Episode 107: From Residency to ICU innovation: Advancing Early Mobility & Verticalization with Jenna Hightower

Early mobility is not just a catch phrase. It’s activity that can change the trajectory of a patient’s condition, hospital stay and potentially life.

Join me as we welcome Dr. Jenna Hightower, PT, DPT, CCS, critical care physical therapist, and CVP Emerging Leader award recipient.  

In this episode we learn about Jenna’s physical therapy journey and her evolution from an exercise physiologist in outpatient cardiac rehab to PT residency to her love and passion for the ICU setting. 

Jenna learned early in her career that she could make tremendous impact in the ICU despite the level of complexity and ICU acquired weakness. Listen as we discuss the importance of interdisciplinary collaboration, knowledge sharing, physiologic benefits of in-bed verticalization and early mobility progression. With a little persistence, hard work and communication change can be made.

If you work in acute care, critical care, or are passionate about advancing ICU mobility, this episode is a must-listen!

In this Episode:

• PT residency
• Critical Care Culture
• Bedrest & deconditioning
• Proning & verticalization
• ABCDEF Bundle
• The Ramsey Protocol
• Physiologic benefits of verticalization
• Transition to a non-clinical role

Resources:

VitalGo Website

VitalGo Instagram

Tilt Talk Podcast: Apple.   Spotify     Youtube

Kayli Dayton website

Bio:

Dr. Hightower earned her Doctorate in Physical Therapy from Western Carolina University in 2017. Following this, she completed a Cardiovascular and Pulmonary Critical Care Residency through Mercer University at Piedmont Atlanta Hospital in 2018. 

Dr. Hightower has served as a Critical Care Physical Therapist in multi-specialty intensive care units at both Piedmont Atlanta Hospital and Mayo Clinic Florida. Her expertise lies in early mobility interventions within the ICU, particularly for patients on advanced mechanical circulatory support devices such as ECMO, IABP, Impella, and LVAD, as well as those on various forms of mechanical ventilation. She specializes in managing complex cases involving multiple end-organ failure or shock requiring invasive support, with a particular passion for pre- and post-heart and lung transplant care. Dr. Hightower has frequently integrated the use of the Total Lift Bed into her patients' care plans to enhance outcomes, despite the complexity and acuity of their conditions.

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Linked-In: Rachele Burriesci

Text at 913-308-4494

Transcript

Rachele Burriesci: Hello, hello, and welcome to Talking All Things Cardiopulm. I am your host, Dr. Rachel Burriesci, and today we have a very special guest, Dr. Jenna Hightower, Critical Care PT and CCS. Jenna, welcome to the podcast.

Jenna Hightower, PT, DPT, CCS: Thank you for having me, super excited to be here.

Rachele Burriesci: Me too. Before we even get started, just want to give a big congratulations on your CVP award for Emerging Leader. Just want to put that out there. We have the Emerging Leader on the podcast, maybe, maybe first, maybe first, besides, besides… maybe not, maybe not.

Jenna Hightower, PT, DPT, CCS: I didn't even know I was nominated, so I'm super excited.

Rachele Burriesci: I feel like it happens that way sometimes, but there is literally no surprise, and so I'm super excited to get into your story and get to learn a little bit more about you, and so if you can just give us a brief little introduction on your background and how we got into critical care PT.

Jenna Hightower, PT, DPT, CCS: Yeah, for sure. So, I'm gonna dial it back to undergrad. I went to undergrad for exercise physiology, at East Carolina University. I'm a North Carolina girl. You probably hear it in my accent slightly. Some people call me out. But I actually didn't get into PT school my first year, and so I did a year in outpatient cardiac and pulmonary rehab, which was a really unique experience and really

Jenna Hightower, PT, DPT, CCS: I guess, beefed up my cardiopulm knowledge before school. And then fast forward, got into PT school the next year. During that time, I also was a, throughout all of college, actually, inpatient, like, acute care, PT tech.

Jenna Hightower, PT, DPT, CCS: So getting some hands-on experience, especially in the ICU. So I kind of fell in love with the ICU early.

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: I was a super nerd in college, and took way too many hours, and then worked every other… or every weekend at the hospital, two different hospitals I would alternate. So I'm a working horse by… by trade, I guess. And then got into PT school.

Jenna Hightower, PT, DPT, CCS: And I was really fortunate to have Dr. Ellen Hillegass teach our cardiopulm content in school.

Rachele Burriesci: That's awesome.

Jenna Hightower, PT, DPT, CCS: Yeah, and so I was that nerd, like, in the back of her class, answering all of the questions.

Rachele Burriesci: Yeah, we love those nerds.

Jenna Hightower, PT, DPT, CCS: Yeah, and, like, we'd even have kind of, like, some case scenarios to speak from, from experience, and she would be like, what's your background? And then, you know, we got to know each other, and she's kind of said, have you ever considered doing a residency? And I was like, what's that? I'd never even heard of residency in PT. Yeah. And so we continued talking, and she convinced me to apply, and went through the process, and then ended up doing it.

Jenna Hightower, PT, DPT, CCS: And so I did my residency through Mercer University in Atlanta, Georgia, at Piedmont Atlanta Hospital. And Dr. Hillegass was my mentor for that, my main mentor, and then I also had some kind of on-the-ground mentors, one of which was Stephen Ramsey, which everyone I'm sure has heard of, and then Erica Cokla and Tiffany Haney, who are both big educators now.

Jenna Hightower, PT, DPT, CCS: So, super unique experience, and my whole residency was in critical care.

Jenna Hightower, PT, DPT, CCS: Which, again, I never thought I would really… I always wanted to do acute care in PT school, but, you know, I never… I went into school with an open mind. I was like, you know, I did the outpatient cardio palm, you never know what I'm gonna kind of fall in love with, but.

Rachele Burriesci: Absolutely. Ended up being acute care through and through, and then residency just really made me fall in love with all things ICU, I think. I love that.

Jenna Hightower, PT, DPT, CCS: especially, I think, the ICU crowd weakness population is really what I think made me stick.

Jenna Hightower, PT, DPT, CCS: I think really seeing the big difference that we can make in that population, and you're seeing a patient at the worst time in their life, and can really make a difference. For sure. That's kind of where my heart is, I think.

Rachele Burriesci: Did you do the residency directly out of PT school? Okay, so that's also a unique experience.

Jenna Hightower, PT, DPT, CCS: Yes, I… I think it has its pros and cons, you know.

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: Residency… I'll give my residency… my shameless plug for residency.Jenna Hightower, PT, DPT, CCS: I think… I think everybody should do it. Yeah. The experience that you gain is…

Jenna Hightower, PT, DPT, CCS: phenomenal. It was the hardest thing I've ever done in my life. Hardest thing, you know, cognitively, emotionally, and physically, you know, you're working a lot of hours. Yes. But I would do it 10 times over to know what I know now, and to be able to practice at the autonomy level that I do now, for sure.

Rachele Burriesci: I 100% agree. I think the residency year is, like, an expedited growth in your professional abilities, and just gives so much access to different types of opportunities that might take you 5 to 10 years to do.

Rachele Burriesci: If you did not do a residency.

Jenna Hightower, PT, DPT, CCS: Yeah, yeah, for sure. And doing it right out of school is hard, because you're just… you're trying to figure out who you are as a PT. You're learning time management skills and documenting, and I think juggling that all while trying to just drink from a fire hose of information, it's just really hard.

Jenna Hightower, PT, DPT, CCS: Because, like, you know, in school, especially since mine was primary critical care, we don't learn a lot of that stuff in school, so I really.

Rachele Burriesci: You're learning. Yes. Yeah. When you're working your learning…

Rachele Burriesci: when you're not working, you're learning, it's a constant go. I agree with that part, where you're learning how to actually be a PT. Like, who are you as a PT? Learning your bedside manner, learning your handling skills while You know, learning the specialty care.

Jenna Hightower, PT, DPT, CCS: Yeah, and all of these new things.

Rachele Burriesci: Absolutely, but there is a big pro to doing it right at a school.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: that really is that you… you've been in it, right?

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: clinical affiliations. You've been in this learning mode, and it's sort of just like this next step, so it…

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: You're kinda like… You're ready for that, endeavor, so to speak.

