
00:12:07,029 --> 00:12:09,350
why you're here and why you've become so

317
00:12:09,350 --> 00:12:12,069
passionate about this. And actually when

318
00:12:12,069 --> 00:12:14,384
I heard you were involved in this, it

319
00:12:14,384 --> 00:12:16,644
made perfect sense with, as you said, your

320
00:12:16,705 --> 00:12:19,365
core values of, you know, patient safety, quality,

321
00:12:19,504 --> 00:12:20,804
all of those things. So,

322
00:12:21,424 --> 00:12:23,125
let's hear your praises on this.

323
00:12:23,504 --> 00:12:24,705
Yeah. Yeah. So,

324
00:12:25,649 --> 00:12:27,809
I first learned about this while I was

325
00:12:27,809 --> 00:12:30,149
actually at a course learning about manometry

326
00:12:30,769 --> 00:12:31,269
myself,

327
00:12:31,889 --> 00:12:34,870
pharyngeal manometry, pharyngeal and esophageal manometry.

328
00:12:35,649 --> 00:12:36,870
And I,

329
00:12:37,409 --> 00:12:39,725
also came to that course with

330
00:12:40,184 --> 00:12:42,204
a bit of a novice interest

331
00:12:42,904 --> 00:12:45,784
and trying to figure out why my acute

332
00:12:45,784 --> 00:12:47,784
care team at the time was really having

333
00:12:47,784 --> 00:12:51,225
a hard time getting involved early in critical

334
00:12:51,225 --> 00:12:52,924
care ICU cases.

335
00:12:54,320 --> 00:12:56,720
Patients were being told they were telling us

336
00:12:56,720 --> 00:12:58,399
they were too sick for us to start

337
00:12:58,399 --> 00:13:00,800
working with them, to scope them. They were

338
00:13:00,800 --> 00:13:03,440
too metabolically deranged. They were trying to get

339
00:13:03,440 --> 00:13:05,840
access. So I sort of had these

340
00:13:05,840 --> 00:13:08,794
two looming things in my brain, wanting to

341
00:13:08,794 --> 00:13:10,254
learn about pharyngeal manometry,

342
00:13:11,034 --> 00:13:14,254
wanting to solve this problem of early intervention,

343
00:13:14,394 --> 00:13:17,914
early access, and working in unison with our

344
00:13:17,914 --> 00:13:19,054
critical care team.

345
00:13:19,674 --> 00:13:20,174
So

346
00:13:20,554 --> 00:13:21,855
my experience

347
00:13:22,860 --> 00:13:23,360
actually,

348
00:13:24,700 --> 00:13:25,200
was

349
00:13:25,580 --> 00:13:26,559
was more,

350
00:13:27,259 --> 00:13:30,379
pronounced because I experienced a blind pass at

351
00:13:30,379 --> 00:13:32,240
this pharyngeal manometry course.

352
00:13:32,779 --> 00:13:33,279
And,

353
00:13:34,139 --> 00:13:36,639
the student who was placing the catheter

354
00:13:37,154 --> 00:13:39,794
to get into my esophagus actually entered my

355
00:13:39,794 --> 00:13:42,615
airway before they got into my esophagus.

356
00:13:43,714 --> 00:13:45,254
And that was

357
00:13:45,794 --> 00:13:48,034
that was, I think, life changing for me,

358
00:13:48,434 --> 00:13:50,919
because I started to ask the question, can

359
00:13:50,919 --> 00:13:52,840
we do this better? Is there a tool

360
00:13:52,840 --> 00:13:54,700
out there? Do we already have

361
00:13:55,240 --> 00:13:55,740
anybody

362
00:13:56,120 --> 00:13:57,980
in health care who has the skills

363
00:13:58,279 --> 00:13:58,779
to,

364
00:13:59,879 --> 00:14:01,019
to 

365
00:14:01,399 --> 00:14:02,379
to scope somebody

366
00:14:03,080 --> 00:14:04,600
and to have eyes on where we are

367
00:14:04,600 --> 00:14:07,254
going and what is this practice,

368
00:14:07,475 --> 00:14:10,274
and why does it feel so archaic and

369
00:14:10,274 --> 00:14:10,774
intrusive?

370
00:14:11,555 --> 00:14:14,514
So at that point, I said, I commit

371
00:14:14,514 --> 00:14:15,254
to never,

372
00:14:16,115 --> 00:14:19,154
experiencing a blind past myself and also trying

373
00:14:19,154 --> 00:14:20,375
to figure out a solution

374
00:14:20,879 --> 00:14:21,860
to support,

375
00:14:24,000 --> 00:14:24,820
more humane,

376
00:14:26,000 --> 00:14:27,460
catheter feeding tube,

377
00:14:28,639 --> 00:14:29,139
guidance

378
00:14:29,519 --> 00:14:31,299
for patients in my care.

379
00:14:31,679 --> 00:14:33,519
And then I met the Patcom team, and

380
00:14:33,519 --> 00:14:34,419
I met Shelby,

381
00:14:36,674 --> 00:14:39,634
And I wanna bounce back to the first

382
00:14:39,634 --> 00:14:40,934
question, which was

383
00:14:41,794 --> 00:14:43,815
the scope of practice and the responsibility

384
00:14:44,674 --> 00:14:46,835
for the therapist to be involved in the

385
00:14:46,835 --> 00:14:48,995
esophagus because I get asked this question all

386
00:14:48,995 --> 00:14:49,575
the time.

387
00:14:50,000 --> 00:14:51,600
So a little bit about me, I started

388
00:14:51,600 --> 00:14:52,899
as a head and neck clinician

389
00:14:53,200 --> 00:14:53,700
changing

390
00:14:54,159 --> 00:14:54,659
tracheoesophageal,

391
00:14:55,279 --> 00:14:56,100
voice prosthesis,

392
00:14:56,799 --> 00:14:58,659
working with advanced surgeons,

393
00:14:59,759 --> 00:15:03,139
and also doing very initial for pharyngeal manometry

394
00:15:03,360 --> 00:15:04,954
about ten years ago.

395
00:15:05,254 --> 00:15:07,674
So in my perspective and in my raising,

396
00:15:08,054 --> 00:15:09,514
I've been in the esophagus

397
00:15:09,894 --> 00:15:11,595
since the beginning of my career.

398
00:15:11,975 --> 00:15:13,434
I'm actually in the esophagus

399
00:15:13,894 --> 00:15:16,134
when my surgeons call me into the OR

400
00:15:16,134 --> 00:15:19,399
and say, we're doing a secondary placement on

401
00:15:19,399 --> 00:15:21,720
a laryngectomy. Where is the best place to

402
00:15:21,720 --> 00:15:23,500
place this? And I am guiding

403
00:15:24,039 --> 00:15:26,779
the surgeon's placement of that voice prosthesis.

404
00:15:27,559 --> 00:15:29,320
When I'm in my outpatient clinic and I'm

405
00:15:29,320 --> 00:15:32,459
changing the voice prosthesis, we're working together to

406
00:15:32,554 --> 00:15:35,434
to size to make sure that the patient

407
00:15:35,434 --> 00:15:38,414
is, sized appropriately and they're getting good voicing.

408
00:15:39,034 --> 00:15:39,934
I think, also,

409
00:15:40,394 --> 00:15:41,754
you know, we have to care about the

410
00:15:41,754 --> 00:15:44,154
esophagus as it relates to dysphagia for all

411
00:15:44,154 --> 00:15:46,394
the good reasons. Your recent focus on the

412
00:15:46,394 --> 00:15:47,134
rest protocol,

413
00:15:47,834 --> 00:15:48,334
we

414
00:15:48,690 --> 00:15:51,169
we truly have separated the parts of the

415
00:15:51,169 --> 00:15:52,870
body from a,

416
00:15:53,570 --> 00:15:55,350
insurance billing reimbursement

417
00:15:56,129 --> 00:15:59,029
perspective, but we really are in total

418
00:15:59,570 --> 00:16:01,570
connected, and we need to remember that in

419
00:16:01,570 --> 00:16:02,294
our care.

420
00:16:03,254 --> 00:16:04,794
So in my perspective,

421
00:16:05,334 --> 00:16:06,714
I have been in the esophagus

422
00:16:07,174 --> 00:16:08,794
since the start of my career,

423
00:16:09,174 --> 00:16:10,554
and it actually was

424
00:16:11,095 --> 00:16:14,375
pretty shocking when people would ask, let's say,

425
00:16:14,375 --> 00:16:14,875
from

426
00:16:15,209 --> 00:16:17,610
modified barium swallows, why are we why are

427
00:16:17,610 --> 00:16:18,909
we messing with the esophagus?

428
00:16:19,610 --> 00:16:22,429
We clearly know we should be getting visualization

429
00:16:22,490 --> 00:16:25,289
of the esophagus to inform dysphagia diagnostic. So

430
00:16:25,289 --> 00:16:27,610
those questions and that response goes hand hand

431
00:16:27,610 --> 00:16:30,894
in hand with our general responsibility of care.

432
00:16:31,595 --> 00:16:34,095
So I did my due diligence. And

433
00:16:34,394 --> 00:16:36,235
as I was bringing this on to my

434
00:16:36,235 --> 00:16:38,315
team and learning more about this, I started

435
00:16:38,315 --> 00:16:40,554
to look at ASHA's code of ethics and

436
00:16:40,554 --> 00:16:42,975
picking it apart as how do they define

437
00:16:43,340 --> 00:16:45,259
our scope of practice, how do they define

438
00:16:45,259 --> 00:16:45,759
competency,

439
00:16:46,379 --> 00:16:49,100
how do they define our different skills and

440
00:16:49,100 --> 00:16:51,200
everything. And they were wonderful.

441
00:16:51,820 --> 00:16:53,899
Every question that I asked, you know, the

442
00:16:53,899 --> 00:16:56,804
person who was receiving them knew, okay. This

443
00:16:56,804 --> 00:16:58,965
is Laura now. She's she's gonna just keep

444
00:16:58,965 --> 00:17:00,345
hitting me with all these questions.

445
00:17:01,205 --> 00:17:03,125
And I did it intentionally because I led

446
00:17:03,125 --> 00:17:07,045
a team of eighteen, nineteen clinicians where they

447
00:17:07,045 --> 00:17:09,059
were relying on me to get

448
00:17:09,460 --> 00:17:10,440
a good understanding,

449
00:17:10,900 --> 00:17:12,279
a good patient safety,

450
00:17:13,539 --> 00:17:14,039
perspective

451
00:17:14,340 --> 00:17:16,519
on bringing this into our practice.

452
00:17:17,299 --> 00:17:19,460
And I had a lot of responsibility on

453
00:17:19,460 --> 00:17:21,880
my shoulders to really make sure we were

454
00:17:22,125 --> 00:17:23,884
we were aligned and good to go and

455
00:17:23,884 --> 00:17:24,785
feeling confident.

456
00:17:26,045 --> 00:17:29,005
And ASHA's code of ethics, they cited back

457
00:17:29,005 --> 00:17:30,785
to me, competence in training.

458
00:17:31,244 --> 00:17:33,025
As as long as you are

459
00:17:33,404 --> 00:17:36,919
defining that and well within the parameters of

460
00:17:36,919 --> 00:17:39,480
how you define competence, have you defined training

461
00:17:39,480 --> 00:17:41,819
on your team to implement this skill,

462
00:17:42,119 --> 00:17:44,139
it is very similar to what we

463
00:17:44,519 --> 00:17:45,740
encourage with

464
00:17:46,279 --> 00:17:46,779
tracheoesophageal

465
00:17:47,399 --> 00:17:49,559
voice prosthesis training. Have you been to a

466
00:17:49,559 --> 00:17:52,194
course? Have you had patient passes? Do you

467
00:17:52,194 --> 00:17:53,095
have guided,

468
00:17:53,875 --> 00:17:54,375
mentorship?

469
00:17:54,755 --> 00:17:56,694
And do you have a long term quality,

470
00:17:57,954 --> 00:17:59,015
quality observation

471
00:17:59,954 --> 00:18:00,454
process?

472
00:18:00,914 --> 00:18:02,515
Now they can't help you set that up,

473
00:18:02,515 --> 00:18:04,275
but those are the things that they encourage,

474
00:18:04,275 --> 00:18:07,089
and that is what ASHA does encourage the

475
00:18:07,089 --> 00:18:09,650
clinician clinician leaders to implement as they're bringing

476
00:18:09,650 --> 00:18:11,670
anything new, not just the introducer.

477
00:18:13,730 --> 00:18:14,710
And then I guess

478
00:18:15,250 --> 00:18:17,330
the more feedback that they gave me, the

479
00:18:17,330 --> 00:18:18,789
more I realized, wow.

480
00:18:19,865 --> 00:18:21,705
A lot of the processes and the quality

481
00:18:21,705 --> 00:18:23,865
improvement work that I had been focusing on

482
00:18:23,865 --> 00:18:25,865
with my own team set the stage for

483
00:18:25,865 --> 00:18:28,424
for this to really fit nicely into expanding

484
00:18:28,424 --> 00:18:29,644
our clinical services

485
00:18:30,184 --> 00:18:32,445
and just simply adding this into our care.

