Fast and Effective Communication within the ECMO/ECLS Team

Hello and welcome to all of you hundreds (or is it thousands?) of ECMO nurse specialists throughout Europe. This newsletter is the start of what we hope will be an amazing way for us all to communicate with each other, share ideas , challenges and hopefully solutions.

Let’s start with a brief introduction of who/what I am. My name is Margaret Farley, I was elected as the Nurse representative to EuroELSO earlier this year.
I completed my 4 year nurse training to register with a combined adult and paediatric qualification in….. a long time ago ! I have since that time worked in adult intensive care – at the Queen Elizabeth Hospital, Birmingham, UK, a neonatal intensive care at the King Khalid National Guard Hospital, Jeddah, Saudi Arabia and to my final resting place ( ! ) for the last 15 years the Paediatric Intensive Care Unit at Birmingham Children’s Hospital, UK .
I have been the ECMO coordinator there since we started our ECMO programme six years ago.


The more I meet other ECMO professionals the more I have come to appreciate how diverse our teams and programmes are. The centres in the UK differ greatly in team size and structure , workload and case variety and so the variation throughout mainland Europe I assume will be as great if not greater. Apart from the odd exception we will all work with either neonates/paediatrics or the adult population, very few centres will manage both either side by side or in adjacent ICUs – yes Glenfield, in Leicestershire, I know you do ☺ ! – Your centre will probably specialise primarily in either cardiac with respiratory as a side line or respiratory with the occasional cardiac patient on support.

Nursing NovFig1I believe, that for this forum to work for all of us it can not be focussed in one area geographically or in one speciality so I will welcome ideas for topics or even better ready made articles for inclusion. I will use the ELSO website for names of nurse coordinators in the centres that are currently registered and will be contacting you all as a group and individually over the coming months to discuss your thoughts and ideas on how we can develop this page. Better still please contact me at any time to discuss your thoughts on how we can together develop this way of communicating with each other.

To kick it all off I thought I would share with you a solution we have found in my centre in Birmingham Children’s Hospital to help us communicate quickly and simultaneously with each of our ECMO nurse specialists. We are a relatively low volume centre supporting 16-18 children each year. These patients are managed in our 30 bedded general Paediatric Intensive Care Unit (PICU) .
We staff our service exclusively with our own PICU nurses. As there may be a few weeks at a time without a patient on support we do not have a dedicated ECMO team who manage only ECMO patients. We currently have a team of approximately 40 nursing staff in the ECMO team. The staff understand that they must complete a minimum number of hours ‘on pump’ each year to maintain skills and confidence and so are highly motivated to make themselves available for hours on pump as and when required.

Many of our staff have part time contracts in PICU and then work additional Nurse Bank hours to suit their own commitments and schedule. In the past when a patient was put on to ECMO support, due to our PICU frequently running at full capacity we would try and manage the ECMO patient exclusively with Nurse Bank staff (who were nurses with contracts in our PICU) to reduce the impact on PIC capacity. This involved someone – frequently me – phoning around the ECMO nurse team to try and cover the shifts for up to a week ahead. Not only was this horribly time consuming but often staff would be unhappy if they were at the end of the call list as many of the available shifts would have already gone.

Then along came WhatsApp!

Nursing NovFig2

WhatsApp is a messaging application that can be down loaded to most smart phones and can be used to send messages to other peoples mobile phones.

It’s FREE ! The most obvious benefit to using this type of messaging application is that you don’t have to pay for messages sent. As long as you have a data package included in your mobile subscription, or if you can use your mobile over WiFi networks, you can send and receive messages at no cost.
Multimedia Even though writing messages using text is the most common way that we choose to communicate, you can also include images, videos, audio files, and should you want to, you can add a number of emoticons in your messages ☹
Easier group chats – Using WhatsApp we were able to create a number of different groups with people you can message all at once. So we now have one for all ECMO specialists, one for our team of 6 ECMO coordinators and have now recently also introduced one for our haemofiltration nurses.

Quickly we realised that we had to make some simple ground rules
• No patient identifiable information – ever !
• No social chit chat – just business
• Don’t text back what you can’t do – I don’t need to know that its your Grandmothers birthday and so you can’t come to work, I only need to know what shifts you can do on the ECMO circuit

Now, as soon as we know a patient is going on to ECMO we send out a message informing staff and asking for them to reply with their availability for the next seven days.

Usually within 30 minutes we have 20 plus responses with staff giving their availability for the next week. Completing the rota is then simple.
I just sit down with a blank rota and fill in the gaps , no phone calls to make, no messages left with answer machines , boyfriends, mothers and flatmates followed by a wait for the replies and all staff have equal access to shifts as they all get the message instantly and simultaneously.

Having used this for the last year with complete success we would never wish to return to the old method.

If you do not wish me to update you every few weeks on how things are managed in Birmingham Children’s Hospital then I hand you the challenge to get involved and get writing!