Jenna Hightower, PT, DPT, CCS: Yeah, I think, yeah, the work ethic was still there. I'm still just keeping the ball rolling, and, like, the… there's real beauty in having that constant oversight and mentorship, because, like, I feel like your first year out of school is like, am I doing this right? Is it… you know, you're just second-guessing everything, and it's someone there to say, yes, you're doing it, you know, you got it, or you need to go look that up.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: And you get that all stages in your career, Jessie.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: Alright, so in your residency, you were very, you know, you were put into that critical care setting. Was that your primary set… were you in the ICU the entire time, or did you have other settings that you kind of worked through in the hospital?

Jenna Hightower, PT, DPT, CCS: Yeah, so we rotated through all, ICUs at our hospital at Piedmont Atlanta, which was CVICU, CCU, which is, like, your pre-intervention, cardiac ICU, medical ICU, well, two different medical ICUs, and then at the time, we didn't have a neuro ICU, but the neuro patients were in the medical ICU.

Jenna Hightower, PT, DPT, CCS: So, like, strokes and, things like that, a few EVDs here and there.

Rachele Burriesci: Did you do any outside, Cardiac pulmonary rehab in that setting.

Jenna Hightower, PT, DPT, CCS: We had to do rotations in outpatient cardiac and pulmonary rehab to kind of meet the criteria for residency, and then I also got, to do a little rotation at, Children's Hospital of Atlanta in the cardiac ICU, which was really cool. I wasn't primary treating, but I was, you know, kind of hands-on with the primary treating therapist.

Rachele Burriesci: Absolutely.

Jenna Hightower, PT, DPT, CCS: It's a really unique experience, too.

Rachele Burriesci: Absolutely. Yeah, we did something similar. We had about a week at the Children's Hosp… you know, Children's Hospital part of, the university, and just… it's also… I feel like pediatric…

Rachele Burriesci: Cardiopulm is its own specialty.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: hands down, no questions.

Jenna Hightower, PT, DPT, CCS: Yeah, and even more learning of just, like, all the congenital birth defects and the surgical fixes for those, and there's 10 different fixes, or 10 different procedures.

Rachele Burriesci: For one…

Jenna Hightower, PT, DPT, CCS: You know, disorder, it's wild.

Rachele Burriesci: And then handling…

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: Little itty bitty…

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: Yeah, it's just a different, different world.

Rachele Burriesci: Yes. Okay, so, I mean, we can already see there, residency just gave you so many different opportunities and places and observations and hands-on skills, but at the end of the day, your favorite population favorite setting. Seems to be the ICU.

Jenna Hightower, PT, DPT, CCS: Yeah, for sure. So through through.

Rachele Burriesci: Throughout.

Rachele Burriesci: No questions asked, hands down.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: what about the ICU are you so passionate about? Like, what makes you want to go back? It's a very complex place, it's very, you know, easy to get overwhelmed. What is it about the ICU that you're like, yes, let's do more?

Jenna Hightower, PT, DPT, CCS: I think it's the challenge of it as well. I think for sure, the unique aspect of you know, getting to care for somebody in their, you know, the worst, scariest time in their life, and really being able to make an impact. You know, in critical care, if we leave a patient in bed and let them rot there, so to speak, like, it can drastically changed the trajectory of their care. For sure. And so, just learning more about early mobility and, like, the right intervention for the right time, for the right patient, is so crucial, and it's such a unique skill set that's really lacking out in the field still. Like, I feel like that skill set is a rarity, and so I kind of fell in love with expanding that, too, and helping other clinicians learn that, because we

Jenna Hightower, PT, DPT, CCS: all don't get the opportunity to go through residency. For sure. It's kind of on-the-job learning, and I've been really fortunate to only practice in the ICU in my career, and practice in some really high-level ICUs with really strong multidisciplinary, you know, relationships and frameworks in the ICU as well, which is what has helped me learn the most, I would say.

Rachele Burriesci: Yeah, is there a specific, patient population within the ICU setting that is kind of your…

Jenna Hightower, PT, DPT, CCS: Yeah, I would definitely say, of course, like, I'm one of the mechanical circulatory support nerds, just love the physiology behind it. I think all of us in Cardiopalm really love, like, the black and white of Cardiopulm, like, it's all pressure and volume, and you can visualize it and imagine it, whereas neuro is just literally gray space, literally, and I can figure out anything with pressure and volume in Cardiopalm, and… but, like, the challenge of that and the hemodynamics is what I love the most, the really complex hemodynamics.

Rachele Burriesci: I think that's what had…

Jenna Hightower, PT, DPT, CCS: push me towards the mechanical circulatory support population, which now, in my career, I don't get to do as much of that. I get to kind of live through other people doing that and help other people learn.

Rachele Burriesci: Hate other people, yep.

Jenna Hightower, PT, DPT, CCS: Yeah, I still work in patient care, but just, you know, general ICU population for the most part.

Rachele Burriesci: Before we jump into the non-clinical role that you've moved into, let's talk a little bit more about the things that you've learned in the ICU. As you said, it's not standard of care across the country, and I will say.

Rachele Burriesci: having moved across the country in different states, you see different trends, different cultures, different, levels of PT collaboration, or PT input. So, at MRSA… Mercer… wow, see, New York fell out there. The ER…

Rachele Burriesci: ER disrupt at Mercer, your… or Piedmont Hospital, I should say, you had this opportunity of being in a place that I'm gonna assume, and I'm making this assumption, that is very…

Rachele Burriesci: pro-PT, a lot of PT input. So, I guess, tell me a little bit about that part, where…

Rachele Burriesci: PT is in that care, right out the gate, getting those patients moving early, like, just a little bit about the culture first.

Jenna Hightower, PT, DPT, CCS: Yeah.

Jenna Hightower, PT, DPT, CCS: I think a lot of it, you know, it wasn't always that way, but…

Jenna Hightower, PT, DPT, CCS: in the early days, like, Steven and Erica and Tiffany worked really hard on the relationships in the ICU and building that trust. You know, our patients are very sick, and I think it's just part of the ICU clinician nature, all disciplines, to be very protective over your patient. For sure. And I don't know you, and I don't know what you know, you know? And so you kind of have to prove yourself a little bit, so I think, like, the big part of how we've become so successful in the ICU is being there, building the relationships, showing our worth, but also showing our knowledge, so putting extra time in to learn the physiology behind all of the critical care interventions, so that you can really articulate that conversation in those multidisciplinary settings of why I think this intervention would be successful for this patient, or this didn't really work great, what can we do? Can we go to the drawing board to… what can we do to optimize that patient to be able to, you know, successfully mobilize or successfully tolerate?

Jenna Hightower, PT, DPT, CCS: I think… You know, traditionally, early mobility

Jenna Hightower, PT, DPT, CCS: used to have very, like, hard cut-off values of, like, 60% FiO2, we're not mobilizing any more than that, or, you know, they're on

Jenna Hightower, PT, DPT, CCS: two pressers, they can't do anything else or whatever. To now, it's… I feel like it's a lot more fluid, and I feel like we have a little bit of COVID to thank for that, because there was just so many people that were on high amounts of oxygen for such a long time.

Rachele Burriesci: break those rules a little bit more frequently. Yes.

Jenna Hightower, PT, DPT, CCS: Yeah, so I think, like, my biggest piece of advice for someone who is trying to build this role in the ICU would be just insert yourself in multidisciplinary rounds. You know, even if you're not invited.

Jenna Hightower, PT, DPT, CCS: insert yourself. You know, I had a couple years where I worked down at Mayo Clinic in Florida, and they didn't really mobilize a ton of their, mechanical circulatory support when I started there. They would only mobilize their Avalon, you know, IJ catheters, or IJ cannulas. And I just started showing up. You know, of course I had to stay late for work because of this, but it was worth it.But I would just show up to the ECMO rounds and be like, hey, you know, why not? Why can't we do this?

Rachele Burriesci: Absolutely.

Jenna Hightower, PT, DPT, CCS: You know, other places are doing it, this is the benefit, let's give it a try. And that's how you kind of build that relationship, and kind of show your worth, and show that we just… we do more than just walk patients down the hallway. Oh, my God. I knew you were going to react to that.