486
00:18:32,585 --> 00:18:34,265
Because the reality is, and I think you

487
00:18:34,265 --> 00:18:36,450
can speak to this, you know, there are

488
00:18:36,450 --> 00:18:39,670
endoscopy programs without competencies and without real training.

489
00:18:40,130 --> 00:18:41,809
So when you look at ASHA code of

490
00:18:41,809 --> 00:18:42,309
ethics,

491
00:18:42,929 --> 00:18:44,929
you have to validate you have those that

492
00:18:44,929 --> 00:18:47,329
minimum skill, minimum competence, and,

493
00:18:47,730 --> 00:18:49,170
we really need to be taking a hard

494
00:18:49,170 --> 00:18:51,244
look at even just the basics of our

495
00:18:51,244 --> 00:18:51,744
field

496
00:18:52,125 --> 00:18:53,724
to then get to the point of being

497
00:18:53,724 --> 00:18:54,464
able to,

498
00:18:55,164 --> 00:18:57,025
bring this type of care

499
00:18:57,884 --> 00:19:00,005
to your to your health care settings. So

500
00:19:00,005 --> 00:19:02,125
I hope that answered a few questions about

501
00:19:02,125 --> 00:19:02,625
scope.

502
00:19:03,590 --> 00:19:04,809
Very, very much so.

503
00:19:05,830 --> 00:19:08,150
Let's let's dive into sort of the other

504
00:19:08,150 --> 00:19:09,690
elephant in the room with this topic.

505
00:19:10,230 --> 00:19:10,730
And,

506
00:19:11,430 --> 00:19:13,350
Christoph, why would we do this if we

507
00:19:13,350 --> 00:19:15,350
can't bill for it? I need to make

508
00:19:15,350 --> 00:19:17,355
money if I'm gonna do this this procedure.

509
00:19:17,654 --> 00:19:18,154
Right.

510
00:19:18,615 --> 00:19:19,595
Absolutely. That's,

511
00:19:20,454 --> 00:19:22,855
that's true, and that makes sense. Now, you

512
00:19:22,855 --> 00:19:25,755
know, when sometimes when people see the Introducer

513
00:19:26,615 --> 00:19:28,214
and then actually say, like, you know, can

514
00:19:28,214 --> 00:19:30,394
we do this? They might actually not talk

515
00:19:30,454 --> 00:19:33,330
necessarily about the Introducer itself, but they might

516
00:19:33,330 --> 00:19:35,269
talk about the ng tube placement,

517
00:19:35,890 --> 00:19:38,130
which, again,  is the one just because

518
00:19:38,130 --> 00:19:39,349
how of how many

519
00:19:39,809 --> 00:19:41,970
times it's placed each year, and there really

520
00:19:41,970 --> 00:19:43,029
is, like, 12,000,000,

521
00:19:43,570 --> 00:19:45,730
a year worldwide. So the the number is

522
00:19:45,730 --> 00:19:47,444
very large, so it makes sense. But so

523
00:19:47,444 --> 00:19:48,724
when they say, like, can we do this?

524
00:19:48,724 --> 00:19:51,125
They actually might refer to, can we place

525
00:19:51,125 --> 00:19:54,085
an NG tube? Is that within the scope

526
00:19:54,085 --> 00:19:56,404
of our practice? And, you know, I'll I'll

527
00:19:56,404 --> 00:19:58,484
just mention it, but then, I think Laura

528
00:19:58,484 --> 00:20:00,884
can probably expand on that, better because,

529
00:20:01,679 --> 00:20:04,399
honestly, we actually really learned from Laura and

530
00:20:04,399 --> 00:20:06,579
her team in that regard how,

531
00:20:07,039 --> 00:20:09,359
you know, it's like, the SLP using the

532
00:20:09,359 --> 00:20:10,980
Introducer and the nurse

533
00:20:11,359 --> 00:20:13,539
still placing the NG tube

534
00:20:13,964 --> 00:20:15,404
where then the,

535
00:20:15,724 --> 00:20:17,884
you know, the the actual placement of the

536
00:20:17,884 --> 00:20:18,865
NG tube

537
00:20:19,484 --> 00:20:22,765
remains with nursing rather than SLPs taking that

538
00:20:22,765 --> 00:20:23,984
over. Now

539
00:20:24,285 --> 00:20:25,164
as far as,

540
00:20:25,819 --> 00:20:27,759
you know, making the introducer,

541
00:20:29,179 --> 00:20:32,059
placement in itself something that's billable and it's,

542
00:20:32,140 --> 00:20:33,900
you know, sort of like a service that

543
00:20:33,900 --> 00:20:35,119
SLPs can do,

544
00:20:35,660 --> 00:20:37,900
that is something that hopefully at some point

545
00:20:37,900 --> 00:20:40,134
in the future will be possible. And that's

546
00:20:40,134 --> 00:20:42,535
something that, you know, of course, PatCom would

547
00:20:42,535 --> 00:20:44,234
absolutely advocate for,

548
00:20:44,535 --> 00:20:46,054
but we can't do it alone, right? We

549
00:20:46,054 --> 00:20:48,954
need to do that together with,

550
00:20:49,654 --> 00:20:51,974
healthcare professionals. And then of course, one of

551
00:20:51,974 --> 00:20:53,275
the questions is, okay,

552
00:20:53,789 --> 00:20:56,190
how needed is this? How many 

553
00:20:56,190 --> 00:20:57,950
people out there, you know, want to do

554
00:20:57,950 --> 00:21:00,029
that are already doing it? So it's a

555
00:21:00,029 --> 00:21:01,870
little bit the chicken in the egg question

556
00:21:01,870 --> 00:21:04,049
where it's like, okay, can you first,

557
00:21:04,830 --> 00:21:07,484
go somewhere and receive an actual amount of

558
00:21:07,484 --> 00:21:09,264
money for placing an Introducer,

559
00:21:09,964 --> 00:21:11,184
and then you start,

560
00:21:11,964 --> 00:21:14,204
you know, everyone starts using it? That's not

561
00:21:14,204 --> 00:21:16,044
really how it works in reality. Right? You

562
00:21:16,044 --> 00:21:17,424
need to actually

563
00:21:17,950 --> 00:21:18,670
have that,

564
00:21:19,070 --> 00:21:21,869
group that's spearheading things and that is using

565
00:21:21,869 --> 00:21:22,369
it

566
00:21:22,830 --> 00:21:25,230
for the number one reason, which is, patient

567
00:21:25,230 --> 00:21:28,130
benefit. And then, you know, from there,

568
00:21:28,670 --> 00:21:29,330
in collaboration,

569
00:21:30,430 --> 00:21:32,590
absolutely also look at, okay, how can this

570
00:21:32,590 --> 00:21:34,724
be built for? I do wanna say when

571
00:21:34,724 --> 00:21:37,125
I asked Christoph that, I was being very

572
00:21:37,125 --> 00:21:38,644
facetious when I was at I need to

573
00:21:38,644 --> 00:21:39,765
bill for that. I need to get

574
00:21:39,765 --> 00:21:41,445
paid bills. I was being facetious in saying

575
00:21:41,445 --> 00:21:43,704
that. So thank you for sharing that, Christoph.

576
00:21:43,765 --> 00:21:45,845
Go ahead, Laura. So with the billing,

577
00:21:45,845 --> 00:21:47,525
I actually that's a good I get asked

578
00:21:47,525 --> 00:21:49,779
that question. And I think the perception of

579
00:21:49,779 --> 00:21:52,740
anything new is much more work or more

580
00:21:52,740 --> 00:21:55,960
work, and I want to invite everybody to

581
00:21:56,179 --> 00:21:57,859
kind of pause on that thought. I think

582
00:21:57,859 --> 00:22:00,825
we're all burned by the productivity discussion. But

583
00:22:01,065 --> 00:22:03,944
when you add the Introducer to your general

584
00:22:03,944 --> 00:22:04,684
skill set

585
00:22:05,224 --> 00:22:06,904
on the team that I was with in

586
00:22:06,904 --> 00:22:08,904
my current team, you know, we consider this,

587
00:22:08,904 --> 00:22:10,984
like, the fourth step of our endoscopy. It's

588
00:22:10,984 --> 00:22:12,744
in our policy and procedure. It is the

589
00:22:12,744 --> 00:22:14,264
fourth step. You know, you have your anatomy,

590
00:22:14,264 --> 00:22:16,204
your swallowing, your content story strategies,

591
00:22:16,740 --> 00:22:19,700
introduce replacement if indicated. Right? It is just

592
00:22:19,700 --> 00:22:20,200
simple.

593
00:22:20,819 --> 00:22:21,319
And

594
00:22:21,859 --> 00:22:24,339
what you are offering to that patient and

595
00:22:24,339 --> 00:22:27,059
actually to the hospital is very similar and

596
00:22:27,059 --> 00:22:28,900
not just hospital to the clinic, to the

597
00:22:28,900 --> 00:22:29,400
subacute

598
00:22:29,859 --> 00:22:31,000
facility is,

599
00:22:31,835 --> 00:22:35,214
efficiency and care around nutritional stability to participate

600
00:22:35,355 --> 00:22:36,654
in their medical care.

601
00:22:36,955 --> 00:22:38,894
So you are helping with throughput.

602
00:22:39,275 --> 00:22:41,515
It's very similar to what happens with the

603
00:22:41,515 --> 00:22:43,355
magic of a trach team. Once we start

604
00:22:43,355 --> 00:22:46,174
talking about trachs, we start talking about decannulation,

605
00:22:47,000 --> 00:22:49,160
patients start getting trachs out of their neck,

606
00:22:49,160 --> 00:22:51,259
and they start getting out the door. Right?

607
00:22:51,480 --> 00:22:52,940
So when we talk about

608
00:22:53,320 --> 00:22:53,820
temporary,

609
00:22:54,680 --> 00:22:55,180
NG

610
00:22:55,720 --> 00:22:57,580
by way of dysphagia diagnostics,

611
00:22:57,960 --> 00:22:59,340
you have early access

612
00:22:59,799 --> 00:23:01,259
to therapeutic assessment,

613
00:23:01,804 --> 00:23:04,924
earlier access to medical stability by way of

614
00:23:04,924 --> 00:23:07,424
nutrition and medical,

615
00:23:08,365 --> 00:23:08,865
intake

616
00:23:09,404 --> 00:23:09,904
for,

617
00:23:10,285 --> 00:23:12,464
medicines that have to be taken orally.

618
00:23:13,164 --> 00:23:15,880
And you then have early partnership with your

619
00:23:15,880 --> 00:23:18,460
critical care providers or your other providers

620
00:23:18,840 --> 00:23:19,820
to help facilitate

621
00:23:20,360 --> 00:23:22,220
rehab sooner, earlier, faster.

622
00:23:22,920 --> 00:23:25,240
One of the biggest interest that I have

623
00:23:25,240 --> 00:23:27,019
is the geriatric trauma population

624
00:23:27,320 --> 00:23:27,820
who

625
00:23:28,424 --> 00:23:28,924
falls,

626
00:23:29,224 --> 00:23:30,125
gets a UTI,

627
00:23:30,664 --> 00:23:32,125
and suddenly they can't swallow.

628
00:23:32,505 --> 00:23:34,505
Right? So that hip that hip bone is

629
00:23:34,505 --> 00:23:37,224
connected to the swallow bone. Well, what is

630
00:23:37,224 --> 00:23:38,764
that? 

631
00:23:39,304 --> 00:23:42,424
that's not small. That's medical instability and medical

632
00:23:42,424 --> 00:23:45,849
derangement, and some of that is induced by

633
00:23:45,849 --> 00:23:46,990
coming to the hospital.

634
00:23:47,529 --> 00:23:50,650
So what an Introducer can offer with a

635
00:23:50,650 --> 00:23:53,930
Dysphagia diagnostic or partnered with it and your

636
00:23:53,930 --> 00:23:56,890
care team is actually more efficient delivery of

637
00:23:56,890 --> 00:23:58,349
care and medical stability

638
00:23:59,005 --> 00:23:59,664
to prevent

639
00:24:00,125 --> 00:24:02,865
medical derangement or metabolic derangement.

640
00:24:03,404 --> 00:24:03,904
So

641
00:24:04,525 --> 00:24:07,424
it's cost benefit and cost positive

642
00:24:07,884 --> 00:24:09,345
because you're actually getting

643
00:24:09,724 --> 00:24:11,164
at some of the,

644
00:24:11,884 --> 00:24:13,265
health care quality improvement,

645
00:24:14,029 --> 00:24:16,909
the health care acquired injuries such as pressure

646
00:24:16,909 --> 00:24:17,409
injuries,

647
00:24:17,710 --> 00:24:18,210
a

648
00:24:18,509 --> 00:24:19,730
nutritional instability,

649
00:24:20,109 --> 00:24:20,609
dehydration,

650
00:24:21,069 --> 00:24:21,890
pressure wounds

651
00:24:22,909 --> 00:24:24,049
by offering this.

