**5. Equipment**

*Advances in Extracorporeal Membrane Oxygenation - Volume 3*

**3.5 Critical care transport**

**3.6 Nonclinical support**

discussed more fully later in the chapter.

consistent skill sets for new team members.

bridge to long-term LVAD support or transplant.

**4. Rapid change management**

**4.2 Change management approach**

**4.1 Triad leadership structure**

**3.7 Establishing relationships with other tertiary centers**

higher levels of care for consideration of ECMO support.

must communicate progress within the executive team.

considered for ECLS. Since patients might require ECMO at any time, day or night, and given the amount of resources required to initiate and care for such patients, nursing administration must be involved to help develop protocols to organize "phone tree" lines of communication and specialized competent staff schedules to

As the program grows beyond supporting the host hospital, it is necessary to engage Critical Care Transport to organize a system to transport patients from outside the facility with appropriate support and skill sets. This engagement is

The IT department can help with order set development and the Medical Staff office will need to support the development of privileging requirements to assure

Especially in the situations with VA-ECMO use, long-term myocardial support may be needed. It is essential to build relationships with centers that can provide

Additionally, the marketing and public relations departments engage to help in creating materials to help outlying hospitals and physicians have awareness of the program, with knowledge of how to identify patients and when to transport to

A rapid pace for implementation is best served by a strong triad leadership: experienced physician leaders and champions who are experts in ECMO; nursing leadership; and hospital executives. All need experience in change management and are given support and authority to use project tools and cross-functional influence to fast track project goals across a wide span of departments. These members then

Following Kotter's change management theory, a small group of physicians, nursing leadership, and administrators gather to set a vision, determine the feasibility and challenges of the project, then create a shared project plan for the organization, structure, and timeline for implementation of the program [17]. The creation of a Gantt chart with key requirements and milestones is helpful in the early stages of program development—also useful in a sense of accomplishment and motivation of the team. Regular recurrent frequent meetings with agendas driven by a project management tool to assure progress is made on key deadlines, accountability to the individuals and team, and to create a shared message and plan for continued communication. Initial work should focus on best practice, research-based literature review,

help recruit and arrange appropriate resources on very short notice.

**30**