Rachele Burriesci: Well, I say it so frequently, I just… we can get into that side of it. I actually just had Erin on the podcast, and we talked a little bit about building culture.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: And, you know, every place has different experiences where, you know, if it is very pro-PT from the go, there's less of that need to, like, build the trust and show what you can do. But I absolutely agree with you. It starts at, like, not the ECMO patient. It starts at

Rachele Burriesci: Yeah. Maybe the patient who's on a vent and has… doesn't have as many,

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: extra support needed. But if you're not seeing the patient that's on the vent, you're not…

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: We're not even talking about walking with a patient on ECMO, right?

Jenna Hightower, PT, DPT, CCS: Right.

Rachele Burriesci: I do agree. One of the things I also did was insert myself into rounds, and even just having those relationships and conversations on, hey, I'm going to, you know.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: join you for this, and then insert on, like, well, why isn't this patient ready yet, or what can you do? I think just being able to articulate with the physicians and allow them to see that knowledge, like you said, is step one.

Jenna Hightower, PT, DPT, CCS: Yeah, and definitely, like, you would probably agree with this, that especially starting out early mobility in ICU, sedation is a huge barrier. Huge. And until you can overcome that, like, it's a lot of work, especially physically on yourself, if you're just getting started with those patients when they've already been sedated for a whole week or whatnot. Like, it's physically hard work. I used to joke with my family, like, I don't leave work without being drenched in sweat, at least at once during the day, like…

Jenna Hightower, PT, DPT, CCS: Because those patients are so much work, but, like, the more you get in there and put in that work, the more it advocates for that benefit, and the sedation starts coming off sooner and sooner and sooner. But of course, educate yourself on sedation and how to advocate for it coming off of culture in the ICU, right?

Rachele Burriesci: Where you typically have more sedated patients.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: on high-level support systems, right? That's just the culture of it.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: Just starting to change that culture is, maybe that's step one, to be honest.

Jenna Hightower, PT, DPT, CCS: Yeah, yeah, for sure. And just helping educate your colleagues on sedation culture and the A to F bundle and things like that. I will give, like, a little plug for my friend Kaylee Dayton, who's a nurse practitioner who does the Awaken Walking ICU approach. Like, if you ever need a resource her podcast and website is, like, the, you know, the start from the basics. If you know nothing, like, you can learn a lot from her, for sure. And, like, she speaks the nursing language, you know, so it really helps, you know, translate that message, if you know what I mean.

Rachele Burriesci: Yeah, she's a great bridge between the nursing world and the PT world, to be honest.

Jenna Hightower, PT, DPT, CCS: For sure.

Rachele Burriesci: is, you know, that relationship is necessary to make this successful.

Jenna Hightower, PT, DPT, CCS: Yes, yes.

Rachele Burriesci: down.

Jenna Hightower, PT, DPT, CCS: Yeah, something else I would do a lot in residency, especially when I was just trying to build relationships and get comfortable in the ICU, is I would sit up there and write my notes, and, you know, all the time, somebody's poking their head off, can you grab me some socks? Can you give me a boost? And, like, sure, I'm here! You're the favor, and then they learn to really appreciate you, so that when you need those second pair of hands, when you're mobilizing patients.

Rachele Burriesci: for sure.

Jenna Hightower, PT, DPT, CCS: They don't mind to stop what they're doing and helping you.

Rachele Burriesci: It's all those little interactions that.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: build that trust, build that relationship, because, like you said, if I just show up, right, maybe as a PRN, maybe as a new therapist, maybe someone who doesn't frequent the ICU much, and I'm like, oh, hey, you have this patient who's on this high-level oxygen, who has an IABP, who has ECMO going, who's vented, you know, fill in the blank. Right. I'm just… I'm gonna go get them up, see you later.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: pump the brakes, right? So you have to build…Some of that before you even get going.

Jenna Hightower, PT, DPT, CCS: Yes, for sure. And it keeps the nurse from going, you're not touching my patient.

Rachele Burriesci: Exactly, right? And it's also just, like, that familiarity of knowing somebody in the ICU.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: Right? Like, oh yeah, Rachel has come this many times, and she's always really proactive for her patients, and they tend to do really well. Jenna comes, and, you know, they start really progressing after that, having those.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: sort of… experiences, I think, also add to the trust.

Jenna Hightower, PT, DPT, CCS: Absolutely.

Rachele Burriesci: Let's backtrack a little bit. So, we do have, you know, still many ICUs that are heavily involved in sedating when we are on these higher-level supports, and then PT is consulted when they're either extubated or they're starting to pull back on some of the sedation. And we have this significant IC weakness. We're just, you know…Not able to lift our arms, unable to dorsiflex, like, ankle pumps would be considered an activity at this point.

Jenna Hightower, PT, DPT, CCS: Right.

Rachele Burriesci: Let's talk about that patient, besides the laborious part, right? Because we can all talk about the old school way of, you know, getting that person to the edge of the bed, dependent of 2 to 3, whatever it might be.

Rachele Burriesci: You have mentioned, in our conversations previously, and from what I know about you, a concept of verticalization. Tell me a little bit about when you were introduced to verticalization in the ICU, how this has helped with this very extreme, you know, weakness-type situation. Like, give me some of that history.

Jenna Hightower, PT, DPT, CCS: Okay, so in my residency, I was introduced to verticalization, or the concept of verticalization, specifically in-bed verticalization. So, a hospital bed that has capability to fully stand a patient, without having to transfer on and off to another device. Yes. And…it…I mean, transformed my care in the ICU, and I… some people may think I'm biased, because I work for one of those companies now, but, like, truly, I have seen, like, miracles happen with this type of therapy and the right approach. And that's kind of how I fell in love with it, was that patient. So, the patient that maybe ended up prone and paralyzed with ARDS, Especially during COVID. And they were down a month, and they come to you, and they literally can't even lift their finger off the bed. They're just a shell of a human, and it's like, what do I even do with this patient? Right. So I was first introduced in residency to that type of patient, and then they also, at Piedmont used the total lift bed or verticalization a lot for, ambulating femoral balloon pumps, the Ramsey Protocol.

And then also ECMO patients as well, complex ECMO patients. But I really, really got my most experience with verticalization in my time at Mayo to bring the bed in there, we were getting all these patients from outside hospitals during COVID that, again, prone and paralyzed for a long time, they would send them to us, they would say, you know, put them on ECMO as a last-ditch effort. Well, now their lungs are super scarred, and they need a lung transplant.

Rachele Burriesci: Right.

Jenna Hightower, PT, DPT, CCS: And it's like, oh, you can't listed for a lung transplant until they can walk down the hallway. And you're like, that takes months. Like, how's this person gonna survive that? And so, what we did, I… luckily, before that point, was super annoying to our medical director, and would literally place, like, an article or a brochure on his desk or in his inbox every single day for literally 9 months. That's how long it took me to get approval. Wow. So, persistent.

Rachele Burriesci: Persistence. Lesson of persistence. But it worked.

Jenna Hightower, PT, DPT, CCS: And of course, he was like, yes, you can do this, right when, like.

Jenna Hightower, PT, DPT, CCS: you know, crap hit the fan during COVID, and it got really bad. And I was also, since I was the sole CCS down at Mayo, leading the COVID task force for our rehab department, on, you know, how are we treating these patients? What's our approach? What protocols should we have in place for titrating oxygen? That sort of thing. And so, I was very busy at the time, but I was like, I care a lot about both of these things, and I'm not

Jenna Hightower, PT, DPT, CCS: gonna let this fail. So I was working a lot. But again, it was worth it. So we would… what we would do is we would put these patients on the total lift bed as soon as they would cannulate them for ECMO. Usually, they were already trached because they had been on the ventilator so long.