652
00:24:26,029 --> 00:24:28,450
My argument my question, Laura, is

653
00:24:29,924 --> 00:24:31,684
wouldn't a nurse be able to just do

654
00:24:31,684 --> 00:24:33,065
this quick fast

655
00:24:34,164 --> 00:24:34,664
anyways?

656
00:24:35,684 --> 00:24:37,605
Mhmm. Great question. And that was part of

657
00:24:37,605 --> 00:24:40,424
my learning curve. So when I started

658
00:24:40,884 --> 00:24:43,045
to when I did my due diligence before

659
00:24:43,045 --> 00:24:43,545
I

660
00:24:43,960 --> 00:24:46,200
reached out further with the Patcom team for

661
00:24:46,200 --> 00:24:48,299
competencies, I started to ask nurses

662
00:24:49,400 --> 00:24:51,880
similar to asking the question, how do you

663
00:24:51,880 --> 00:24:52,940
do oral care?

664
00:24:53,960 --> 00:24:56,505
How do you pass an NG tube? Who

665
00:24:56,505 --> 00:24:58,505
is good at it? Tell me how you

666
00:24:58,505 --> 00:25:00,125
do it. Show me how you do it.

667
00:25:00,265 --> 00:25:01,945
And what I noticed is there was such

668
00:25:01,945 --> 00:25:04,265
variance across the bedside. There was,

669
00:25:05,785 --> 00:25:08,924
kind of a degrading training since COVID.

670
00:25:10,079 --> 00:25:12,240
And I found one nurse who's an amazing

671
00:25:12,240 --> 00:25:15,519
nurse who was the NG tube passer, and

672
00:25:15,519 --> 00:25:16,339
she described

673
00:25:17,039 --> 00:25:17,539
this

674
00:25:18,000 --> 00:25:20,880
very common way of coaching a patient through

675
00:25:20,880 --> 00:25:23,115
getting the tube placed, but it hinged on

676
00:25:23,115 --> 00:25:25,855
the patient being able to cough and swallow

677
00:25:26,154 --> 00:25:26,894
and voice.

678
00:25:27,434 --> 00:25:29,035
What do we know about our patients? What

679
00:25:29,035 --> 00:25:31,035
do we know about our acutely ill patients

680
00:25:31,035 --> 00:25:33,115
who've had a stroke and might not be

681
00:25:33,115 --> 00:25:34,714
able to do those things? What do we

682
00:25:34,714 --> 00:25:36,659
know from doctor Humbert who says, you don't

683
00:25:36,659 --> 00:25:38,899
know if they're swallowing unless you're seeing it.

684
00:25:38,899 --> 00:25:39,399
Right?

685
00:25:39,700 --> 00:25:40,200
So

686
00:25:40,740 --> 00:25:43,700
to me, that was a pathway into

687
00:25:43,700 --> 00:25:44,839
politely disrupt

688
00:25:45,299 --> 00:25:45,960
a very,

689
00:25:46,740 --> 00:25:49,940
common nurse practice to say, I support you.

690
00:25:49,940 --> 00:25:50,919
You have confidence.

691
00:25:51,565 --> 00:25:53,565
But could there be another way to make

692
00:25:53,565 --> 00:25:54,705
this safer,

693
00:25:56,125 --> 00:25:56,865
more accurate,

694
00:25:57,244 --> 00:25:59,805
and also couple with a diagnostic that's already

695
00:25:59,805 --> 00:26:00,305
needed?

696
00:26:00,684 --> 00:26:03,105
And in that population, say,

697
00:26:03,805 --> 00:26:04,705
neuro neurotrauma,

698
00:26:05,539 --> 00:26:07,700
you're likely gonna be doing a FEES as

699
00:26:07,700 --> 00:26:10,099
one of the first dysphagia diagnostics in acute

700
00:26:10,099 --> 00:26:10,759
care anyway.

701
00:26:11,299 --> 00:26:11,799
So

702
00:26:12,579 --> 00:26:14,759
in sense, some of those nurse leaders

703
00:26:15,220 --> 00:26:15,720
who

704
00:26:16,339 --> 00:26:19,319
have had that confidence and somewhat overconfidence

705
00:26:19,945 --> 00:26:21,625
and didn't know that there was could be

706
00:26:21,625 --> 00:26:22,525
a different way

707
00:26:22,825 --> 00:26:25,065
are some of the biggest champions for using

708
00:26:25,065 --> 00:26:28,205
the Introducers on their units because they know

709
00:26:28,505 --> 00:26:30,904
the benefits of coupling it with the Dysphagia

710
00:26:30,904 --> 00:26:31,404
diagnostic

711
00:26:32,184 --> 00:26:32,684
and

712
00:26:33,250 --> 00:26:35,650
not having to do things like sedate patients

713
00:26:35,650 --> 00:26:38,069
to pass the tube and also the risks

714
00:26:38,369 --> 00:26:39,509
that they have learned

715
00:26:39,970 --> 00:26:41,890
with patients who they think are swallowing, but

716
00:26:41,890 --> 00:26:42,549
they're not.

717
00:26:43,809 --> 00:26:46,069
Talk to me about logistics, Laura. So

718
00:26:46,450 --> 00:26:48,865
is this something that okay. So so say

719
00:26:48,865 --> 00:26:50,644
we have a patient come into the ER.

720
00:26:50,704 --> 00:26:51,924
They need a FEES

721
00:26:52,304 --> 00:26:53,444
relatively quickly.

722
00:26:54,384 --> 00:26:56,964
When you're doing the FEES, do you automatically

723
00:26:57,345 --> 00:26:59,284
have an NG ready to go

724
00:26:59,585 --> 00:27:01,825
during that and do it right then, or

725
00:27:01,825 --> 00:27:02,964
do you do a FEES,

726
00:27:03,559 --> 00:27:06,440
take the scope out, regroup later, and do

727
00:27:06,440 --> 00:27:08,599
another fees with the Introducer? I'm just

728
00:27:08,839 --> 00:27:11,319
Mhmm. Verify the logistics for me. Yeah. So

729
00:27:11,319 --> 00:27:13,480
that was that was a learning curve, I

730
00:27:13,480 --> 00:27:16,279
think, and it's all facility dependent. So if

731
00:27:16,279 --> 00:27:16,859
you have

732
00:27:17,240 --> 00:27:19,755
an access team, a vascular access team who

733
00:27:19,755 --> 00:27:21,914
is your tube team or just a tube

734
00:27:21,914 --> 00:27:22,414
team,

735
00:27:22,875 --> 00:27:25,515
finding their leader, partnering with them, they often

736
00:27:25,515 --> 00:27:28,015
sit under the critical care nursing leadership.

737
00:27:28,875 --> 00:27:29,375
And

738
00:27:29,674 --> 00:27:31,295
what we did at first

739
00:27:31,595 --> 00:27:33,835
is we would let them know the room

740
00:27:33,835 --> 00:27:35,809
we were going to to see if they

741
00:27:35,809 --> 00:27:37,890
had orders for a tube. Because if we

742
00:27:37,890 --> 00:27:39,349
had a patient who had had

743
00:27:39,730 --> 00:27:42,070
a stroke or was admitted for,

744
00:27:43,329 --> 00:27:43,990
a myasthenic

745
00:27:44,690 --> 00:27:45,190
crisis,

746
00:27:45,570 --> 00:27:47,670
that's likely a patient that's going to

747
00:27:48,095 --> 00:27:49,234
trigger an auto,

748
00:27:50,494 --> 00:27:51,394
tube placement.

749
00:27:52,015 --> 00:27:53,714
And they would

750
00:27:54,255 --> 00:27:55,474
match their workflow

751
00:27:55,934 --> 00:27:58,355
with when we were doing our endoscopy.

752
00:27:59,535 --> 00:28:00,950
We would pull the,

753
00:28:01,509 --> 00:28:03,750
our scope out, leave the introducer in, and

754
00:28:03,750 --> 00:28:04,730
they would align

755
00:28:05,109 --> 00:28:07,830
their next steps with placing the NG, whether

756
00:28:07,830 --> 00:28:09,750
it would be in the stomach or post

757
00:28:09,750 --> 00:28:10,809
pryolark position

758
00:28:11,190 --> 00:28:12,650
with immediately after

759
00:28:13,109 --> 00:28:14,009
we were done.

760
00:28:14,789 --> 00:28:17,455
Now, you know, I think we worked

761
00:28:17,835 --> 00:28:18,654
very closely

762
00:28:19,115 --> 00:28:22,174
with the that team, the tube team,

763
00:28:22,555 --> 00:28:23,055
but

764
00:28:23,434 --> 00:28:26,414
nurses, critical care ICU nurses, saw

765
00:28:26,715 --> 00:28:30,255
that these patients were more comfortable, better supported,

766
00:28:30,670 --> 00:28:32,430
and there was good understanding of where the

767
00:28:32,430 --> 00:28:34,190
tube needed to go. So if the tube

768
00:28:34,190 --> 00:28:35,730
only needed to go to the stomach,

769
00:28:36,269 --> 00:28:38,430
ICU nurses were jumping in ready to place

770
00:28:38,430 --> 00:28:40,829
the tube after we had the Introducer in

771
00:28:40,829 --> 00:28:43,170
place. So it just became more efficient.

772
00:28:44,029 --> 00:28:44,529
And

773
00:28:45,070 --> 00:28:46,210
some of the logistics,

774
00:28:46,565 --> 00:28:49,045
so in my observation of the logistics around

775
00:28:49,045 --> 00:28:51,204
tubes, I started to follow patients that also

776
00:28:51,204 --> 00:28:52,025
went to fluoroscopy

777
00:28:52,404 --> 00:28:53,625
to have tubes placed.

778
00:28:54,164 --> 00:28:56,565
And if you're thinking about the Introducer, you're

779
00:28:56,565 --> 00:28:58,424
thinking about your endoscopy program,

780
00:28:59,220 --> 00:29:00,900
You really need to figure out what's going

781
00:29:00,900 --> 00:29:02,819
on when a patient goes to fluoro to

782
00:29:02,819 --> 00:29:04,740
get a tube placed. Because I think a

783
00:29:04,740 --> 00:29:06,519
lot of speech therapists think,

784
00:29:06,980 --> 00:29:08,839
oh, they couldn't pass it at bedside.

785
00:29:09,859 --> 00:29:11,539
So they're gonna go to radiology, and they're

786
00:29:11,539 --> 00:29:12,980
gonna look they're gonna turn their head, and

787
00:29:12,980 --> 00:29:14,484
they're gonna get it in the place that

788
00:29:14,484 --> 00:29:17,065
they need to go. Not the case. Fluoro

789
00:29:17,605 --> 00:29:20,105
is here down, and they're very rarely

790
00:29:20,404 --> 00:29:22,424
turning the patient to get a better look

791
00:29:22,644 --> 00:29:24,184
at how to pass the nasopharynx.

792
00:29:25,365 --> 00:29:28,105
So they're likely getting two double blinded passes

793
00:29:28,644 --> 00:29:29,144
and

794
00:29:29,500 --> 00:29:31,900
a really challenging health care experience when it

795
00:29:31,900 --> 00:29:33,440
comes to transnasal endoscopy.

796
00:29:34,059 --> 00:29:35,500
One thing I'd love to add to

797
00:29:35,500 --> 00:29:35,900
this,

798
00:29:36,380 --> 00:29:39,099
you know, because other groups and people have,

799
00:29:39,339 --> 00:29:42,140
of course, talked about, placement of NG tube.

800
00:29:42,140 --> 00:29:44,375
So ASPEN, the American

801
00:29:45,235 --> 00:29:47,654
Society of Parenteral and Enteral Nutrition,

802
00:29:49,394 --> 00:29:50,535
years ago already,

803
00:29:51,154 --> 00:29:53,075
came out with a statement and

804
00:29:53,075 --> 00:29:53,815
saying that

805
00:29:55,410 --> 00:29:56,450
the goal should be,

806
00:29:56,930 --> 00:29:59,430
zero preventable death from misplaced

807
00:29:59,890 --> 00:30:00,789
feeding tubes.

808
00:30:01,410 --> 00:30:03,269
And their recommendation is

809
00:30:03,970 --> 00:30:04,470
use

810
00:30:05,009 --> 00:30:05,750
a technology.

811
00:30:06,450 --> 00:30:07,750
There should not be

812
00:30:08,174 --> 00:30:11,535
any blind placement whatsoever, and there's several technologies

813
00:30:11,535 --> 00:30:13,375
out there. Right? Of course, we are talking

814
00:30:13,375 --> 00:30:15,475
about the introducer, but there is a,

815
00:30:16,495 --> 00:30:18,735
there is a feeding tube that has a

816
00:30:18,735 --> 00:30:20,275
camera actually integrated.

817
00:30:21,860 --> 00:30:24,580
And then there's also another technology that has

818
00:30:24,580 --> 00:30:25,880
a transmitter receiving

819
00:30:26,420 --> 00:30:27,160
kind of technology,

820
00:30:27,860 --> 00:30:28,759
for

821
00:30:29,380 --> 00:30:29,880
visualization

822
00:30:30,580 --> 00:30:32,820
during placement, not with video, but with a

823
00:30:32,820 --> 00:30:34,005
with a sensor,

824
00:30:34,625 --> 00:30:37,605
as well. And then, you know, our technology,

825
00:30:37,744 --> 00:30:39,125
and that is their

826
00:30:39,505 --> 00:30:40,005
recommendation.

