EM Pulse Podcast™ cover art

EM Pulse Podcast™

EM Pulse Podcast™

By: UC Davis Department of Emergency Medicine
Listen for free

Bringing research and expert opinion to the bedside2023 UC Davis Emergency Department Education Hygiene & Healthy Living Physical Illness & Disease
Episodes
  • The Power of the Debrief: TeamSTEPPS

    The Power of the Debrief: TeamSTEPPS
    Jul 3 2026
    In this episode, we welcome back guest host Dr. Neelou Weeker and ED nurse Leigh Clary to talk about a tough emergency medicine reality that we often avoid discussing: what teamwork looks like when, despite our best efforts, the patient doesn’t survive. We work though a recent, emotionally heavy resuscitation and explore how TeamSTEPPS tools—specifically the structured debrief—serve as a vital safety net for our own mental health, helping us find our footing and reclaim our humanity in a chaotic environment. The Reality of “Doing Everything Right” and Still Losing We often connect good teamwork with saving lives, but in the ED, bad outcomes sometimes happen. The true test of a team’s culture is how we handle the aftermath of those tough cases. 1. The Emotional Roller Coaster of the ED The “Would-Have, Could-Have, Should-Haves”: When a patient comes in talking and dies in the ED, it carries a heavy psychological weight for everyone and we often replay these cases over and over in our minds.Flipping the Switch to Withdrawal of Care: Putting your heart and soul into a long resuscitation, getting pulses back, and then having to pivot and make the decision to withdraw care is an exhausting emotional shift for the whole team.The Illusion of the Robot: The ED forces us to “code switch” instantly—moving from declaring a death straight to treating a minor complaint. Without a moment to pause, you start to feel like a robot, which takes a signficant toll on your wellbeing. 2. The Anatomy of a High-Quality Debrief Debriefing after a tough case should be a priority, not a luxury. A solid debrief balances a clinical review with immediate psychological first aid. ComponentStandard Protocol & Best PracticesThe Core PurposeFramed around three pillars: Education, Quality Improvement, and Emotional Processing.The ToneStrictly confidential, safe, and non-punitive. It is explicitly stated at the outset that the session is not for assigning blame.The LocationIdeally a quiet, isolated space physically removed from the immediate clinical chaos (a “doc box” or dedicated staff room).The LeadershipFacilitated by designated Debrief Champions. If unavailable, any comfortable team member can step up.The AttendeesOpen to everyone who was involved in or affected by the case, including physicians, nurses, techs, students and scribes. The Power of Prioritization: The emergency department is chronically busy, but a culture of safety means charge nurses actively shuffle staff and adjust coverage to carve out the 10 to 15 minutes required for a team to debrief. Applying TeamSTEPPS to Team Longevity 1. The Need for a Clinical Respite Data shows that the most important thing for a clinician after a bad outcome is just a brief break from the clinical area to regroup and compose themselves. Since we physically can’t just leave the ED to get a breath of fresh air, a structured debrief acts as that necessary “bubble” outside of active patient care. 2. Modeling Vulnerability as Leaders To move away from the expectation that healthcare workers must act as emotionless automatons, leaders must intentionally model healthy processing. Visible Humanity: When Attendings and nurse leaders show vulnerability and admit that a case hit them hard, it builds a culture where it’s okay to not be okay.Creating “Fence Posts”: We can’t carry the weight of every patient we lose on our backs and still function. Structured debriefs allow us to package the experience into a “fence post” of clinical learning, honoring the patient while protecting the provider’s mental health. Key Takeaways De-Link Teamwork from the Outcome: Perfect teamwork can’t always override catastrophic pathology. Evaluate the team’s performance based on coordination, communication, and execution, not solely on whether the patient survived.Establish a Standard Debrief Script: Protect your team by starting every post-event huddle with a reminder that the space is confidential, educational, and completely non-punitive.Invest in Your Team: Implementing a formal debrief infrastructure requires minimal resources and builds team morale and resilience. (Pro-tip: bring candy to engage all the senses in a sensory reset!) Do you use TeamSTEPPS or a similar model in your ED? We’d love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com Host: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guest Host: Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis Guest: Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis Resources: TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, ...
    Show More Show Less
    14 mins
  • Lost in Translation – TeamSTEPPS