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: Not that that would be a barrier, but, at least at that point, sedation was off, for sure. Okay. And we would slowly verticalize them, so easing into upright. A lot of times they can only tolerate, like, 25 or 30 degrees at a time. And I would work on gravity-limited exercises with their upper extremities, trying to lift their head off the bed, you know, quad sets, mini squats, things like that, and slowly progressing them. But I was very aggressive, so, you know, those patients, as you know, don't tolerate long periods of time. It's very short windows. So, like, we spend all of this time transferring them onto an external device, they only tolerate 5-10 minutes, and then you gotta get them back, and there's your session. Yep. So it was really convenient with the beds that we could do this multiple times a day, so I would coordinate with the OT, and we would usually alternate, like, who got morning session, who got afternoon session, because typically the patient did a little better in the morning. Yeah. And then we would have chair position in between, exercises with the family, and then nursing was doing tilt. So, PT would do a tilt, OT would do a tilt, day shift nursing would do a tilt, and night shift nursing would do a tilt.

Rachele Burriesci: Nice, so now we got 4 times upright.

Jenna Hightower, PT, DPT, CCS: Yeah, plus chair position in between. I mean, the patients were exhausted, but it was working. And of course, you know, I could go on another tangent about nutrition in these type of patients, especially when you've got, you know, metabolic demand and all sorts of systemic inflammation, so that was a key part of the multidisciplinary conversation as well. But these patients were maxed out on support on ECMO, on the ventilator.

Rachele Burriesci: Okay.

Jenna Hightower, PT, DPT, CCS: Whereas previously, like, we wouldn't really touch those patients, because, you know, if they decompensate, you have.

Rachele Burriesci: You have no backup. Right.

Jenna Hightower, PT, DPT, CCS: Yeah, so it was a lot of trust and heavy communication in the multidisciplinary team on optimizing everything in that patient picture. Okay. And it worked. So ee got, and I ended up writing up one of these cases, but we were able to get these patients standing with menaces at the edge of the bed in 3 weeks.

Rachele Burriesci: Wow.

Jenna Hightower, PT, DPT, CCS: Which is just crazy fast. That's crazy fast. Yeah, like, with traditional PT of, like, only working with those patients 4 or 5 times a week, once a day, like, it takes at least 3 months to get there.

Rachele Burriesci: Yeah. And that's if you have an aggressive family and whatnot. So it definitely… And so it's happening in between. Yeah, yeah, setbacks and other procedures, and they've got wounds and all of that. Yep. So it…

Jenna Hightower, PT, DPT, CCS: that's when I really, like, fell in love and was like, wow, this isn't…

Rachele Burriesci: Amazing. So much better.

Jenna Hightower, PT, DPT, CCS: Cool. Yeah. Yeah. And then we would even, I'm sure you've heard of the Moveo, but that's another one of my favorite toys. Like, we would even progress to the Moveo to get, you know, more reps in of those squats to work on that side egress. And I would get to a point, like, once patient had some head control. I would work on sitting edge of bed and progress from there, as well as leave the session with them in a tilted position for nursing to monitor, so that you're kind of optimizing your therapy time, so you're still working on those functional outcomes, but also supplementing with some additional weight-bearing time.

Jenna Hightower, PT, DPT, CCS: Yeah. Which is really nice.

Rachele Burriesci: And building endurance simultaneously with all that.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: So let's talk a little bit about why verticalization helps from, like, a nerdy perspective, digging into some of the physiologic benefits, right? Yes. So, what types of things, and we can kind of go just systematically a little bit, and just do bits and pieces, and we'll kind of point them in a direction to your podcast to get more on this, but let's just do a little bit of a brief.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: So, we're using a bed to verticalize. And with that, we're increasing time upright. What… what is the patient… what's happening? Why is.

Jenna Hightower, PT, DPT, CCS: Yeah.

Jenna Hightower, PT, DPT, CCS: So, first and foremost, there's many pulmonary benefits, and there's very preliminary data on this, but we're working on some bigger studies to try to prove it, but, you know, it actually has, you know, the preliminary data shows there's very similar benefits to verticalization as there is proning.

Jenna Hightower, PT, DPT, CCS: So, you're changing position of the lungs. Our bodies are designed to be upright, they're not designed to be flat in bed. So, just with, like, proning, in upright, you're changing that position of blood flow. Also, changing the position of all the exudate or whatever gunk is in your lungs.

Rachele Burriesci: Yep.

Jenna Hightower, PT, DPT, CCS: And setting up a better success for VQ matching, or ventilation perfusion matching.

Rachele Burriesci: Yep.

Jenna Hightower, PT, DPT, CCS: Which then helps your PF ratios, or your oxygenation part. It helps with secretion clearance, helps with lung volume, so, you know, not only does the diaphragm come off the belly, or belly come off the diaphragm, so you have more expansion, but also, when you're flat on your back, your heart is on your left lower lobe, so when you sit upright, that comes towards anterior, towards the chest, and you've got room for that anterior or lower lobe to, expand. And then also, there was an interesting study out of China in 2022, where they just passively tilted patients on tilt tables for 30 minutes a day, patients on ventilators, so on ventilator support, which we know patients' long-term ventilator use causes diaphragm atrophy.

Rachele Burriesci: Yeah, significant diaphragm weakness.

Jenna Hightower, PT, DPT, CCS: Yeah, and just the passive change of position in these patients that were sedated for 30 minutes a day, they had improved diaphragm strength and less diaphragm atrophy.

Rachele Burriesci: Interesting.

Jenna Hightower, PT, DPT, CCS: Which is super interesting. Yeah. So I would love somebody come approach me, let's publish more about this.

Rachele Burriesci: For sure.

Jenna Hightower, PT, DPT, CCS: I was actually just.

Rachele Burriesci: I was talking with a colleague about some of the bed rest studies that were done in astronauts, and one of the things, like, from the pulmonary perspective, that really isn't spoken about, and I was like, correct me if I'm wrong, but the diaphragm really isn't mentioned. Like, we talk about mismatch, we talk about volumes and, you know, volume changes, but there's not a lot of talk about diaphragm weakness, and I assume it's because most of these studies are done in Trendelenburg, where you're not positive pressure ventilated, and you're technically breathing against gravity, so it's not a true…Right. …show of what happens in true bed rest.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: So, when you verticalize, right, what's happening with the position of the diaphragm? Let's talk about that a little bit.

Jenna Hightower, PT, DPT, CCS: Yeah. So, of course, allowing for more diaphragmatic expansion in upright, especially patients with the big ol' rock-hard bellies, which is, like, classic a lot of our patients. Yeah. And just being able to get your ribs in a more physiologic position, too, to come down and out. Rather than having to fight gravity, as well. So, that's super interesting, and like. I would love… I know that you're a big inspiratory muscle training gal, but I would love to research that aspect in different position changes, too, you know, especially in that very weak patient.

Rachele Burriesci: Yeah, for sure.

Jenna Hightower, PT, DPT, CCS: Maybe even, you know, after they get off the ventilator, of course, but yeah.

Rachele Burriesci: I really even think just being in that upright position kind of creates that parachute sort of position, right? And it reminds me of, the change that happens in the pediatric patient. So, when they're, you know, real infants, they have these flat ribs and a flat diaphragm, and they're not very efficient in their breathing, and it's not until they start walking and they're upright that the ribs start to drop in angle.

Jenna Hightower, PT, DPT, CCS: Yep.

Rachele Burriesci: that you create that nice parachute change, which allows that increased excursion, so I can just, like I'm just seeing that picture kind of push through of being okay, and just being able to change that position for the diaphragm to allow, especially if they're not vented. I mean, there's some.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: there's still some things that are happening if you are vented, but the study from China is actually really interesting, then. Yeah. It's interesting, I'll just send it to you. Yeah, absolutely. I actually heard about that study on your podcast, and I was like, I need to… I have to download… I haven't downloaded it yet, so if you want to send it to me.

Jenna Hightower, PT, DPT, CCS: Yes, it's very interesting.

Rachele Burriesci: So, let's go back to VQ matching just a little bit.I think it's a really important thing to just kind of think about, is gravity's role in air and perfusion, right? Yeah. And when you're flat, everything is sitting against that posterior aspect of the back, and so…

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: what… why is that a problem? And I have a…

Jenna Hightower, PT, DPT, CCS: So…

Rachele Burriesci: I like to do with this, so you go first.