827
00:30:41,265 --> 00:30:43,345
You know, with the Introducer, it was the

828
00:30:43,345 --> 00:30:45,765
goal to really make this very cost effective,

829
00:30:45,904 --> 00:30:47,444
which, you know, with a

830
00:30:47,920 --> 00:30:48,420
relatively,

831
00:30:49,359 --> 00:30:51,279
low price for the Introducer, I think we

832
00:30:51,279 --> 00:30:51,779
achieved.

833
00:30:52,799 --> 00:30:54,500
And you do see that,

834
00:30:54,960 --> 00:30:56,420
so they're saying it, but also,

835
00:30:56,799 --> 00:30:58,099
you know, the top tier

836
00:30:58,480 --> 00:31:00,339
hospitals in the United States,

837
00:31:00,640 --> 00:31:03,535
they've adopted this already. They have zero

838
00:31:03,535 --> 00:31:05,475
blind placement. It's just not tolerated,

839
00:31:06,174 --> 00:31:07,634
in a lot of places already.

840
00:31:08,894 --> 00:31:11,535
And I do think that over time, that

841
00:31:11,535 --> 00:31:14,674
is something where more and more hospitals

842
00:31:14,815 --> 00:31:16,115
will implement that.

843
00:31:16,490 --> 00:31:18,410
And why speech therapists need to be empowered

844
00:31:18,410 --> 00:31:21,390
by this. Because if they've adopted these policies

845
00:31:21,529 --> 00:31:22,190
to reduce

846
00:31:22,890 --> 00:31:23,390
patient

847
00:31:23,849 --> 00:31:24,349
harm

848
00:31:24,809 --> 00:31:25,789
and risk aversion

849
00:31:26,410 --> 00:31:26,910
and

850
00:31:27,210 --> 00:31:29,789
we are having visualized passes,

851
00:31:30,255 --> 00:31:32,335
if these are already in patients who need

852
00:31:32,335 --> 00:31:33,634
a dysphagia diagnostic,

853
00:31:34,015 --> 00:31:36,255
the clinician, the health care professional with the

854
00:31:36,255 --> 00:31:39,055
most technical skill to traverse the nose and

855
00:31:39,055 --> 00:31:42,195
behaviorally work with that patient through that assessment

856
00:31:42,470 --> 00:31:44,630
is a speech pathologist if it aligns with

857
00:31:44,630 --> 00:31:46,329
the functional assessment of swallowing.

858
00:31:47,190 --> 00:31:49,589
And getting over that hump that we should

859
00:31:49,589 --> 00:31:51,509
be part of that and do have skills

860
00:31:51,509 --> 00:31:53,849
to use that, that's our superpower.

861
00:31:54,390 --> 00:31:56,089
We have that training.

862
00:31:56,390 --> 00:31:57,210
And 

863
00:31:57,744 --> 00:31:59,585
I continue to be amazed at some of

864
00:31:59,585 --> 00:32:02,704
the training of the nonspeech pathology professionals who

865
00:32:02,704 --> 00:32:05,284
do scope and how little they get for

866
00:32:06,144 --> 00:32:08,325
working with a patient who has dementia

867
00:32:08,625 --> 00:32:09,765
or is confused

868
00:32:10,144 --> 00:32:11,684
to get where they need to go.

869
00:32:12,649 --> 00:32:15,130
That's where we shine, and that's where we

870
00:32:15,130 --> 00:32:17,049
can continue to partner with our critical care

871
00:32:17,049 --> 00:32:17,869
teams to

872
00:32:18,250 --> 00:32:20,750
make it less traumatic for our patients.

873
00:32:21,849 --> 00:32:23,389
Christoph, let me ask you,

874
00:32:23,929 --> 00:32:26,125
where did this idea come from? It did

875
00:32:26,204 --> 00:32:27,804
what was were you did you just keep

876
00:32:27,804 --> 00:32:29,585
hearing about all of these concerns

877
00:32:29,964 --> 00:32:30,944
or yeah.

878
00:32:31,325 --> 00:32:33,325
Yeah. Yeah. Very good, very good question. And,

879
00:32:34,365 --> 00:32:37,085
typically I don't go as far best back

880
00:32:37,085 --> 00:32:37,804
as I will now,

881
00:32:39,299 --> 00:32:39,799
because,

882
00:32:40,340 --> 00:32:42,740
you know, I just celebrated my

883
00:32:42,740 --> 00:32:44,820
my mom's seventieth birthday, and one of

884
00:32:44,820 --> 00:32:47,220
the anecdotes that she's telling from, you know,

885
00:32:47,220 --> 00:32:48,259
when I was,

886
00:32:48,580 --> 00:32:50,420
young following her in the garden, she was

887
00:32:50,420 --> 00:32:52,580
cutting herbs and whatnot. I told her, I

888
00:32:52,580 --> 00:32:54,740
wanna be an inventor. I wanna invent something.

889
00:32:54,740 --> 00:32:56,315
Like, tell me what I can invent.

890
00:32:56,875 --> 00:32:58,494
She didn't tell me about the introducer.

891
00:32:58,955 --> 00:33:00,015
She wanted a,

892
00:33:00,795 --> 00:33:02,335
like a lighter that can

893
00:33:02,875 --> 00:33:04,955
light 10 candles on a birthday cake all

894
00:33:04,955 --> 00:33:06,974
at once. That's what she told me.

895
00:33:07,434 --> 00:33:09,434
Later, I found out that already existed, so

896
00:33:09,434 --> 00:33:12,039
I couldn't invent that anymore. But I, you

897
00:33:12,039 --> 00:33:14,859
know, always really wanted to invent something.

898
00:33:15,160 --> 00:33:15,660
Now

899
00:33:15,960 --> 00:33:18,600
when you look at, you know, where should

900
00:33:18,600 --> 00:33:21,160
I start to invent something? But like a

901
00:33:21,160 --> 00:33:23,240
good idea that many people will say, and

902
00:33:23,240 --> 00:33:25,259
I agree with that is, you know,

903
00:33:25,785 --> 00:33:28,025
in your daily life, if you come across

904
00:33:28,025 --> 00:33:29,644
something that is really

905
00:33:29,945 --> 00:33:31,705
seems to be a problem and you feel

906
00:33:31,705 --> 00:33:32,365
like there

907
00:33:32,744 --> 00:33:35,144
there should be a better way, that's a

908
00:33:35,144 --> 00:33:38,205
good starting point. Right? Now jumping,

909
00:33:38,664 --> 00:33:39,465
many years,

910
00:33:39,785 --> 00:33:40,285
forward,

911
00:33:41,305 --> 00:33:44,080
it was around 2012,

912
00:33:44,080 --> 00:33:45,059
2013

913
00:33:45,839 --> 00:33:48,720
I was a sales rep for,

914
00:33:50,080 --> 00:33:53,119
a company, MEI Scientific here in Canada, who's

915
00:33:53,119 --> 00:33:54,180
now actually our,

916
00:33:54,880 --> 00:33:55,380
manufacturing

917
00:33:55,680 --> 00:33:56,180
partner.

918
00:33:56,640 --> 00:33:57,140
And

919
00:33:57,575 --> 00:34:00,234
I was selling high resolution manometry

920
00:34:01,095 --> 00:34:01,595
equipment.

921
00:34:02,214 --> 00:34:04,134
And so if you're, you know, a proud

922
00:34:04,134 --> 00:34:05,914
sales rep, you volunteer,

923
00:34:06,615 --> 00:34:08,695
for the products that you sell.

924
00:34:08,695 --> 00:34:10,715
If you they're not too invasive anyways,

925
00:34:11,255 --> 00:34:13,289
to be tested on you. So I was

926
00:34:13,289 --> 00:34:15,070
up in Northern British Columbia.

927
00:34:15,690 --> 00:34:18,670
We had sold that equipment. A nurse,

928
00:34:19,369 --> 00:34:22,030
we called them the motility nurses in GI,

929
00:34:22,730 --> 00:34:25,050
was trained on using high rise manometry. So

930
00:34:25,050 --> 00:34:26,590
we know it's a very long,

931
00:34:27,554 --> 00:34:31,315
rather large diameter catheter that is typically placed

932
00:34:31,315 --> 00:34:31,815
blindly.

933
00:34:32,275 --> 00:34:34,695
And I volunteered for that, and

934
00:34:35,875 --> 00:34:38,514
that changed my life, similar to Laura's story.

935
00:34:38,514 --> 00:34:40,534
Right? That it really did because

936
00:34:40,994 --> 00:34:41,974
to this day,

937
00:34:43,170 --> 00:34:45,329
you know, and I've been by now scoped

938
00:34:45,329 --> 00:34:45,829
probably

939
00:34:46,849 --> 00:34:48,070
2,000 times.

940
00:34:48,530 --> 00:34:51,089
I will volunteer with my left nostril all

941
00:34:51,089 --> 00:34:53,329
day long, but I'll never let anyone go

942
00:34:53,329 --> 00:34:55,664
through my right nostril. And that is because

943
00:34:56,045 --> 00:34:57,664
that traumatic experience

944
00:34:57,964 --> 00:35:00,224
there was through my, right nostril.

945
00:35:00,605 --> 00:35:03,404
It was absolutely not the nurse's fault. She

946
00:35:03,404 --> 00:35:05,244
had never done this. Right? If you 

947
00:35:05,244 --> 00:35:07,005
 never done this and you now have

948
00:35:07,005 --> 00:35:08,464
to blindly play something,

949
00:35:09,210 --> 00:35:12,170
into a human, that's quite difficult. And

950
00:35:12,170 --> 00:35:13,929
even if you think about the steps, right,

951
00:35:13,929 --> 00:35:14,989
the first thing is

952
00:35:15,289 --> 00:35:17,469
go straight in until you feel resistance.

953
00:35:17,929 --> 00:35:19,230
Well, feeling resistance

954
00:35:20,090 --> 00:35:22,364
already means you're hitting something. So that can't

955
00:35:22,364 --> 00:35:23,184
be comfortable.

956
00:35:23,485 --> 00:35:25,405
Right? So then comes the chin tuck and

957
00:35:25,405 --> 00:35:27,565
then you're dangling there in the back of

958
00:35:27,565 --> 00:35:30,204
the throat, and now you instruct the patient,

959
00:35:30,204 --> 00:35:32,545
okay, swallow. And not just swallow, but swallow,

960
00:35:32,605 --> 00:35:35,190
swallow, swallow, swallow. So, you know, do 10

961
00:35:35,190 --> 00:35:37,590
little consecutive swallows with a cup

962
00:35:37,590 --> 00:35:38,250
of water.

963
00:35:38,550 --> 00:35:40,469
Even just like that is hard enough. And

964
00:35:40,469 --> 00:35:42,309
then as you swallow, you know, the

965
00:35:42,309 --> 00:35:44,170
tube is pushed forward.

966
00:35:44,469 --> 00:35:46,630
But even that, you know, that's really something

967
00:35:46,630 --> 00:35:49,110
that you have to learn and

968
00:35:49,110 --> 00:35:51,535
and learn the feeling of what is

969
00:35:51,535 --> 00:35:53,875
the right timing, how fast is the swallow,

970
00:35:54,175 --> 00:35:56,275
how fast should I move this tube forward.

971
00:35:56,414 --> 00:35:57,934
And if someone is new, and that was

972
00:35:57,934 --> 00:35:58,675
my experience,

973
00:35:59,295 --> 00:36:01,775
it's not that easy. Right? I swallowed

974
00:36:01,775 --> 00:36:04,094
and she moved too slowly. Next time, you

975
00:36:04,094 --> 00:36:06,630
know, she too fast. And then hit all

976
00:36:06,630 --> 00:36:08,010
the structured gagging,

977
00:36:08,549 --> 00:36:09,449
lot of discomfort.

978
00:36:09,989 --> 00:36:11,909
We got it done eventually, so all good.

979
00:36:11,909 --> 00:36:12,650
And,

980
00:36:13,349 --> 00:36:15,190
you know, they got through the learning curve,

981
00:36:15,429 --> 00:36:15,929
eventually.

982
00:36:16,549 --> 00:36:18,789
But that was when initially I thought, man,

983
00:36:18,789 --> 00:36:20,695
there needs to be a better way than

984
00:36:20,695 --> 00:36:22,155
this. Because if I

985
00:36:22,534 --> 00:36:24,394
am barely tolerating this,

986
00:36:24,775 --> 00:36:26,554
like, what are you gonna do with patients

987
00:36:26,855 --> 00:36:29,014
that are already not feeling good? Right? They're

988
00:36:29,014 --> 00:36:30,855
there for something. They're not feeling good or

989
00:36:30,855 --> 00:36:32,375
something. So now you get a test like

990
00:36:32,375 --> 00:36:32,875
that.

