We took care of a complex 2 ventricle patient who required LV mechanical circulatory support and subsequently required membrane oxygenation. Never before in our center had we placed a membrane oxygenator into an LVAD configuration to create ECMO.  However, utilizing a constructivist platform and some creative bedside brainstorming, we devised a method of care and communication across the interprofessional continuum. Conversation between team members led to a primitive cartoon-like sketch of all essential elements of her configuration, including location of LVAD cannulae, the oxygenator, all available sampling pigtails, central and arterial patient access, and non-invasive oximetry markers such as NIRS, arterial saturations and pre-membrane saturation. This sketch was drawn simply but thoroughly, with side-bar explanations, and was the topic of many chats between members of our VAD team, ECMO team, cardiac surgeons, CICU intensivists, respiratory therapists, physical and occupational therapists, and yes, bedside nurses. The sketch went through many revisions and sparked numerous conversations and ah-hah educational moments.

The more complex and fragile our patient are, the more the interprofessional ICU team must collaborate, open thinking and get creative to ensure consistent care at the highest standard. Communication among all members of the bedside team works to ensure that all are utilizing the data in a consistent manner to determine readiness for progress versus worsening clinical status. Following pre-programmed notions and old paradigms could lead to costly errors in judgement. A customized sketch, which remains prominently posted at the bedside, is one idea to spark conversation, develop understanding and promote conversation to achieve such goal.