Jenna Hightower, PT, DPT, CCS: Yeah, so when you're flat on your back, especially in very sick lungs, and you've got all the exudate, all your vascular beds are also, like, strongest and posterior in your lungs, and so you just get all of that exudate. On top of that, and so if you're, like, down to the little tiny alveoli, you're… you're messing with that ability for your oxygen and carbon dioxide to… to move across that barrier, so to be able to literally, you know, exchange gas. And so being able to change position, and same concept with proning, so proning, you're flipping over, and you're… you're putting all the exudate in the front of your lungs. back to actually perform gas exchange. Yes, yeah, and so it's a very similar concept. And it's really interesting, if you've ever had a patient where you've experienced this, is, like, especially pulmonary hypertension patients, but even my ARDS patients, if they've got a pulmonary artery catheter, and you can see those pressure changes, as well as, like, starting out with, you know, if they're flat, their stats drop to, like, 

Jenna Hightower, PT, DPT, CCS: And then you can get close to 100%, and upright is really wild with just that position change and not having to alter, you know, the amount of supplemental oxygen that you're giving them. Yeah, so that's kind of one of my other favorite pools, so something I did… we… I learned in residency also was, we would verticalize patients kind of off… off PT plan of care, so they weren't… we weren't necessarily seeing them yet because they were still heavily sedated or whatever, but they would tilt them for those, you know, gas exchange benefits. Yeah, for sure. To kind of, you know, avoid proning, which is really interesting.

Rachele Burriesci: I could also see that being beneficial for the RT to actually do their breathing treatments during upright positioning, and improved ability to move that air more distally.

Jenna Hightower, PT, DPT, CCS: Yeah, yeah, and get more effective cough, things like that. And then also, yeah, also something unique. that I did in my residency was, we would extubate our, like, bigger patients, bariatric patients, in upright, so in the tilt position, to get their belly off so that they could come down on those peak pressures and come down on the peep on the ventilator to be able to successfully extubate them. And then we would leave them upright for a good hour or so afterwards to help them kind of be successful.

Jenna Hightower, PT, DPT, CCS: For those first bits off, And I will never forget walking in, I was there by myself on a weekend, mid-residency, and the doctor's like, hey, Jenna, let's go, we're gonna extubate bed such and such, and standing, and you're like, wait, what?

Rachele Burriesci: That's awesome, I love that idea. I mean, it makes so much sense.

Jenna Hightower, PT, DPT, CCS: Yeah, and come to find out, now that I've kind of gotten out and, networked at other hospitals and such, there's quite a few hospitals that use our bed to do that, which is really interesting.

Rachele Burriesci: That's very cool. I love that.

Rachele Burriesci: Yeah, I think that's a great addition. I mean, what I really love about the idea of using a specific bed for verticalization is the ease of it, right? And the ability to use it throughout the day. I remember in my residency, having a patient who is actually one of my favorite patients, he kind of sticks in my mind. He was an ARDS patient was sedated for a very prolonged period of time. He had significant orthostatic hypotension post, and we were just bottoming out, bottoming out, bottoming out. So I was like, alright, we're doing the whole tilt table thing, guys. Like, we're gonna try it. And so here I am, by myself, pushing this tilt table through a hospital, trying to get to the elevators that will fit said tilt.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: Getting it into the ICU, getting it into the room, transferring the patient to the tilt table, which is hard, and doesn't have, like, the right mattress support, and, you know, probably have wounds, and…

Rachele Burriesci: And then… we went right back.

Jenna Hightower, PT, DPT, CCS: Yep.

Rachele Burriesci: And that was, like, a 2-hour… venture for.

Jenna Hightower, PT, DPT, CCS: Yeah, you, like, don't have a choice with a patient like that.

Rachele Burriesci: Right. But having the ability to have the person in that bed, and be able to verticalize multiple times a day, throughout the day, with different disciplines, is just, I think, game changer.

Jenna Hightower, PT, DPT, CCS: Yeah, absolutely. It's really… that's what I tell people all the time, is use it to augment your plan of care, because it truly can accelerate that rehab process if it's used appropriately.

Rachele Burriesci: For sure. And not just during your PT session. Yeah. Yeah. Let's talk a little bit about the cardiovascular benefits, if you don't mind.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: So what is The physiologic benefits from a cardiovascular perspective, the verticalization aspect.

Jenna Hightower, PT, DPT, CCS: Yeah, so, you know, just like everything else in our body, you know, when we don't stimulate our baroreceptors in our vessels, they get lazy too, and, you know, our patients will get orthostatic hypotension, when they lose that, you know, input. into, you know, the vascular system, and so that simple change in position really helps stimulate those. But also, you know, getting muscle pumping and things like that also helps that systemic response. But it can help prevent it, but also it helps treat it in those patients that already have that, or, you know, maybe they have been down for a long time, or they're septic, or whatever it may be, and they're just not quite tolerating the upright yet, being able to ease into that, without having to, you know, heave-ho to the side of the bed, they drop immediately, you lay them back down. done, you can kind of find that sweet spot. You can work with your nurses to titrate your pressers, your inotropes, to really figure out what support the patient needs to be able to tolerate upright. Because at the end of the day, we want to keep our patients strong and functional, or excuse me, with a disorder like that, you know, it can really set a patient back. For sure. Because it does… it does take time to, It does take time to recover from those type of things.

Rachele Burriesci: Yeah. And just the hemodynamic response of tolerating it and then doing exercise in it, right?

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: like two separate entities. Where now we're able to work on Strength.

Jenna Hightower, PT, DPT, CCS: Yay.

Rachele Burriesci: Endurance, in an upright position, start to get some of that.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: sensitivity back.

Jenna Hightower, PT, DPT, CCS: And for, like, the very low-level patient, just that simple gravitational load is their exercise. Like, that is very taxing for them, so building that endurance for just tolerating upright can be a big barrier in the beginning, too.

Rachele Burriesci: So that's a good segue into, like, how do we document this? How do we call this skilled? Because I'm thinking about that person, right? Where we're just lifting them. Yeah. They have a hemody… they're responding to it. Heart rate's going up, blood pressure's coming down, we're titrating pressures. Literally, the verticalization is the treatment.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: How are we documenting? How are we showing skill in said activity?

Jenna Hightower, PT, DPT, CCS: Yeah. There's something, I guess, misconception I hear all the time is like, oh, I can't bill for that because it's passive. When that's definitely not true. Like, it's still a very skilled therapy, and it's all on how you document it. So, what are your goals? So, for that type of patient, I'm working on gravitational load for muscular strengthening. I'm working on pulmonary hygiene through improved BQ matching and, you know, improving diaphragm function, cough effectiveness, cough position, postural strengthening, all things that you can work on, and of course, you can supplement upper body, you know, exercises during that time to maximize your time upright as well. You're also working on cognitive stimulation, so you know, stimulating your vestibular system, you know, especially if patients have hypoactive delirium, getting that multimodal positional cognitive stimulation is really important.

Though all things that you can document to really maximize that time in verticalization, where you feel like you're not really doing anything, but if you think about it from a system level, you really are impacting each system, and it's just, what is your main goal for that patient?

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: Is it upright tolerance? Is it strength? Is it, you know, percentage of weight-bearing? That sort of thing? Is it pulmonary hygiene? Is it improved vital signs?

Rachele Burriesci: Yeah, even time could be included in that.

Jenna Hightower, PT, DPT, CCS: Yes, yeah.

Rachele Burriesci: I really… I really can see, doing a ton of breathing exercises and airway clearance in this position, and just Having that gas exchange, ventilation being a big focus.

Jenna Hightower, PT, DPT, CCS: Yes, yeah. And, like, your… those are your outcomes, so angle can be an outcome, percentage of weight-bearing can be an outcome, time can be an outcome, ability to progress from gravity eliminated to gravity resistance exercises to even TheraBand. You know, time, you can advance to marching in place, you can do secretion clearance, you know, incentive spirometry… incentive spirometry, you know. inspiratory muscle training, like, there's so many things that you can do in Upright. Exactly. And you can check cognition as well. Yeah, would be fun. Fun stuff.