991
00:36:33,269 --> 00:36:35,349
And, you know, through my time of selling

992
00:36:35,349 --> 00:36:36,090
this equipment,

993
00:36:36,469 --> 00:36:37,210
I've seen

994
00:36:37,670 --> 00:36:38,170
many,

995
00:36:38,949 --> 00:36:39,769
adult patients

996
00:36:40,869 --> 00:36:42,550
trying to get it in, didn't work, and

997
00:36:42,550 --> 00:36:45,110
they said, no thank you. They were there

998
00:36:45,110 --> 00:36:47,394
for GERD. You know, you know what? I

999
00:36:47,394 --> 00:36:49,815
got GERD, but I'll take my PPI,

1000
00:36:50,115 --> 00:36:50,934
you know, for

1001
00:36:51,394 --> 00:36:53,335
fifty more years before I have ever

1002
00:36:54,115 --> 00:36:56,434
the procedure like that again. And that is,

1003
00:36:57,075 --> 00:36:59,235
yeah, where initially it was like, okay, needs

1004
00:36:59,235 --> 00:37:00,210
to be a better way.

1005
00:37:00,849 --> 00:37:03,010
Then I was lucky enough with that same

1006
00:37:03,010 --> 00:37:05,589
company I was working for to take on

1007
00:37:06,210 --> 00:37:06,949
an endoscopy

1008
00:37:07,329 --> 00:37:07,829
product,

1009
00:37:08,210 --> 00:37:10,550
to be sold in Canada, as well.

1010
00:37:11,010 --> 00:37:13,409
And, you know, you all know obviously flexible

1011
00:37:13,409 --> 00:37:16,015
endoscope has a camera at the end, you

1012
00:37:16,015 --> 00:37:17,635
see where you're going. And then

1013
00:37:18,175 --> 00:37:18,675
I,

1014
00:37:19,534 --> 00:37:21,695
stayed after work and just wrapped the

1015
00:37:21,695 --> 00:37:23,775
thing and said, okay, let's see what happens

1016
00:37:23,775 --> 00:37:26,015
and started scoping myself for the first time.

1017
00:37:26,015 --> 00:37:26,515
And

1018
00:37:26,894 --> 00:37:27,954
I think you've both

1019
00:37:28,255 --> 00:37:30,730
been through that. That's weird in

1020
00:37:30,730 --> 00:37:32,730
the beginning, right? And I, you know, and

1021
00:37:32,730 --> 00:37:34,910
even not as a healthcare professional,

1022
00:37:34,970 --> 00:37:37,130
like a grandma, I'm gonna end up in

1023
00:37:37,130 --> 00:37:39,769
the brain or what. But, anyways, got through

1024
00:37:39,769 --> 00:37:41,550
that eventually and then

1025
00:37:41,930 --> 00:37:44,110
once that's done, you're like, oh my god.

1026
00:37:44,555 --> 00:37:46,255
That is amazing. That experience

1027
00:37:46,555 --> 00:37:48,735
in contrast to that blind placement

1028
00:37:49,114 --> 00:37:50,875
is day and night. I always say, you

1029
00:37:50,875 --> 00:37:53,614
know, would you rather go through a tunnel

1030
00:37:53,914 --> 00:37:54,414
blindfolded

1031
00:37:55,114 --> 00:37:57,035
or, you know, with your eyes wide open

1032
00:37:57,035 --> 00:37:59,650
and a flashlight in hand? That's, like, how

1033
00:37:59,650 --> 00:38:01,590
different the two experiences are.

1034
00:38:01,969 --> 00:38:02,469
And,

1035
00:38:03,170 --> 00:38:05,809
you know, there then was like, oh, thinking

1036
00:38:05,809 --> 00:38:07,349
back to years

1037
00:38:07,730 --> 00:38:08,630
before, it's like,

1038
00:38:09,170 --> 00:38:10,929
that might be a solution. Like, you just

1039
00:38:10,929 --> 00:38:12,769
need to see where you're going and then

1040
00:38:12,769 --> 00:38:15,014
that's fine. So then it's like okay, high

1041
00:38:15,014 --> 00:38:17,255
res manometry probe, let's just put a camera

1042
00:38:17,255 --> 00:38:18,635
inside, can't be that hard.

1043
00:38:19,494 --> 00:38:20,394
It's doable,

1044
00:38:21,094 --> 00:38:21,594
but

1045
00:38:22,534 --> 00:38:24,875
those probes are already, you know, $20,000.

1046
00:38:25,494 --> 00:38:27,434
If you now add a camera into that,

1047
00:38:27,574 --> 00:38:29,099
so now you're like maybe at

1048
00:38:29,980 --> 00:38:31,180
$25,000.

1049
00:38:31,180 --> 00:38:33,900
So who's truly gonna gonna buy that just

1050
00:38:33,900 --> 00:38:34,559
for that?

1051
00:38:35,019 --> 00:38:36,559
That's probably pretty tricky.

1052
00:38:36,860 --> 00:38:37,579
Right? And,

1053
00:38:38,460 --> 00:38:39,440
and then it was,

1054
00:38:40,220 --> 00:38:42,220
you know, months and months of thinking about

1055
00:38:42,220 --> 00:38:42,720
that.

1056
00:38:43,235 --> 00:38:44,994
One good friend of mine, that I grew

1057
00:38:44,994 --> 00:38:47,394
up with who is, an orthopedic surgeon now,

1058
00:38:47,394 --> 00:38:49,974
I, you know, I used to bounce ideas

1059
00:38:50,114 --> 00:38:51,635
back and forth with him a little bit.

1060
00:38:51,635 --> 00:38:52,695
And then eventually,

1061
00:38:54,594 --> 00:38:57,315
I realized it doesn't have to all happen

1062
00:38:57,315 --> 00:38:58,375
in one step.

1063
00:38:58,730 --> 00:39:01,309
Right? And the idea of, okay, let me

1064
00:39:01,609 --> 00:39:02,109
place

1065
00:39:02,969 --> 00:39:04,190
a tunnel first,

1066
00:39:04,489 --> 00:39:06,909
and then we can put our catheters through.

1067
00:39:07,609 --> 00:39:09,710
That came to mind. And, you know, that

1068
00:39:11,164 --> 00:39:13,824
in itself, like, placing something

1069
00:39:14,204 --> 00:39:16,204
and then through there or over that you

1070
00:39:16,204 --> 00:39:18,764
place something else, that's not new. That's not

1071
00:39:18,764 --> 00:39:20,925
the invention because especially in the,

1072
00:39:21,964 --> 00:39:24,204
in the vascular field, it's being done all

1073
00:39:24,204 --> 00:39:26,219
the time. Right? So you place a guidewire,

1074
00:39:26,280 --> 00:39:28,200
and over the guidewire goes something or even

1075
00:39:28,200 --> 00:39:28,860
an introducer.

1076
00:39:29,880 --> 00:39:31,640
However, what was very new,

1077
00:39:32,119 --> 00:39:34,219
is to have that done

1078
00:39:34,680 --> 00:39:35,660
in the esophagus

1079
00:39:36,039 --> 00:39:38,599
swallowing airway in that field to

1080
00:39:38,599 --> 00:39:40,675
play something like that. And,

1081
00:39:42,094 --> 00:39:43,135
and, yeah, that's where,

1082
00:39:44,974 --> 00:39:47,795
the idea originated from. And then it was

1083
00:39:49,454 --> 00:39:50,755
still several years

1084
00:39:51,534 --> 00:39:52,034
before,

1085
00:39:52,574 --> 00:39:55,109
you know, figuring out a product that could

1086
00:39:55,109 --> 00:39:57,369
actually do this. So the introducer,

1087
00:39:57,909 --> 00:39:58,409
you

1088
00:39:58,710 --> 00:40:00,789
know, it's made of,

1089
00:40:01,349 --> 00:40:02,569
a plastic material.

1090
00:40:02,949 --> 00:40:03,670
It's in,

1091
00:40:06,804 --> 00:40:07,465
like, in intruded,

1092
00:40:07,844 --> 00:40:09,605
sort of like, fold as a plastic.

1093
00:40:09,605 --> 00:40:10,105
And,

1094
00:40:10,405 --> 00:40:12,724
you know, I had to learn about, things

1095
00:40:12,885 --> 00:40:15,545
how do plastic behave? There's something called durometer.

1096
00:40:16,005 --> 00:40:18,804
It's how plastic bends and how far does

1097
00:40:18,804 --> 00:40:21,150
it bend, when does it break. So still,

1098
00:40:21,150 --> 00:40:22,449
like, many, many iterations,

1099
00:40:23,469 --> 00:40:25,089
to go through to find a product

1100
00:40:25,630 --> 00:40:27,569
that will, you know, work

1101
00:40:28,109 --> 00:40:29,730
comfortable enough for the patient,

1102
00:40:30,109 --> 00:40:32,589
not break, still allows you to slide tubes

1103
00:40:32,589 --> 00:40:33,630
through and all of that. And,

1104
00:40:34,454 --> 00:40:37,275
you know, eventually, yeah, we got it and

1105
00:40:37,494 --> 00:40:38,474
and then, of course,

1106
00:40:38,775 --> 00:40:39,914
had the final product

1107
00:40:40,375 --> 00:40:43,015
to the FDA, Health Canada. It's approved in

1108
00:40:43,015 --> 00:40:43,994
Europe as well,

1109
00:40:44,535 --> 00:40:47,015
and getting got the patent on

1110
00:40:47,015 --> 00:40:48,989
the way. And, you know, that's something where

1111
00:40:48,989 --> 00:40:50,670
where people said, this is never gonna be

1112
00:40:50,670 --> 00:40:51,170
patented

1113
00:40:51,630 --> 00:40:54,449
because, you know, it's a tube.

1114
00:40:54,590 --> 00:40:56,269
It's like I call it the fancy straw

1115
00:40:56,269 --> 00:40:57,789
sometimes, a tube with a funnel at the

1116
00:40:57,789 --> 00:40:59,809
end. How you know, that's not new.

1117
00:41:01,315 --> 00:41:02,054
But thankfully,

1118
00:41:02,515 --> 00:41:04,355
you know, we were able to prove that,

1119
00:41:04,675 --> 00:41:06,375
indeed, it is new,

1120
00:41:06,994 --> 00:41:08,994
specifically for that field of,

1121
00:41:09,474 --> 00:41:11,155
that we're in and where we're placing it.

1122
00:41:11,155 --> 00:41:13,590
And, yeah. So I'm very happy and

1123
00:41:13,590 --> 00:41:15,670
proud that we have a a US patent

1124
00:41:15,670 --> 00:41:16,170
Canadian,

1125
00:41:17,030 --> 00:41:19,510
and couple others that that I would have

1126
00:41:19,510 --> 00:41:20,550
to look up by now. But,

1127
00:41:21,190 --> 00:41:23,030
yeah, that's the story behind it and

1128
00:41:23,030 --> 00:41:24,710
where it come from.  I love that,

1129
00:41:24,710 --> 00:41:26,869
Christoph. I  love hearing about this nerdy

1130
00:41:26,869 --> 00:41:28,884
inventor side of you. So thank you for

1131
00:41:28,884 --> 00:41:30,644
sharing that. But, you know, one thing I

1132
00:41:30,644 --> 00:41:32,005
I do wanna commend you on, and I

1133
00:41:32,005 --> 00:41:33,764
think everybody in this field needs to give

1134
00:41:33,764 --> 00:41:36,085
him the respect that is due for going

1135
00:41:36,085 --> 00:41:37,764
through the things that you go through to

1136
00:41:37,764 --> 00:41:39,844
bring things to market. I don't think people

1137
00:41:39,844 --> 00:41:42,005
realize how awful and grueling going through an

1138
00:41:42,005 --> 00:41:42,690
FDA process

1139
00:41:43,889 --> 00:41:44,389
process

1140
00:41:44,929 --> 00:41:46,849
or other things like that. It's just the

1141
00:41:46,849 --> 00:41:47,989
most tedious

1142
00:41:48,849 --> 00:41:50,690
work that feels like it's never, ever, ever

1143
00:41:50,690 --> 00:41:51,829
going to end. So,

1144
00:41:52,609 --> 00:41:54,289
thank you for doing that for our field

1145
00:41:54,289 --> 00:41:56,550
because I think it's not appreciated

1146
00:41:56,690 --> 00:41:58,684
as much as it should be. So thank

1147
00:41:59,144 --> 00:41:59,644
you.

1148
00:42:01,385 --> 00:42:04,025
Alright. Anything else we wanna cover? I think

1149
00:42:04,025 --> 00:42:06,184
you guys answered all of my questions I

1150
00:42:06,184 --> 00:42:06,684
had.

1151
00:42:07,144 --> 00:42:08,824
I'd like to talk about a couple cases

1152
00:42:09,144 --> 00:42:10,204
Yeah. Yeah. Just,

1153
00:42:10,824 --> 00:42:13,385
briefly that really opened my eyes as we

1154
00:42:13,385 --> 00:42:16,369
were we were working into this and,

1155
00:42:16,989 --> 00:42:18,929
pulling it into our endoscopy,

1156
00:42:19,789 --> 00:42:20,289
program.