    Lost in Translation – TeamSTEPPS
    Jun 8 2026
    In this episode, the we welcome back guest host, Dr. Neelou Weeker, and ED nurse, Leigh Clary, to discuss the critical intersection of language barriers, patient equity, and emergency care. Through two powerful clinical scenarios, the team explores the “gold standards” of medical translation, the challenges of resource-limited community settings, and how TeamSTEPPS tools—specifically closed-loop communication and situational monitoring—can be leveraged to ensure true informed consent and patient safety. The Gold Standard vs. Clinical Reality Providing equitable care means ensuring every patient, regardless of language or culture, fully understands their medical team. While academic centers are often highly resourced, executing communication seamlessly remains a universal challenge. 1. Translation Tools and Hierarchy The Gold Standard: Video- or audio-based professional interpretation tablets allow face-to-face or direct vocal translation.The Secondary Backup: In-house dual-handset “blue phones” connect directly to professional phone lines when tablets experience connectivity issues.The Tertiary Backup: Multilingual staff members can help act as a bridge. Many institutions feature language fluencies on staff ID badges. Note: Staff members should only be used to establish initial rapport or identify the required dialect, not as official medical interpreters. The Danger of Family Interpreters: While family members bring invaluable cultural context and an understanding of the patient’s baseline, studies show they only correctly interpret medical dialogue 19% of the time.The Bottom Line: Always utilize the official route first. When technology fails, do your absolute best—never settle for “good enough” when better communication is possible. 2. Academic vs. Community and Rural Settings Emergency medicine requires extreme adaptability. In resource-limited community or rural hospitals, finding an interpreter for less commonly spoken languages can take upwards of 30 minutes.Physicians must sometimes physically carry translation phones from room to room while managing other patients just to maintain an open line with a rare-dialect interpreter. Applying TeamSTEPPS to Patient Communication We routinely use TeamSTEPPS tools to communicate with our fellow clinicians, but we must remember that the patient is the most important member of the healthcare team. 1. Closed-Loop Communication & The Teach-Back Method To confirm true patient understanding, avoid simple “yes or no” questions, nods, or smiles. Instead, utilize the Teach-Back Method, requiring the patient to repeat the instructions or choices back to you in their own words. How to Phrase It (Taking Responsibility): “I want to make sure that I have been clear in what I’ve said to you. To help me feel reassured that I communicated everything correctly, could you tell me what you understand is going on?” Clinical Value: This is particularly vital for high-stakes decisions and ED discharge instructions.Multimodal Approach: In high-stakes moments, combine professional translation, family context, and teach-back to minimize errors. 2. Situational Monitoring Resuscitative environments are chaotic, and the primary physician trying to run a cod or secure an airway has immense cognitive load. The Team Safety Net: Other team members (nurses, techs, scribes) can help monitor the situation and catch critical communication errors. Reconciling Clinical Urgency with Informed Consent How do you balance the immediate need to save a life with the time-consuming process of formal translation? The ABC Priority: First and foremost, secure Airway, Breathing, and Circulation. If a patient presents to the ED in extremis and cannot communicate, clinicians must operate under the assumption that the patient wants life-saving measures performed.Task Delegation: While the medical team manages the immediate ABCs, immediately task support staff (such as social workers) with finding an official interpreter, locating family members, and gathering background information.Next Steps: Once the ABCs are stable, the team has the time and space to pause, establish formal translation, and dive deeper into informed consent for further procedures. Key Takeaways Acknowledge the Bias of Urgency: Time pressure can tempt us to bypass official translation channels. Guard against this by maintaining an equity-first mindset.Close the Loop with Patients: Ensure they can paraphrase their care plan or consent choices.Protect the Team via Shared Roles: Trust your teammates to monitor the big picture and catch subtle communication gaps during high-stress resuscitations. Do you use TeamSTEPPS or a similar model in your ED? We’d love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com Host: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guest Host: Dr. Neelou Tabatabai, Assistant ...
    Show More Show Less
    23 mins
  • ED Sustainability: Small Changes, Big Impact