Rachele Burriesci: I was gonna actually talk to you about progression of activity, so you just did a great job of doing that, so let's… let's keep going with that. We have the patient now.

tolerating upright position. We're able to do some pre-gate activity. How might we then progress to ambulation, or off the bed? Is it even… I guess we'll switch a little bit, and we'll talk about your specific bed that you… the company that you work for, if you want to just kind of give the name to start.

Jenna Hightower, PT, DPT, CCS: So it's the VitalGo Total Lift Bed.

Jenna Hightower, PT, DPT, CCS: And it does have the unique feature of, one, a movable footboard, but also it has biofeedback scale in the footboard, so it'll actually calculate the percentage of total body weight. And so some of my progression on it, I'll actually have Patients do, like, leg press on it to, like, a certain, like, weight, or a certain amount of force. On it as well, or I'll do percentage of weight-bearing, like, maybe once they can tolerate at least 50% weight-bearing for 30 minutes, and they can hold their head up off the bed, lift their arms against gravity, let's try sitting on the edge of the bed. You know, working on those more functional sit-to-stands, and then still supplementing with that verticalization time to just continue to work on that upright tolerance and strengthening, if that makes sense.

Rachele Burriesci: Yeah. That's fantastic.

Jenna Hightower, PT, DPT, CCS: Like I said, like, I will… I'll use my session working on those functional things, and then, you know, have… have them tilted at the end of the session for nursing to monitor, or things like that.

Rachele Burriesci: For sure. And that specific bed, you can stand on the foot of the bed and step off of that foot of the bed safely, correct? Yeah, it goes fully to the floor, yep. Awesome. And so, I mean, that's a huge benefit if you're thinking about other circulatory support devices like IABP, which tends to be a very limited depending on your facility, on femoral access. So, we have femoral access in a lot of these patients. We're able to stand with said.

Jenna Hightower, PT, DPT, CCS: Yep.

Rachele Burriesci: Bed, and then literally walk off the bed. Yes, yes. I mean, that's also a game changer.

Jenna Hightower, PT, DPT, CCS: Yeah, yeah, and, like, it's also nice, like, bringing OT into the picture, like, they can do standing ADLs and things like that in full standing, but also, like, especially if that patient started out weak and you're working up to it, you can still work on those kind of pre-gay activities or marching in place and being hands-free, because they've still got safety straps or whatnot, you can work on standing balance.  Whereas, like, maybe you're not confident to walk away from the bed yet, that sort of thing. Yeah. But you still can have that kind of safe, hands-free environment. But it is… it's crucial with the mechanical circulatory support, Especially femoral balloon pumps, because those patients would otherwise be on bed rest.

Rachele Burriesci: Right.

Jenna Hightower, PT, DPT, CCS: But, I interviewed Steven Ramsey on our podcast recently, and, like, something I didn't think about was, like, just the ability to, like. Stand up frequently throughout the day when you're stuck in the bed the rest of the time with a balloon pump, and, like to be able to, like, stand to use the bathroom for the men, like, things like that, like, your most human thing. Whereas, you know, if you didn't have that type of technology, you would just be stuck there. And I can't imagine… a lot of those people that end up with the balloon pumps are relatively active people, that have this kind of life-altering event. And then you end up, you know, you gotta go to surgery, and you get weak by the time you go to surgery. It just makes things much, much more complicated.

Rachele Burriesci: Yeah, it definitely prolongs your time in the hospital.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: level of impairment that you're gonna see, just because you have this device that is literally life-saving, but now you can't do anything.

Jenna Hightower, PT, DPT, CCS: Yeah. And then for ECMO, you know, there's a lot of facilities that mobilize ECMO well. But that's still only happening one time a day, where it takes 3, 4, or 5 people to do it, depending on what other equipment the patient's got going on. For sure. So the nice thing about the bed is that it's… the patient can still get upright and weight-bearing with just the nurse.

Rather than having to have the whole team there, depending on the complexity of the patient, which is really nice, because I tell people all the time, like, we… we put our patients in the hospital, and we only get them up once a day, and it's just… it's not enough. Like, even when you're quote-unquote sick at home, like, you're getting up to go to the bathroom, you're getting up to get a drink of water, fix yourself some food, like, minimum 5 times a day.

Rachele Burriesci: For sure.

Jenna Hightower, PT, DPT, CCS: And the more we can simulate in the hospital, the better our patients are gonna do.

Rachele Burriesci: Yeah, it's gonna allow the ability to get more reps more frequently, and with less, like, team support, right? Because it becomes a difficult thing when you have to get 4 or 5 people in a room to coordinate this, like, one big activity, when you can have it done 4 or 5 times in a day, just by literally pressing a button.

Jenna Hightower, PT, DPT, CCS: Yeah. And if your facility doesn't mobilize these patients, and you would like to, it's a, like, very low barrier to entry, if that makes sense. So, like, it's very safe, you're easing into upright. If they don't tolerate, you just put them back down, and it helps kind of build that confidence level with the medical team of, like, oh, we can do this. Helps you get your protocols in place, your multidisciplinary dynamic.

Jenna Hightower, PT, DPT, CCS: With a very, you know, low-risk scenario.

Rachele Burriesci: Yeah, for sure, it's a good starting point. I mean, I have worked in a number of different hospitals now, and, like, some are very proactive, and some are still not mobilizing patients on MMO because they have femoral lines, or just because they don't have the experience, or.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: culture to do that.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: This just being a really easy.

Jenna Hightower, PT, DPT, CCS: Yeah. You would be surprised how many places don't mobilize patients on CRT, or just a Swan gan's catheter, like…it's… there's… there's a lot of facilities that are behind, and not to put those facilities down, like, it's… it's not the PTs, necessarily. It may be, but you don't know what you don't know, but it also, a lot of times, is the old school physicians that just will not change… will not change their practice.

Rachele Burriesci: Yeah, it is not a, universal standard of care, so to speak.

Jenna Hightower, PT, DPT, CCS: No, yeah, it's not.

Rachele Burriesci: So, I think that's a good segue into a little bit more about VitalGo.

Rachele Burriesci: Let's talk about if you're a facility who doesn't have this type of bed. How do we even… how do we get access to this? How do we even go about ordering it? How do we get some in-service about it? How do we… like, what does this even look like?

Rachele Burriesci: Yeah. That process.

Jenna Hightower, PT, DPT, CCS: Yes, so, we don't do any direct sales. We operate through larger distributors that have kind of bigger… bigger footprints. And so those companies in the U.S, are Agility, Arjo, and U.S. MediQuip.

And typically, hospitals already have some sort of relationship with one of those companies, and those companies offer our bed for daily rentals, so, like, a case-by-case basis, or purchase. I think a lot of people make the assumption that the bed is, like, astronomically expensive. It's not, it's the same price as a traditional ICU bed. Yeah, which really helps with the conversation, because it's like, you gotta buy beds for your patients. Why not buy ones that stand, you know?

Rachele Burriesci: For sure.

Jenna Hightower, PT, DPT, CCS: But also, most hospitals start out with the bed with daily rentals, and then if they're using a lot of them, then they'll end up purchasing a couple.

Rachele Burriesci: Especially to kind of get your protocols in place, and what you're using it for, and that sort of thing. For sure. So access isn't quite as hard as you think.

Jenna Hightower, PT, DPT, CCS: Sometimes, you know, there is a lot of red tape and, you know, barriers to getting it on contract, and that process just takes time at hospitals. But, of course, the company, so our distributors take care of all of that. So, you know, if I can get this bed into Mayo Clinic, of all places, as a PT, you know, you can do it too, is what I tell people all the time. You just have to have the right key players involved. So, like, in my experience, it helps if you have a physician champion to help bring it on board, because they're the, you know, the money makers of the hospital.

Jenna Hightower, PT, DPT, CCS: And if you have a physician advocating for it, it usually helps, you know, the procurement and operations people say, okay, let's… let's look at this, at least. And then usually what happens is we bring it on-site for a demo, the medical team says yes or no, and then procurement works with the distributor to try to get it on contract for either rental or purchase.

But the key part is education. So, making sure that the nurses and all members of the multidisciplinary team know how to use the bed, and since I've been with the company, we have really kind of figured out that formula for success, because if the nurses don't know how to use it, they're not going to use it.

And then you're just basically overpaying for a tilt table if only PT and OT is the ones making the effort to tilt.