1157
00:42:21,070 --> 00:42:21,570
So

1158
00:42:22,589 --> 00:42:24,429
I think the the the case that I

1159
00:42:24,429 --> 00:42:26,609
talk about the most often when I discuss

1160
00:42:26,670 --> 00:42:29,824
the utility of an introducer in your endoscopy

1161
00:42:29,965 --> 00:42:32,465
program is actually the placement that didn't happen.

1162
00:42:34,284 --> 00:42:36,125
So to your question of do you have

1163
00:42:36,125 --> 00:42:39,164
the introducer on with most scopes, so that

1164
00:42:39,164 --> 00:42:41,724
goes back to really good conversations with your

1165
00:42:41,724 --> 00:42:43,505
doctors, your critical care doctors,

1166
00:42:44,079 --> 00:42:46,400
letting them know if this is a very

1167
00:42:46,400 --> 00:42:48,400
sick patient that may or may not need

1168
00:42:48,400 --> 00:42:50,800
a tube or likely needs a tube and

1169
00:42:50,800 --> 00:42:52,239
you're going to be placing it at the

1170
00:42:52,239 --> 00:42:55,059
end of your assessment, having that good conversation

1171
00:42:55,199 --> 00:42:58,260
before. So everybody's aware. All bases are covered.

1172
00:42:58,514 --> 00:43:00,835
You're still working under the doctor's order.

1173
00:43:00,835 --> 00:43:03,335
You know, you're saying protocol for this. But,

1174
00:43:04,275 --> 00:43:06,194
you know,  I had one

1175
00:43:06,194 --> 00:43:07,494
of our first patients that

1176
00:43:07,954 --> 00:43:10,914
I partnered with our tube team to

1177
00:43:10,914 --> 00:43:13,255
work together and really observe each other's workflow.

1178
00:43:13,800 --> 00:43:15,320
They had an order for a patient who

1179
00:43:15,320 --> 00:43:17,820
had a prior stroke, admitted with a UTI

1180
00:43:17,960 --> 00:43:18,460
confusion.

1181
00:43:18,840 --> 00:43:20,219
And when she was admitted,

1182
00:43:20,519 --> 00:43:22,920
she was really contracted, and I'm doing

1183
00:43:22,920 --> 00:43:25,179
this motion of, like, head head retroflexed.

1184
00:43:26,364 --> 00:43:28,204
And that wasn't her normal state, but

1185
00:43:28,204 --> 00:43:30,045
that was her acute state. And I walked

1186
00:43:30,045 --> 00:43:31,805
into this room, and I looked at this

1187
00:43:31,805 --> 00:43:32,305
person.

1188
00:43:33,085 --> 00:43:35,485
And I said to the clinician I was

1189
00:43:35,485 --> 00:43:37,485
working with, because we were partnering, it was

1190
00:43:37,485 --> 00:43:37,985
new,

1191
00:43:38,329 --> 00:43:40,329
that, you know, I'm I am not confident

1192
00:43:40,329 --> 00:43:42,650
we're going to see a swallow in this

1193
00:43:42,650 --> 00:43:46,010
person right now. But we also had a

1194
00:43:46,170 --> 00:43:48,030
the tube team behind us who

1195
00:43:48,489 --> 00:43:49,550
please understand,

1196
00:43:50,489 --> 00:43:53,530
they often tube teams follow orders. They have

1197
00:43:53,530 --> 00:43:54,030
to

1198
00:43:54,534 --> 00:43:57,175
do first and second attempts at trying to

1199
00:43:57,175 --> 00:43:59,014
do things before they can move on and

1200
00:43:59,014 --> 00:44:01,675
do a different type of access method. So

1201
00:44:01,815 --> 00:44:03,655
be kind to your partners. They have very

1202
00:44:03,655 --> 00:44:05,514
different guidance, very different workflows.

1203
00:44:06,630 --> 00:44:07,130
And

1204
00:44:07,429 --> 00:44:07,929
I

1205
00:44:08,309 --> 00:44:10,569
scoped this individual as a lady,

1206
00:44:11,670 --> 00:44:13,829
and I saw very quickly I couldn't get

1207
00:44:13,829 --> 00:44:15,529
good visualization of the airway.

1208
00:44:16,069 --> 00:44:17,690
She was not able to volitionally

1209
00:44:18,549 --> 00:44:19,609
trigger a swallow.

1210
00:44:20,025 --> 00:44:21,164
We could not facilitate

1211
00:44:21,545 --> 00:44:23,244
much with oral stimulation.

1212
00:44:24,105 --> 00:44:26,744
At that point, we did not advance the

1213
00:44:26,744 --> 00:44:29,065
introducer because I we couldn't trigger swallow. Right?

1214
00:44:29,065 --> 00:44:31,385
Like, that key point, that key goal

1215
00:44:31,385 --> 00:44:32,924
of speech pathology endoscopy.

1216
00:44:34,519 --> 00:44:35,980
And even with that information,

1217
00:44:36,359 --> 00:44:38,199
our tube team had to go behind us

1218
00:44:38,199 --> 00:44:38,859
and try.

1219
00:44:39,880 --> 00:44:40,380
And

1220
00:44:40,760 --> 00:44:43,000
they did their normal series of trying to

1221
00:44:43,000 --> 00:44:44,619
get them to swallow

1222
00:44:44,920 --> 00:44:47,320
to swallow water. As I'm I'm saying, they

1223
00:44:47,400 --> 00:44:49,239
they're not able to. They are not able

1224
00:44:49,239 --> 00:44:51,635
to do that. This needs to stop.

1225
00:44:52,175 --> 00:44:52,675
And,

1226
00:44:53,535 --> 00:44:54,355
they advanced

1227
00:44:54,815 --> 00:44:55,315
blindly

1228
00:44:55,934 --> 00:44:58,974
where they thought was the esophagus, but I

1229
00:44:58,974 --> 00:45:00,735
knew they couldn't they could not

1230
00:45:01,535 --> 00:45:03,530
the aim was not where they thought it

1231
00:45:03,530 --> 00:45:06,269
was because of the anatomical physician. Right?

1232
00:45:06,650 --> 00:45:08,889
And that patient actually ended up decompensating and

1233
00:45:08,889 --> 00:45:09,949
going to the ICU.

1234
00:45:11,050 --> 00:45:11,550
So,

1235
00:45:12,650 --> 00:45:15,150
we met that individual days later,

1236
00:45:15,530 --> 00:45:17,550
and we had a more relaxed posture.

1237
00:45:18,554 --> 00:45:20,815
They survived, and we were able to get

1238
00:45:20,875 --> 00:45:21,855
a better visualization,

1239
00:45:22,234 --> 00:45:23,295
trigger a swallow,

1240
00:45:23,914 --> 00:45:25,775
get a dysphagia diagnostic,

1241
00:45:26,155 --> 00:45:29,434
and get the introducer in

1242
00:45:29,434 --> 00:45:30,974
place for better access

1243
00:45:31,275 --> 00:45:32,574
of a temporary NG.

1244
00:45:33,079 --> 00:45:34,780
And she survived, discharged,

1245
00:45:35,400 --> 00:45:37,900
recovered through her dehydration and UTI.

1246
00:45:39,159 --> 00:45:41,500
However, that was very eye opening to me

1247
00:45:41,719 --> 00:45:44,440
because there's just a better way. And since

1248
00:45:44,440 --> 00:45:46,219
then, we've had more partner conversations

1249
00:45:46,974 --> 00:45:48,734
with our tube team. If we're 

1250
00:45:48,734 --> 00:45:51,694
not able to get access with eyes and

1251
00:45:51,694 --> 00:45:53,694
see with eyes of where to go, that

1252
00:45:53,694 --> 00:45:56,335
should be an automatic rollout for a blind

1253
00:45:56,335 --> 00:45:57,474
pass at bedside.

1254
00:45:58,014 --> 00:45:59,155
So quality improvement.

1255
00:46:00,039 --> 00:46:00,539
And

1256
00:46:00,920 --> 00:46:02,920
I think one of the questions that I

1257
00:46:02,920 --> 00:46:05,420
get, and I know, Christoph, you've probably

1258
00:46:05,880 --> 00:46:07,719
gotten this too. You know, what about the

1259
00:46:07,719 --> 00:46:08,219
unexpected

1260
00:46:09,079 --> 00:46:11,339
anatomical differences of the cervical esophagus?

1261
00:46:11,724 --> 00:46:13,885
Right? The Zanker's that's there that you don't

1262
00:46:13,885 --> 00:46:14,385
know.

1263
00:46:14,844 --> 00:46:16,625
The CP bar,

1264
00:46:16,925 --> 00:46:19,804
you know, Barrett's, which is more distal, but

1265
00:46:19,804 --> 00:46:21,505
still, what are you doing?

1266
00:46:22,045 --> 00:46:22,545
And,

1267
00:46:23,820 --> 00:46:25,900
when I was reviewing this with our quality

1268
00:46:25,900 --> 00:46:26,400
improvement

1269
00:46:26,700 --> 00:46:28,559
partners, patient safety professionals,

1270
00:46:29,820 --> 00:46:31,680
what we realized is actually

1271
00:46:32,140 --> 00:46:34,400
the medical assessment from the speech pathologist

1272
00:46:35,660 --> 00:46:38,300
in partnership with the tube team from a

1273
00:46:38,300 --> 00:46:39,119
GI perspective

1274
00:46:39,655 --> 00:46:41,195
is actually a stronger

1275
00:46:41,494 --> 00:46:41,994
assessment

1276
00:46:42,375 --> 00:46:44,235
than when we are doing this in isolation.

1277
00:46:45,015 --> 00:46:46,775
So the tube team has to look at

1278
00:46:46,775 --> 00:46:48,855
is are there any GI indications? Are there

1279
00:46:48,855 --> 00:46:51,275
any issues that I should not place this?

1280
00:46:51,670 --> 00:46:53,750
And they're doing their same assessment. So we

1281
00:46:53,750 --> 00:46:54,650
actually strengthened

1282
00:46:54,949 --> 00:46:56,969
our patient safety by partnering together.

1283
00:46:57,909 --> 00:47:00,010
And I have actually run into his anchors

1284
00:47:00,869 --> 00:47:01,769
with eyes.

1285
00:47:02,389 --> 00:47:03,769
And in contrast

1286
00:47:04,150 --> 00:47:05,690
to what has happened before,

1287
00:47:06,150 --> 00:47:08,425
because some people have probably seen

1288
00:47:08,724 --> 00:47:11,045
a patient who had a blind pass and

1289
00:47:11,045 --> 00:47:12,505
then a perforated esophagus

1290
00:47:13,684 --> 00:47:14,664
from his anchors.

1291
00:47:15,925 --> 00:47:18,425
When I hit resistance in his Zankers diverticulum,

1292
00:47:18,724 --> 00:47:19,619
I could see it,

1293
00:47:20,180 --> 00:47:22,280
and I stopped. And then I retracted,

1294
00:47:22,740 --> 00:47:25,300
and that patient got a different approach to

1295
00:47:25,300 --> 00:47:26,119
a tube placement.

1296
00:47:26,500 --> 00:47:29,220
And that is the difference between being able

1297
00:47:29,220 --> 00:47:30,200
to see in the tunnel

1298
00:47:31,220 --> 00:47:31,960
and not

1299
00:47:32,364 --> 00:47:32,864
and

1300
00:47:33,405 --> 00:47:35,425
likely prevented an adverse event

1301
00:47:35,885 --> 00:47:38,385
because there was no awareness of that anatomical

1302
00:47:38,445 --> 00:47:39,905
abnormality until that moment.

1303
00:47:40,605 --> 00:47:41,105
So

1304
00:47:41,565 --> 00:47:43,885
I definitely have a few other, like, patient

1305
00:47:43,885 --> 00:47:46,989
case examples, but, you know, I think we

1306
00:47:46,989 --> 00:47:47,889
all experience

1307
00:47:48,269 --> 00:47:50,829
the silly things that are put in place

1308
00:47:50,829 --> 00:47:52,670
in health care to keep us safe, but

1309
00:47:52,670 --> 00:47:54,369
actually get it get in our way.

1310
00:47:54,989 --> 00:47:58,289
Like, tubes that can't be placed, temporary tubes,

1311
00:47:58,349 --> 00:48:01,089
and acute trauma because of facial fractures.

1312
00:48:01,445 --> 00:48:03,605
But, like, what if it's, like, orbital, like,

1313
00:48:03,605 --> 00:48:04,824
up in your eyebrow?

1314
00:48:05,204 --> 00:48:05,864
You know?

1315
00:48:06,644 --> 00:48:08,804
Why is why are you know, that's good.

