 Somebody told me that you might have to fill in for time depending on the next speaker where he's going to be and what's exactly going on. So I think I have to stay here because I'm not I'm not I'm not Mike. I am Mike but not Mike. So I think it's my job to fill in the next hopefully only five minutes. Who I am? I'm Mike Ramsey. I'm on the board of the Patient Safety Foundation. I've been with it since the start and I think I just like to talk a little bit about moving the needle because one of the things that's impressed me today is that everybody here it's like preaching to the choir. Everybody's on board. Everybody wants to make a change. But how do you get out of here and make the change? And what can we do to move that needle over? And I think our hospitals that there's a Canadian intensivist who drew a cartoon it's a wonderful slide that shows the course of a patient in our hospitals and it shows them getting to the safe place and some of them have problems before they get to the safe place and just occasionally somebody doesn't get to that safe place. That safe place is home. That safe place is home. Our hospitals should be the safest place. So we've got to turn it around. We've got to change it. We've got to make our hospitals the safest place to be when you're sick. No patient in our hospitals should be found dead in bed. Nobody should. Every patient should have a monitor on them. Now does that sound wild? How many people in this room have a monitor on them right now? How many's got a smart watch on an apple, a Fitbit? Yeah, the technology's out there. So why doesn't why don't we have our patients with just a little mobile monitor on them that will transmit to the nurses smartphone? I mean that that would be easy. So you could tell the pulse rates increasing the pulse rate slowing the oxygenation is dropping off. Go check on that patient that we could do today and that would make a difference. But then we could do it. You've got the monitors on you now. We could do that day case total knee replacement and send the patient home and have the monitored at home so you could pick up early pneumonia because the heart rates going up the saturation is dropping off. So there's some things we could do right away. And I think we need to because when you think about the people who've been here talking about their loved ones that have died, the very early patient safety meetings, the summits, we had Lenore Alexander and Pat Lachance both came up here and they talked about Lenore talked about her 11 year old child who died, had a thoracic epidural in place with narcotics opioids going in. She was asleep in the room with a child. She did not realize that a child was not sleeping but was in a CO2 carbon dioxide narcosis and the child died. Pat Lachance, husband, ex Navy SEAL had shoulder surgery. If he'd gone home to that safe place he'd be alive today. But he stayed in the hospital. They gave him some dilordid and opioid and he obstructed respiratory depression and he died. So what Lenore said was a monitor would have saved my child's life. It's all that stands between us and a universal postoperative monitoring is the will to use it. The anesthesia patient safety foundation supported this. CMS, Medicare supported it. The Joint Commission supported it. The summit at number four was the one we wrote that supports it and yet very few hospitals have instituted. Dartmouth Hitchcock have and shown tremendous savings of lives and transfers to ICU and prevention of codes. We have at Baylor and again reduced the rapid response team calls to minimal. But I received an email last month from a nurse in Ohio and she said, Dr. Ramsey, please forgive me for being so bold. I found your name in a news report on the local news. My husband died following a successful laminatectomy. After one hour in surgery he went to pack you the recovery room for one hour and then he was placed on a low risk medical surgical floor. If he had gone home he'd be alive today. A single level laminatectomy he could have gone home but they put him on a hydromorphone PCA pump. This pumps an opioid into him when he hits a button. When they came by two hours later they found him dead. Respiratory depression. So you know just as we just heard you know when you make a mistake you learn from it you never do it again. Here's a mistake we've been making for years. We haven't learned from it. At least very few people have. So that's what I want to impress on everybody here is we've got to make a difference. We've got to go out from here go back to your hospitals, your institutions, your your communities and move that dial. Make a difference. Let's use the technology we have and we've got more coming. Let's drive these manufacturers of the tech companies to come up with the devices we want and the devices that will talk to each other because in our ICUs we have plenty of monitors and yet still we have unexpected cardiac arrests and that's because the monitors aren't integrated yet at least most of them aren't. They're not talking to each other and they should be warning us so we want early warning systems. That technology is out there. In your car you won't back into a wall because it'll alarm to you. You won't run into somebody now because the car will automatically break. So artificial intelligence is where we have to take things and we can stop these preventable deaths in the hospital. No patient in our hospital should be found dead in bed. Nobody should. A hospital should be the safest place in the world to be when you're sick. Every patient should have some wireless non-invasive small monitor attached to them just like many of you have today that transmits to that smartphone so that the nurses will come and have early warning that you're getting into trouble. The technology exists. We have to go out there and make it happen and we can do it today because we've got to learn from these mistakes we're making. We've got to be sure they don't happen again and we can do. So I'm not sure why we are with time. Does anybody know? Five more minutes. Okay thank you. All right. Does anybody know a good joke? I mean we could go around and I know something else I should mention and that is because we're in London we're in Europe and that is there was a group of European doctors who got together about six seven maybe even 10 years ago led by Danish colorectal surgeon Henrik Kalit and they decided that surgery should be safer and surgery should be faster and patients should do better and they came up with this enhanced recovery after surgery concept and the idea was that you know for colorectal surgery patients were staying in hospital for seven eight days and they were debilitated when they went out they were on a lot of pain medication and the morbidity was significant and so they re-looked at it retooled it totally and the reason I bring this up is because it's really only now getting to the United States and that's where I'm living at the moment and we're just instituting it now you know 10 years after the national health service put it in place here and I think every hospital in the national health service now has enhanced recovery what that means is by reducing opioids or eliminating them totally using local anesthetic regional anesthetic non-opioid analgesics patients are recovering faster doing gold directed fluid therapy the right amount of fluids not too much not too little patients recover much faster they're letting patients eat or at least letting them drink up to two hours before surgery we're trying to do that in the United States and I tell you to try and get somebody to drink two hours before surgery someone will stop it they won't let that happen because it's so ingrained in the system that you have to be NPO from midnight well we're slowly doing it and the early adopters we're getting now have two-day admissions for colorectal surgery those patients get out of the hospital they get to that safe place fast and the morbidity is reduced and this is going to save lives so I think this has come out of Europe and they're leading us and showing us a better way to handle surgery and it doesn't have to be just colorectal it can be all kinds of surgeries it results in large reductions in costs reduction in length of stay reduced variability in outcome and patients are doing better with less morbidity and it's saving lives so it's a new concept not here but it's a new concept in the United States and it is making a difference and it's improving patient safety how am I doing for time now we're about there three four minutes oh wow okay there was a man with a three legged camel let you all relax I think I better not go on too much longer but please when you leave here think how as some of the panelists have said how can you actually move that needle because you are the choir we're preaching to people already you're here for a reason you want to make a difference and so we we're not going to convert you into anything you're already converted how do you go out back to your hospitals your communities your institutions and make that difference and that's what we've got to do we've got to leave here and make a difference and we can do it because that's two years left to get to zero by 2020 two years and yet once this takes off and I feel after today's meeting and yesterday we have taken off you know we're making a difference now we have to really make it explode so that we get to that zero number and we can do it you can help us do it you can make it happen so thank you all very much