    ED Sustainability: Small Changes, Big Impact
    May 21 2026
    It is getting hot in California, which has us thinking about the massive carbon footprint of healthcare. The emergency department is famously resource-heavy, but can we save lives and reduce waste? Dr. David Barnes joins us to explain how going green isn’t just about being a “tree hugger”—it’s about saving money, cutting waste, and making our hospitals resilient against supply chain chaos. Defining Healthcare Sustainability Balancing Safety and Footprint: Sustainability in healthcare means delivering efficient, affordable care that minimizes resource waste while remaining clinically safe and meaningful.The Power of Resiliency: A sustainable healthcare system is inherently a resilient one. Reducing reliance on single-use items and utilizing local renewable energy sources (like microgrids) protects hospitals from supply chain disruptions caused by geopolitical conflicts or weather-driven power grid failures. The Three Scopes of Emissions Scope 1 (Direct): Emissions directly produced by hospital operations, such as idling fleet vehicles and leaking anesthetic gases.Scope 2 (Indirect): Purchased energy used to power and heat the facilities (e.g., local electricity and steam lines).Scope 3 (Supply Chain): The largest bucket, making up 60% to 80% of healthcare emissions. This includes employee commutes, medical waste incineration, manufacturing of disposable devices, and food production. Clinical Traps: Where We Waste the Most Pre-packaged Kits: Studies show 75% to 80% of items inside specialized kits (like central lines) go completely unused and are thrown away.Over-Preparation: Opening multiple single-use items (like various ET tube sizes) or donning full trauma PPE for minor injuries creates an immediate, unnecessary trash stream.Pharmaceutical Waste: Standard packaging size leads to heavy drug wasting (e.g., using 5 mL from a 100 mL propofol bottle). This regulated medical waste is costly and energy-intensive to incinerate.The Glove Epidemic: Glove overuse skyrocketed during COVID-19 and became a habit. Most routine encounters carry no contamination risk, making glove use clinically unnecessary. Shifting the Culture “Take What You Need, Leave What You Don’t”: Avoid opening supplies you may not need or bringing extra gauze or syringes into a room. Due to infection safety protocols, these often end up in the trash.Watch Where You Toss: Keep coffee cups and paper out of the red biohazard bins. Regulated medical waste costs six times more to process and must be incinerated, creating massive greenhouse gas emissions.Embrace Reprocessing & Reusables: Support partnerships with companies that safely clean and reuse devices historically labeled “single-use” (like EKG leads or waffle mattresses). Swap disposable plastic gowns for reusable cloth gowns that survive 90 washes.Model the Behavior: Culture change takes patience and persistence. Instead of finger-wagging or shaming colleagues, visibly adopt sustainable habits to drive grassroots practice changes. Key Takeaways for the ED Clinician Speak up on bad design: Clinicians are on the front lines of waste. Advocate for local sustainability initiatives to grab the attention of hospital executives who handle major purchasing contracts.Normalize virtual alternatives: Protect staff well-being and slash commuting emissions by offering Zoom or Teams options for short, solitary administrative meetings.Keep it in perspective: Healthcare sustainability is about finding the sweet spot where clinical safety, resource utilization, and environmental impact meet. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Barnes, Professor of Emergency Medicine, Director of ED Sustainability, and Member of the Sustainability Committee at UC Davis Health Resources: Practice Greenhealth Health Care Without Harm Green ED (Royal College of Emergency Medicine) *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.
    Show More Show Less
    32 mins
adbl_web_anon_alc_button_suppression_t1
No reviews yet