1316
00:48:08,804 --> 00:48:10,965
Tube team's not able to place a tube

1317
00:48:10,965 --> 00:48:13,619
blindly with anybody who has facial fractures. But

1318
00:48:13,700 --> 00:48:15,079
if I'm a speech therapist

1319
00:48:15,539 --> 00:48:18,099
that's coming in to scope them and have

1320
00:48:18,099 --> 00:48:19,320
confidence that those

1321
00:48:19,619 --> 00:48:20,599
eyebrow fractures

1322
00:48:21,619 --> 00:48:23,240
or upper orbital fractures

1323
00:48:23,860 --> 00:48:25,240
are not a contraindication

1324
00:48:26,099 --> 00:48:27,000
to my endoscopy,

1325
00:48:27,664 --> 00:48:28,644
Can I facilitate

1326
00:48:29,824 --> 00:48:32,784
enteral access sooner, faster, quicker for this acutely

1327
00:48:32,784 --> 00:48:35,125
ill patient? We need to be thinking,

1328
00:48:35,905 --> 00:48:37,605
how can we make our skills

1329
00:48:38,545 --> 00:48:39,445
less like,

1330
00:48:40,380 --> 00:48:41,980
what did one of the doctors

1331
00:48:41,980 --> 00:48:43,980
say to me? Less like a box cutter

1332
00:48:43,980 --> 00:48:45,980
and more like a Swiss army knife. Right?

1333
00:48:45,980 --> 00:48:48,699
That is what endoscopy is. We are doing

1334
00:48:48,699 --> 00:48:49,199
aerodigestive

1335
00:48:49,579 --> 00:48:53,234
diagnostics. We are facilitating early access to enteral

1336
00:48:53,234 --> 00:48:54,454
nutrition and medication

1337
00:48:54,914 --> 00:48:57,255
and medical stability. We're getting in the room

1338
00:48:57,394 --> 00:48:58,694
early, faster, quicker.

1339
00:48:59,394 --> 00:48:59,894
So

1340
00:49:00,194 --> 00:49:02,594
think about that, that it expands our

1341
00:49:02,594 --> 00:49:03,094
tools

1342
00:49:03,474 --> 00:49:05,494
to be more useful

1343
00:49:06,514 --> 00:49:07,894
if we are showing up

1344
00:49:09,440 --> 00:49:10,500
demonstrating competence

1345
00:49:10,960 --> 00:49:11,359
and,

1346
00:49:11,760 --> 00:49:13,619
partnering with our medical professionals.

1347
00:49:14,719 --> 00:49:16,400
Thank you for letting me share those

1348
00:49:16,400 --> 00:49:16,900
cases.

1349
00:49:17,359 --> 00:49:20,179
Okay. Amazing. And I just quickly wanna mention

1350
00:49:20,319 --> 00:49:22,179
to close that circle about contraindication,

1351
00:49:22,954 --> 00:49:24,954
which is also something that when you go

1352
00:49:24,954 --> 00:49:27,195
through an FDA submission, you have to talk

1353
00:49:27,195 --> 00:49:28,715
about. You have to actually say what are

1354
00:49:28,715 --> 00:49:29,375
the contraindications

1355
00:49:30,315 --> 00:49:32,875
and there are not many but like the

1356
00:49:32,875 --> 00:49:34,954
the big and important one and that's exactly

1357
00:49:34,954 --> 00:49:36,014
what Laura described

1358
00:49:36,795 --> 00:49:37,775
essentially says,

1359
00:49:38,930 --> 00:49:40,150
if you can't advance,

1360
00:49:41,010 --> 00:49:41,829
don't advance.

1361
00:49:42,450 --> 00:49:44,369
Right? That's that's what it comes down to

1362
00:49:44,369 --> 00:49:45,970
when he said, okay. Well, what if I,

1363
00:49:45,970 --> 00:49:47,730
you know, can't go forward? Yeah. Then you

1364
00:49:47,730 --> 00:49:49,730
don't go forward. Right? And and,

1365
00:49:50,610 --> 00:49:53,010
that is a great example that illustrates that,

1366
00:49:53,864 --> 00:49:56,425
and shows, I think, the, you know,

1367
00:49:56,425 --> 00:49:59,724
risk reward ratio that, that using the technology

1368
00:49:59,864 --> 00:50:00,364
really

1369
00:50:00,664 --> 00:50:03,144
really brings with it. And that patient still

1370
00:50:03,144 --> 00:50:04,445
got a dysphagia diagnostic.

1371
00:50:04,824 --> 00:50:05,324
Right?

1372
00:50:05,625 --> 00:50:06,125
So,

1373
00:50:06,619 --> 00:50:08,380
you know, we still saw we still were

1374
00:50:08,380 --> 00:50:11,420
able to help them with dysphagia and

1375
00:50:11,420 --> 00:50:13,900
also provide a valuable information for what else

1376
00:50:13,900 --> 00:50:15,739
is going on with them and causing them

1377
00:50:15,739 --> 00:50:16,960
to be acutely ill.

1378
00:50:17,579 --> 00:50:17,739
So

1379
00:50:18,664 --> 00:50:20,425
And then maybe one last thing if we

1380
00:50:20,425 --> 00:50:21,864
we do have the time because I know

1381
00:50:21,864 --> 00:50:23,545
that question, I mean, comes to us

1382
00:50:23,545 --> 00:50:25,704
all the time and I'll  mention my

1383
00:50:25,704 --> 00:50:27,625
part, but it's also a great question for

1384
00:50:27,625 --> 00:50:29,405
Laura is, you know, now,

1385
00:50:30,105 --> 00:50:32,025
there will be many, many listeners to that.

1386
00:50:32,025 --> 00:50:33,945
And if someone says, hey. This sounds

1387
00:50:33,945 --> 00:50:34,559
amazing, but

1388
00:50:35,360 --> 00:50:38,099
where do I start? Like, what's my first

1389
00:50:38,160 --> 00:50:40,239
and second and third step? I don't I

1390
00:50:40,239 --> 00:50:41,380
don't know what to do.

1391
00:50:41,680 --> 00:50:44,000
And Laura can speak, very well too.

1392
00:50:44,000 --> 00:50:45,840
They're like within a hospital. Where do we

1393
00:50:45,840 --> 00:50:47,039
do you start? Where do you go to?

1394
00:50:47,039 --> 00:50:48,105
Who do you talk to?

1395
00:50:48,824 --> 00:50:51,385
The part that we do, support is training.

1396
00:50:51,385 --> 00:50:52,744
Right? So there is a,

1397
00:50:53,704 --> 00:50:55,005
like an ASHA,

1398
00:50:55,465 --> 00:50:57,885
approved course, introduce a course

1399
00:50:58,264 --> 00:50:59,224
that we host,

1400
00:50:59,545 --> 00:51:01,704
several times a year. We do offer them

1401
00:51:01,704 --> 00:51:03,005
on-site at facilities,

1402
00:51:04,530 --> 00:51:06,530
and all these courses in small groups

1403
00:51:06,530 --> 00:51:08,610
because, you know, people need to volunteer to,

1404
00:51:08,930 --> 00:51:10,690
to have this placed. And so so it

1405
00:51:10,690 --> 00:51:13,489
makes sense in smaller groups. And, you know,

1406
00:51:13,489 --> 00:51:15,750
as far as we're concerned, that is absolutely

1407
00:51:15,809 --> 00:51:18,210
a good starting point talking to us, to

1408
00:51:18,210 --> 00:51:19,430
get trained. But then,

1409
00:51:19,864 --> 00:51:21,784
Laura, how is it, you know, someone says

1410
00:51:21,784 --> 00:51:23,304
that and was like, what what do what

1411
00:51:23,304 --> 00:51:25,065
do I do within my hospital? Like, who

1412
00:51:25,065 --> 00:51:26,344
do I talk to? What are my first

1413
00:51:26,344 --> 00:51:26,844
steps?

1414
00:51:27,784 --> 00:51:30,424
Yeah. So I think first steps, it's actually

1415
00:51:30,424 --> 00:51:32,105
taking a look at your own team. What

1416
00:51:32,105 --> 00:51:34,840
are your endoscopy competencies? Because if you don't

1417
00:51:34,840 --> 00:51:37,000
have any, you need you need an annual

1418
00:51:37,000 --> 00:51:39,400
competency for your team. You need to have

1419
00:51:39,400 --> 00:51:39,900
good,

1420
00:51:41,480 --> 00:51:44,199
standardized approach, a standard I don't wanna say

1421
00:51:44,199 --> 00:51:47,099
protocol or framework for how you are

1422
00:51:47,534 --> 00:51:49,954
assessing patients. You have to have good mentorship.

1423
00:51:50,255 --> 00:51:52,355
Again, if you can't get a scope in,

1424
00:51:52,574 --> 00:51:54,835
the study is moot. You have to have,

1425
00:51:55,614 --> 00:51:58,815
champions who are interested in really partnering with

1426
00:51:58,815 --> 00:52:01,534
the various doctors and, able to speak to

1427
00:52:01,534 --> 00:52:03,510
the skill in what we're providing. So

1428
00:52:03,510 --> 00:52:04,730
I think having a good

1429
00:52:05,030 --> 00:52:07,349
internal team conversation of what this can do

1430
00:52:07,349 --> 00:52:08,789
and what how this can help us is

1431
00:52:08,789 --> 00:52:09,289
important.

1432
00:52:09,670 --> 00:52:11,289
This goes back to a lot of

1433
00:52:11,590 --> 00:52:14,309
a culture of continuous quality improvement. You have

1434
00:52:14,309 --> 00:52:16,070
to have your your team on the same

1435
00:52:16,070 --> 00:52:16,570
page

1436
00:52:17,105 --> 00:52:19,905
that this is good and right in part

1437
00:52:19,905 --> 00:52:20,405
of,

1438
00:52:21,424 --> 00:52:24,224
the quality care that we are providing. So

1439
00:52:24,224 --> 00:52:24,964
a good

1440
00:52:25,505 --> 00:52:26,405
level setting,

1441
00:52:26,784 --> 00:52:29,444
foundational discussion about endoscopy is needed.

1442
00:52:30,039 --> 00:52:31,179
Also reaching out

1443
00:52:31,719 --> 00:52:33,719
to your tube team if you have one.

1444
00:52:33,719 --> 00:52:35,719
If you don't have one, your nurse leaders,

1445
00:52:35,719 --> 00:52:37,019
your ICU leaders,

1446
00:52:37,319 --> 00:52:40,039
talking with them about current practice, but also

1447
00:52:40,039 --> 00:52:42,380
approaching it from a place of no shame.

1448
00:52:42,519 --> 00:52:43,005
Right?

1449
00:52:43,804 --> 00:52:45,005
A lot of people don't know you could

1450
00:52:45,005 --> 00:52:46,525
even have eyes. I mean, think about all

1451
00:52:46,525 --> 00:52:48,684
the people we meet who see a scope

1452
00:52:48,684 --> 00:52:49,505
for the first

1453
00:52:49,884 --> 00:52:51,484
time, who are have been in health care

1454
00:52:51,484 --> 00:52:53,484
for a long time. Oh, you can see?

1455
00:52:53,484 --> 00:52:55,484
You can do that? You're gonna have that

1456
00:52:55,484 --> 00:52:58,045
experience. So just be kind and be ready

1457
00:52:58,045 --> 00:52:58,545
to,

1458
00:52:59,869 --> 00:53:00,369
understand

1459
00:53:00,829 --> 00:53:02,590
their workflow up to this point and how

1460
00:53:02,590 --> 00:53:04,610
you can partner and expand

1461
00:53:04,910 --> 00:53:07,630
with your knowledge, expertise, and the goals you're

1462
00:53:07,630 --> 00:53:09,250
trying to accomplish with your patients.

1463
00:53:10,030 --> 00:53:10,930
And, also,

1464
00:53:11,445 --> 00:53:11,945
partnering

1465
00:53:12,244 --> 00:53:12,744
with,

1466
00:53:13,364 --> 00:53:13,864
Patcom

1467
00:53:14,244 --> 00:53:17,364
and with just with the Patcom team to

1468
00:53:17,364 --> 00:53:18,585
support the competencies

1469
00:53:19,045 --> 00:53:19,945
and the training

1470
00:53:20,565 --> 00:53:21,065
and,

1471
00:53:21,605 --> 00:53:24,085
the supply chain aspect of getting the product

1472
00:53:24,085 --> 00:53:26,519
in your hospital well vetted because that takes

1473
00:53:26,519 --> 00:53:27,260
some time.

1474
00:53:27,719 --> 00:53:30,679
Again, speaking to that FDA approval and, Teresa,

1475
00:53:30,679 --> 00:53:33,019
what you said earlier, that's huge to just

1476
00:53:33,079 --> 00:53:36,920
make innovative products possible in our health care

1477
00:53:36,920 --> 00:53:37,420
system.

1478
00:53:37,880 --> 00:53:39,900
That takes interested clinicians

1479
00:53:40,894 --> 00:53:44,255
committing to asking good questions about providing good

1480
00:53:44,255 --> 00:53:45,234
care. So

1481
00:53:45,534 --> 00:53:48,034
I like to think about this as a,

1482
00:53:49,054 --> 00:53:50,675
you know, a a a cycle.

1483
00:53:51,295 --> 00:53:53,554
You know, Theresa gets the education out.