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: So the key is really getting that, that, you know, multiple times per day, and getting the buy-in. And even if you don't have a great mobility culture, like, it really does help grow that process, which is really nice. We've helped a lot of… a lot of facilities grow their, their mobility culture, especially with mechanical circulatory support, which is… has been really fun for me in this role.

And then As far as education process, like, we're typically there for several days in a row, making sure we catch multiple nursing shifts, day shift and night shift. We usually do, like, a separate class for PT and OT to do a little more of, like, the treatment aspect, that sort of thing. And then I also encourage facilities to do a super user class, so having a group of, like, key personnel within the facility that really know the bed, you know, know how to troubleshoot the electronics, things like that, to, make sure that… and train the trainer, so you're… you're the person internally that can help the new people that come on board learn how to use the bed, too.

Rachele Burriesci: And then what about education long-term? Because sometimes this requires multiple iterations to really get it going, having, you know, different teams, like, if there's a neuroICU and a CVC ICU, there's a lot of train-the-trainer, but, like, is there any additional, like, later-on education if needed?

Jenna Hightower, PT, DPT, CCS: Yeah, so we typically try to educate every ICU that's involved, especially if we're doing initial rollout, so we spend time in every unit. Okay. Especially because nurses, it's hard for them to leave the unit during the day, so your education is most effective if you're there on that unit.

Jenna Hightower, PT, DPT, CCS: But also, you know, some hospitals may only start out in the CVICU, and they say, okay, we want to expand this to other units. So we would come back for that sort of thing, and come up with a plan with the facility for that sort of thing. But also, we really encourage facilities to let us be a part of, like, skills days, so if they have nursing skills days with mobility equipment or other rental beds, so, like, some of the specialty wound surfaces, that sort of thing, to let us be a part of that, so it's kind of constant exposure for the nurses, and you catch that turnover that naturally happens. Yeah. And then also, a lot of facilities offer classes annually for balloon pumps if a nurse is, you know, competent to care for balloon pump patients, or ECMO patients, or Impella. And so something we do at Piedmont is we are a part of that class, so PT does, like, a little brief lecture on the mobility protocol for mobilizing bloom pumps, and then we're there with the bed, showing them how to use the bed, too. So that way, you know, annually, it's… and we actually do that.

Rachele Burriesci: No, they're.

Jenna Hightower, PT, DPT, CCS: times a year, but they're getting, you know, getting that process in, and it really helps with compliance the more kind of exposure that they get.

Rachele Burriesci: For sure.

Jenna Hightower, PT, DPT, CCS: We have a lot of supplemental material now, too, but really the hands-on practice is what helps the compliance the most.

Rachele Burriesci: Because you, I mean, I just know from experience, like, you get in there, you do the in-service, you're playing with the bed, you're like, yep, got it, and then the first time you see it, you're like, oh, yep.

Jenna Hightower, PT, DPT, CCS: Yeah, or if you don't actually have a patient for a couple weeks, and you're like, wait a minute, how do I use this thing?

Rachele Burriesci: Where is that button that allows me to go?

Jenna Hightower, PT, DPT, CCS: And that's where…

Rachele Burriesci: petition, and… Yeah.

Jenna Hightower, PT, DPT, CCS: Yes, and that's where the super users come in handy, too. So, like, we try to get the charge nurses or the nurses educators to be kind of super users, so that if a nurse hasn't used the bed or hasn't been a while, they can kind of call that person and be like, can you show me how to do this?

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: But of course, Throwing all the supplemental material at them as well usually helps.

Rachele Burriesci: Yeah, for sure. Let's kind of swing to a different topic, and just talk about the new role that you're in, and that transition from being that ICU critical care physical therapist to now working for a company that champions equipment for the critical care.

Those are very different skill sets, and it's, you know, a non-clinical role. So, first of all, like, talk about the transition and how that even… from the sound of it, I can hear that, like, it was an organic transition in some regard.

Jenna Hightower, PT, DPT, CCS: Yes. I mean, I never thought I would be doing anything like that. Especially when I was in residency and coming off residency, you know, I thought I would be in patient care till I retire, which I still am, I still keep my foot in the door. Yeah, for sure. One, just to manage my license and CCS, but also I feel like it just keeps you relevant.

And I… I just, I love patient care, so… but I, met my… my boss during my time at Mayo, and he just was like, we really would be interested in having some, like, someone like you work for our company. They didn't have anybody clinical. And it really is like a clinical sale, like, you really have to kind of know your stuff to bridge that gap with nurses, especially if it's a facility that's new to this type of concept. Right. So, I was like, me? I'm just a PT, like, I don't know anything about the corporate world or working in medical devices, like, no, you're funny, but…

Rachele Burriesci: Here we are.

Jenna Hightower, PT, DPT, CCS: Well, yeah, he was like, well, just think about it, and so the more I thought about it, my husband and I were looking to transition back to the Atlanta area, to you know, be closer to family to start building a family, and I knew I would be leaving Mayo, and I, of course, wanted to work back at Piedmont again, but I was like, well, let me just explore this and see what happens. So I started as just, like, a consultant role, so just literally, I think I was working for them 4 days a month.

Rachele Burriesci: Okay.

Jenna Hightower, PT, DPT, CCS: Basically as a consultant, and then there was just a lot of work to be done, and a huge need for this type of position. And so I ended up going PRN at Piedmont. And when I started back, I was working a lot more in patient care, and then I kind of slowly backed away from it, but having the flexibility of being carrier in was the nice part about that. And now I'm full-time for them, but still work, you know, the occasional weekend at Piedmont, working this weekend. But…Yeah, it was kind of an organic role, and  

Jenna Hightower, PT, DPT, CCS: really, the research behind it has kind of changed my role as well. You know, when I first started with this, it really started as an afterthought, a rescue tool for patients, a really PT-driven tool. And now, studies have come out over the last year where it's like, we really can use this as an early positional intervention.

Rachele Burriesci: For sure.

Jenna Hightower, PT, DPT, CCS: And so I've just gotten passionate about helping that grow more. And I was a little sad to step away from patient care, especially… I really… not that I don't love my job at Piedmont, too, but I really loved my job at Mayo. It was just a really unique situation there with some fantastic physicians. And we had a great, great team in the ICU, but the way I look at it is I Get to reach out and touch many more patients than I could with my own two hands, because, like, at the end of the day, you're impacting mobility all over the world, which is really cool. So we're in over 40 countries all over the world, so I've gotten to travel all over and experience healthcare and culture all over the world, and really influence that. And it's been a wild ride.

Rachele Burriesci: I was gonna say, that's a pretty different experience, and I mean, just going from, like, working in the hospital every day, you know, a full 8-hour, 10-hour shift, whatever you did, to now having this job where you're kind of on the go, on the travel move, teaching in different hospitals, learning new cultures.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: each day. How has the travel… how… have you enjoyed the travel aspect? Have you gone to places when you actually travel, because I also hear that sometimes in other roles.

Jenna Hightower, PT, DPT, CCS: So…

Rachele Burriesci: Where they don't really have the time to… Sometimes.

Jenna Hightower, PT, DPT, CCS: Yeah, I mean…I love the flexibility of a role like this. I get to work from home a lot, but also travel a lot. But I still… I can flex to do, like, teaching in a PT program, or if I wanted to do a CEU course, or things like that. But then also still heavily involved in research, and getting to do stuff like this, but also influencing hospitals all over, so that flexibility piece is really nice.

Jenna Hightower, PT, DPT, CCS: The travel is cool because it's taken me to places that I never thought I would ever go. Like, I got to meet Erin in Abu Dhabi earlier this year, in Dubai and Kuwait, all on the same trip, which was just so cool.

Rachele Burriesci: Yeah, for sure.

Jenna Hightower, PT, DPT, CCS: And to be able to experience especially healthcare in those parts of the world has been really cool. We communicate with China and Japan, and India all the time. Haven't visited those places yet, but those are coming. The travel is cool, but also, I think, if I'm being completely honest, it's a really hard phase of life to have this type of job in. You know, I have a small child. And of course, my husband is a saint and, is a rock star dad when I'm gone, but that part is hard, especially as the mom, especially when she was an infant. I flew to Germany my week coming back from maternity leave.