1484
00:53:54,219 --> 00:53:56,619
People like Christoph and Patcom are thinking about

1485
00:53:56,619 --> 00:53:58,460
how we can do this better. How can

1486
00:53:58,460 --> 00:53:59,360
we make this,

1487
00:53:59,820 --> 00:54:02,219
easier for the patient, patient comfortable, and the

1488
00:54:02,219 --> 00:54:04,239
therapist who are willing to ask,

1489
00:54:05,099 --> 00:54:07,019
could we do this differently where I show

1490
00:54:07,019 --> 00:54:09,005
up every day for our patients? So really

1491
00:54:09,005 --> 00:54:10,704
supporting that good conversation.

1492
00:54:12,285 --> 00:54:15,085
And I I think partnering with your quality

1493
00:54:15,085 --> 00:54:15,585
team,

1494
00:54:15,965 --> 00:54:18,864
making sure that there isn't anything else that

1495
00:54:19,085 --> 00:54:21,585
you need to cover from a consent perspective.

1496
00:54:22,460 --> 00:54:24,559
Again, a lot of the feedback from

1497
00:54:25,179 --> 00:54:28,960
very seasoned quality improvement professionals is this is

1498
00:54:29,019 --> 00:54:29,839
this is kinda

1499
00:54:30,380 --> 00:54:32,779
low budget, not not that risky. We've got

1500
00:54:32,779 --> 00:54:34,299
a lot of precedent for this and a

1501
00:54:34,299 --> 00:54:35,519
lot of other specialties,

1502
00:54:36,219 --> 00:54:37,920
and this just makes good sense.

1503
00:54:38,405 --> 00:54:40,085
We just need to see that your policy

1504
00:54:40,085 --> 00:54:42,184
has been updated and your training is validated.

1505
00:54:42,885 --> 00:54:44,244
So I hope that helps the answer, and

1506
00:54:44,244 --> 00:54:45,065
I'm obviously

1507
00:54:46,085 --> 00:54:48,664
able to speak more to that. And then

1508
00:54:48,804 --> 00:54:51,539
Christoph mentioned the course that it covers that,

1509
00:54:52,420 --> 00:54:54,599
in their course as well.

1510
00:54:55,460 --> 00:54:56,679
Yeah. Christoph,

1511
00:54:57,300 --> 00:54:59,380
thank you for that, Laura. Super, super valuable.

1512
00:54:59,380 --> 00:55:01,140
And to talk about your circle as well,

1513
00:55:01,140 --> 00:55:03,380
we also need people like you who break

1514
00:55:03,380 --> 00:55:04,119
down these

1515
00:55:04,574 --> 00:55:05,795
big bad administrators

1516
00:55:06,094 --> 00:55:07,855
that set all these rules that we think

1517
00:55:07,855 --> 00:55:09,775
we can never break, and you teach us

1518
00:55:09,775 --> 00:55:12,094
how to play nicely with them and things

1519
00:55:12,094 --> 00:55:13,875
that we can bring back to them. So

1520
00:55:13,934 --> 00:55:16,014
thank you for thank you for bridging that

1521
00:55:16,014 --> 00:55:16,914
gap as well.

1522
00:55:17,510 --> 00:55:19,190
Christoph, let me ask you. I I know

1523
00:55:19,190 --> 00:55:21,909
Laura's spoken from the lens of acute care

1524
00:55:21,909 --> 00:55:22,409
today.

1525
00:55:22,710 --> 00:55:25,510
I've also heard from other SLP clinicians that

1526
00:55:25,510 --> 00:55:28,070
there may be a use for this in

1527
00:55:28,070 --> 00:55:29,530
other settings as well.

1528
00:55:29,909 --> 00:55:31,670
Can you speak to that or if if

1529
00:55:31,670 --> 00:55:33,565
you've heard of other SLPs using them in

1530
00:55:33,565 --> 00:55:35,025
settings outside of hospitals?

1531
00:55:36,285 --> 00:55:37,025
Yeah, absolutely.

1532
00:55:37,644 --> 00:55:38,304
You know,

1533
00:55:38,765 --> 00:55:41,085
generally of course, when whenever there's a blind

1534
00:55:41,085 --> 00:55:41,585
placement,

1535
00:55:42,285 --> 00:55:43,105
of a tube,

1536
00:55:44,445 --> 00:55:45,344
this is where

1537
00:55:45,644 --> 00:55:47,744
the Introducer might be an alternative.

1538
00:55:48,045 --> 00:55:49,589
So, you know, one of these

1539
00:55:50,289 --> 00:55:53,250
these ideas I I would love to see,

1540
00:55:53,570 --> 00:55:54,949
happening in the future.

1541
00:55:56,130 --> 00:55:58,449
And, you know, goes back to to also

1542
00:55:58,449 --> 00:56:00,289
where you come from, mobile fees,

1543
00:56:00,769 --> 00:56:02,389
providers. Right? So I

1544
00:56:03,545 --> 00:56:05,085
imagine a world where,

1545
00:56:05,545 --> 00:56:07,244
if in a nursing homes,

1546
00:56:08,505 --> 00:56:10,905
or or a LTCH or where you might

1547
00:56:10,905 --> 00:56:12,664
have a patient with an NG tube and

1548
00:56:12,664 --> 00:56:14,845
this patient pulls the tube out,

1549
00:56:16,900 --> 00:56:19,380
typically now maybe they would be transferred back

1550
00:56:19,380 --> 00:56:21,539
to the hospital or to emergency room to

1551
00:56:21,539 --> 00:56:23,860
get it replaced or anything like that. Like,

1552
00:56:23,860 --> 00:56:26,260
imagine a world where a a mobile fees

1553
00:56:26,260 --> 00:56:26,760
provider

1554
00:56:27,219 --> 00:56:28,920
instead can go in and,

1555
00:56:29,219 --> 00:56:31,000
you know, assist with the placement

1556
00:56:32,285 --> 00:56:34,305
of an NG tube through the Introducer.

1557
00:56:35,565 --> 00:56:37,805
In my personal opinion is that would make

1558
00:56:37,805 --> 00:56:39,164
a lot of sense and,

1559
00:56:39,644 --> 00:56:42,605
would be a great asset to communities where

1560
00:56:42,605 --> 00:56:44,639
it's just very difficult, you you know, to

1561
00:56:44,639 --> 00:56:46,659
transport the patients to the next hospital,

1562
00:56:47,679 --> 00:56:50,239
and all of that. I'll interject here because

1563
00:56:50,239 --> 00:56:52,079
I think that that is that's where we

1564
00:56:52,079 --> 00:56:53,219
need a clinician

1565
00:56:53,599 --> 00:56:55,780
to really disrupt the subacute

1566
00:56:56,239 --> 00:56:59,460
industry when it comes to offering this,

1567
00:56:59,904 --> 00:57:00,964
especially with endoscopy

1568
00:57:01,264 --> 00:57:04,464
and still nursing facilities because you you know

1569
00:57:04,464 --> 00:57:07,204
those patients that because they are,

1570
00:57:08,625 --> 00:57:10,884
trending downward on that vicious cycle

1571
00:57:11,344 --> 00:57:12,164
of nutrition

1572
00:57:12,849 --> 00:57:15,010
because they might be managed for a pneumonia

1573
00:57:15,010 --> 00:57:17,250
or UTI at their location, and they're losing

1574
00:57:17,250 --> 00:57:19,750
valuable time in their rehab plan.

1575
00:57:20,289 --> 00:57:21,730
If they go to the hospital, they come

1576
00:57:21,730 --> 00:57:23,489
back a shell of themselves, or they come

1577
00:57:23,489 --> 00:57:24,630
back just so,

1578
00:57:25,409 --> 00:57:26,389
you know, deconditioned.

1579
00:57:27,184 --> 00:57:30,304
So this tool, this this can really add

1580
00:57:30,304 --> 00:57:31,045
an aspect

1581
00:57:31,344 --> 00:57:34,405
to stability of subacute care plans with

1582
00:57:34,704 --> 00:57:36,164
interested medical providers.

1583
00:57:36,545 --> 00:57:38,005
I think this is a great,

1584
00:57:38,545 --> 00:57:39,844
aspect for partnership

1585
00:57:40,144 --> 00:57:42,405
with a dietitian because a lot of dietitians

1586
00:57:42,545 --> 00:57:43,579
at those locations

1587
00:57:43,880 --> 00:57:45,800
are the ones who are actually doing the

1588
00:57:45,800 --> 00:57:47,019
core track placements

1589
00:57:47,320 --> 00:57:48,619
for temporary tubes.

1590
00:57:49,400 --> 00:57:51,980
And it's just, like, ripe for a clinician

1591
00:57:52,119 --> 00:57:53,900
to say, can we

1592
00:57:54,440 --> 00:57:57,079
quality improve this and show we can keep

1593
00:57:57,079 --> 00:57:57,820
our patients

1594
00:57:58,925 --> 00:57:59,425
well

1595
00:58:00,525 --> 00:58:01,025
through

1596
00:58:01,405 --> 00:58:02,224
some instability

1597
00:58:02,605 --> 00:58:03,505
of their subacute

1598
00:58:04,045 --> 00:58:06,065
journey and prevent an unnecessary

1599
00:58:06,525 --> 00:58:07,025
admission

1600
00:58:07,324 --> 00:58:09,105
just because of nutritional instability.

1601
00:58:09,724 --> 00:58:12,260
I think that'd be a good challenge. My

1602
00:58:12,260 --> 00:58:14,760
wheels just started turning, like, ninety seven

1603
00:58:15,300 --> 00:58:17,000
minutes. So thank you for that.

1604
00:58:18,739 --> 00:58:21,139
Christoph, when are the next upcoming courses? I

1605
00:58:21,139 --> 00:58:22,500
know I was supposed to go to the

1606
00:58:22,500 --> 00:58:25,505
last two, and my daughter's dance ballet plans

1607
00:58:25,505 --> 00:58:28,545
have interjected on both of them. So she

1608
00:58:28,545 --> 00:58:29,905
she will have to accompany me to the

1609
00:58:29,905 --> 00:58:32,065
next one if if that's okay. Yeah. Yes.

1610
00:58:32,065 --> 00:58:34,704
Yes. Absolutely. We should have you. You know,

1611
00:58:34,704 --> 00:58:36,464
you call me a little bit 

1612
00:58:36,464 --> 00:58:38,869
I think I think, but, like, maybe

1613
00:58:38,869 --> 00:58:40,950
we can add this to Shonas also to

1614
00:58:40,950 --> 00:58:42,489
confirm. But I think,

1615
00:58:43,829 --> 00:58:45,610
we have August 3

1616
00:58:46,470 --> 00:58:48,410
in New York City. Oh, awesome.

1617
00:58:48,869 --> 00:58:49,369
And

1618
00:58:50,974 --> 00:58:52,255
and the rest will have to put in

1619
00:58:52,255 --> 00:58:53,934
show and content. Sounds good. Didn't mean to

1620
00:58:53,934 --> 00:58:54,974
put you on the spot there. I just

1621
00:58:54,974 --> 00:58:56,094
got really excited because I was like, I

1622
00:58:56,094 --> 00:58:57,215
don't know how to get to this dang

1623
00:58:57,215 --> 00:58:58,735
course. I know I've been wanting to get

1624
00:58:58,735 --> 00:59:01,535
to the course and yeah. So Right. But,

1625
00:59:02,015 --> 00:59:03,235
but as I said also,

1626
00:59:04,010 --> 00:59:06,170
if you are at a facility where, you

1627
00:59:06,170 --> 00:59:06,670
know,

1628
00:59:06,969 --> 00:59:09,289
there are a few people that would benefit

1629
00:59:09,289 --> 00:59:11,389
from it and from a training, we absolutely

1630
00:59:11,690 --> 00:59:14,170
are very happy to do those those as

1631
00:59:14,170 --> 00:59:15,230
on-site trainings,

1632
00:59:15,929 --> 00:59:17,710
you know, whenever at a facility.

1633
00:59:18,010 --> 00:59:20,785
Awesome. Love that. Awesome. Thank you guys so

1634
00:59:20,785 --> 00:59:23,265
much. I can't love this conversation anymore.

1635
00:59:23,265 --> 00:59:24,965
I obviously love all things

1636
00:59:25,265 --> 00:59:27,505
health care innovation. And then, obviously, Laura, I

1637
00:59:27,505 --> 00:59:30,385
just always appreciate your wisdom and guidance of

1638
00:59:30,385 --> 00:59:32,244
how to actually put all this

1639
00:59:32,670 --> 00:59:35,329
meat and potatoes together. So thank you guys

1640
00:59:35,389 --> 00:59:37,150
so so much. And, yes, Christoph will link

1641
00:59:37,150 --> 00:59:38,989
all the goods in the show notes for

1642
00:59:38,989 --> 00:59:42,030
anybody that wants any extra info. And, yeah,

1643
00:59:42,030 --> 00:59:43,170
thank you guys again.

1644
00:59:43,869 --> 00:59:46,269
Alright. Thanks so much. Thank thank you both.

1645
00:59:46,269 --> 00:59:48,384
It was great talking to you. And that's

1646
00:59:48,384 --> 00:59:49,844
a wrap for this episode.

1647
00:59:50,224 --> 00:59:52,484
As always, thank you so much for listening.