Rachele Burriesci: Oh my goodness. That must have been so hard for you.

Jenna Hightower, PT, DPT, CCS: It was. It was a quick trip, but… So, because of that aspect, I try to make my trips pretty quick, where I'm just jam-packed as much work into it as I can, so that I'm, you know, not spending a ton of time away from home. But I still have gotten to explore a little bit, which is really cool.

Rachele Burriesci: How often do you travel, like, in your week or your month?

Jenna Hightower, PT, DPT, CCS: It comes in waves, so there's definitely busier seasons, like, fall conference season is always busy, and then spring conference season is really busy, like, there'll be a couple of months, like, usually February, March, and April, like, I'm traveling most weeks.

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: Typically, though, it's usually 2 or 3 nights at a time, though, and then there's certain parts of the year, like during the summer or around the holidays, where I won't travel for a couple of months, or maybe just once a month. So it really… it comes in waves. It's unpredictable, but I think that part makes it more sustainable. I don't think I could travel every week all the time, you know?

Rachele Burriesci: I have a couple of friends that did some non-clinical jobs where they traveled a lot, and at some point, they want to pull back a little bit from the travel.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: Living out of a suitcase can be very difficult.

Jenna Hightower, PT, DPT, CCS: to be challenging. Yeah.

Rachele Burriesci: But also rewarding in that regard, because, I mean, that's so cool that you're just, you know, implementing and impacting all parts of the world, and so many different hospital settings, and changing culture, like, you're part of changing culture, which…I think is probably the trickiest thing to do.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: time, and I feel like you have a little bit of that, like, this… this is gonna work, and, like, you have… you have the ability.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: make that change.

Jenna Hightower, PT, DPT, CCS: Yeah, I think that's what makes me stay, if I'm being honest, is… is, like, the passion for that is, like.

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: I know, like, that this is, like, my purpose on this earth is, like, this unique skill set to be able to grow this knowledge in critical care, and if we didn't do it, if we're not sharing our knowledge, then who's doing it? Right. And I think the passion for that is what keeps me going, but also, like, the unique perspective of actually having the experience in it, I think, makes people listen, too. Like, I can talk the talk, I can speak the languages, I can hear the frustrations, because I've experienced them, too.

Rachele Burriesci: You've done it.

Jenna Hightower, PT, DPT, CCS: Yeah, so, like, this morning, I was doing in-services bright and early at 5.30 in the morning, and I got no one in night shift, because they had 3 codes, and it was just chaos, and charge nurse was like, I'm so sorry, like, you know, it's not normally like this, and I'm like, I get it.

Rachele Burriesci: That's the hospital world, I mean…

Jenna Hightower, PT, DPT, CCS: It's just… we work in critical care, and you just gotta roll with the punches, so… Exactly. So, I think that helps kind of build some usual respect as well.

Rachele Burriesci: Yeah. One more question, just about, like, the non-clinical position. Advice, right? So, I'm 40. I have said many, many times, I'm like, oh, I don't know how long I can do acute care. It is… it's a lot on the body. It, you know, you're…You're lifting…

Jenna Hightower, PT, DPT, CCS: critical care.

Rachele Burriesci: Yeah, especially critical care, there's, you know, the emotional piece of it, there's so many different,

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: you know. advice on, you know, finding that type of non-clinical position where you kind of find your place in doing something different. I do feel like physical therapy has some limitations in the non-clinical, like, ladder. Yeah. So any advice in, like, finding something that fits you?

Jenna Hightower, PT, DPT, CCS: Yeah. My first advice would be network. Like, you have to get to the conferences, you have to meet people, you have to go to the events, like you gotta talk to people in the exhibit hall, like, getting out there and networking is… is how this type of thing happened. I got very lucky, both with residency and, you know, exposure to this type of role, but I wouldn't have done that without networking and putting myself out there and having the conversations. Yeah. You know, the… that is the biggest thing. Like, I… I can't speak enough about, like, people I've met at CSM, like, that has changed my life. I go to CSM every year. Yes, it's expensive, especially if, you know, your company doesn't pay for it, but…

Rachele Burriesci: Yeah.

Jenna Hightower, PT, DPT, CCS: It's worth… it's worth it if you're really looking to expand that clinical ladder, for sure.

Rachele Burriesci: Yeah, I think that's… I think that's great advice. I think networking can be scary.

Jenna Hightower, PT, DPT, CCS: Yes.

Rachele Burriesci: You do have to put yourself out there. You do have to force yourself to have conversations with, you know, people maybe that you wouldn't have had conversations with.

Jenna Hightower, PT, DPT, CCS: Yeah, absolutely.

Rachele Burriesci: But,

Jenna Hightower, PT, DPT, CCS: I think, also, I know people have their… their feelings about research, and, you know, some people love it, some people don't. I hated research until.

Rachele Burriesci: to school.Jenna Hightower, PT, DPT, CCS: It was so dry learning about all things research.

Jenna Hightower, PT, DPT, CCS: in PT school, but, like, when you get in the field and you're doing something you're actually interested in, like, you know, it's a lot more fun to do research, and I'm way more involved in research now than I ever thought I would. But…

Jenna Hightower, PT, DPT, CCS: I think in my career as a PT, getting involved in research, especially with other disciplines, really helped bridge that gap as well, especially if you're looking at certain interventions. Like, that can help bridge the gap with a company as well. So looking at publishing data, looking at what's out there, approaching some of these, not customers, these companies. about doing research, things like that, like, that always helps open the door as well. And then you just have to search for the positions. They are few and far between, but I think it's…Like, we do have a unique skill set, too, to where we can add a 

Rachele Burriesci: I was gonna say that I think the clinical… like, your clinical experience makes you a wonderful choice for this type of job, right? Like, you use the bed, you understand the physiology, you've seen it actually work, versus someone who is not a PT, who is just a… I don't want to say just, but is selling said.

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: Like, you have a different, unique ability, and it keeps you in it, like you said, likein the research, you're… you're an educator.

Jenna Hightower, PT, DPT, CCS: Yeah, it's just in a different… Context, yeah.

Rachele Burriesci: Right, right.

Jenna Hightower, PT, DPT, CCS: Yeah. Yeah.

Rachele Burriesci: I love the part where you said that you get to impact across the country, across the world, across hospitals, versus just the patient in front of you, so…

Jenna Hightower, PT, DPT, CCS: Yeah.

Rachele Burriesci: That impact is definitely being seen and felt, and there's a lot of work that needs to still happen across the country, because no two hospitals are the same.

Jenna Hightower, PT, DPT, CCS: No, definitely not. Not even two units in the same hospital.

Rachele Burriesci: You know, that is very… that is very true. That is so true. All right, Jenna, well, I want to thank you for coming on, sharing your expertise. What I would love for you to do is give us some resources. If we are interested in getting a VitalGo system in our hospital, we'll add some context to the show notes, but do you have a website or an Instagram you want to throw out?

Jenna Hightower, PT, DPT, CCS: Yeah, I'll share our website, LinkedIn, Instagram, but also, share out… I'll share the kind of literature-compiled list that I have per topic, if you're interested in exploring the literature. Also check out our podcast we just started, so we're starting to interview some experts in the field that are kind of

Jenna Hightower, PT, DPT, CCS: The explorers in all things verticalization, so being able to hear their, perspectives as well is super interesting.

Rachele Burriesci: Can you give the name of that podcast?

Jenna Hightower, PT, DPT, CCS: It is Tilt Talk. Okay, so go check that. Little play on words.

Rachele Burriesci: I love it. And just really dives more into the physiology, so if you wanted to really get nerdy about the cardiovascular, pulmonary, neurologic, integumentary. MSK

Jenna Hightower, PT, DPT, CCS: Come get nerdy with me.

Rachele Burriesci: Come get nerdy with Jenna, or go get nerdy with Jenna. All right, Jenna, thank you so much for being on the podcast. Thank you, everyone, for listening. I hope you all have a wonderful day, and whatever you have to do, get after it.

Jenna Hightower, PT, DPT, CCS: Thank you.

Rachele Burriesci: You’re welcome.