Innovation is at the Heart of Cardiac Nurse's Practice

'There was not a barrier that she couldn't move out of the way,' Yale New Haven Hospital CNO says of innovator Michele Santoro, RN.

With Michele Santoro’s self-described “questioning attitude,” she has become a highly regarded innovator at Yale New Haven Hospital, been named a Magnet® Nurse of the Year, and saved uncountable lives when cardiac patients worldwide became disconnected from an external monitoring device platform after a vendor’s software update.

With her innovative spirit, Santoro, RN, BSN, a clinical nurse at Yale New Haven Hospital Heart and Vascular Center in New Haven, Connecticut, has developed a monitoring, scheduling, and tracking system for patients with remote cardiac monitoring devices as well as a new process to prepare patients’ skin for surgical procedures. And she’s just getting started.

 “She’s an example of so many others in this organization," says Ena Williams, senior vice president and chief nursing officer at Yale New Haven Hospital. “One of the things that is so special is this idea that there was not a wall high enough that she couldn't get over or there was not a barrier that she couldn’t move out of the way.”

Santoro spoke with HealthLeaders about her solutions to care problems and how Yale New Haven supports nurse innovators.

This transcript has been lightly edited for clarity and brevity.

HealthLeaders: How were you able to figure out that thousands of cardiac patients worldwide had been disconnected from an external monitoring device platform?

Michele Santoro: We do know our patient population and who is disconnected from their external monitor and this particular morning, I noticed a large amount of patients disconnected. In investigating, I found a common denominator: all of them were pacemakers and they were all the same model. I notified the vendor of the issue and they confirmed that it was from a software update that they didn’t know about and that it affected patients globally.

HL: You have developed a monitoring, scheduling, and tracking system for patients with remote cardiac monitoring devices. How did you identify that gap and create a solution?

Santoro: I was hired to come in to run a remote device clinic and when I opened up the five different vendor sites, I noticed there were thousands of patients disconnected and with missed transmissions. I had to call each patient to determine their status and where they were living, and that took a year. In the midst of doing that, I took all five vendor sites and we put them under one comprehensive database tracking system. When we did that, we were able to go from 2,100 to zero patients in one year, lost to follow-up.

The biggest thing about this is we've oriented and trained our staff on the new process, so those patients are not disconnected or missed, and everybody stays safe. During COVID, it was huge to know that our patients would be safely monitored from home and that they were all connected when they couldn't come into the office for almost a year.

HL: You developed a new process to prepare patients’ skin for surgical procedures. Tell me about that.

Santoro: There was no standardization for the documentation process for skin assessment, pre- and post-cardiac device. I identified these agents that contributed to the loss of integrity, pre- and post-op and put them into our safety incident tracking system. We realized that the biggest thing was the change in the dressing process for post-op. There was no standardization across the system.

So, we set out with a multidisciplinary team to standardize the documentation, and it was just amazing because we've had no issues. I see the patients post-op seven to 10 days, and I've never seen an issue again, and it’s been years.

HL: Nurses are known as natural innovators. Are you innovative because you’re a nurse, or have you always been that way?

Santoro: I have to say I've always been this way. I think it's my inner self. I've always had a questioning attitude and never been afraid to bring my concerns to authority. I don’t know if that’s a good thing or bad thing sometimes.

HL: How has Yale New Haven helped to foster your spirit of innovation?

Santoro: I've worked in a few organizations over the years and Yale New Haven is definitely a high reliability organization. This culture has empowered me to identify safety issues and track trends. I am so blessed to have such support of direct management and senior leadership. My direct manager, Annette Dagostino, stands behind me and guides me every day. I don't know many nurses that can say that they know their vice president or president, or their CNO.

The nursing autonomy and nursing shared governance at Yale New Haven empowers us to have the ability to do evidence-based practice and make changes and collaborate with different teams. We're just really lucky.

HL: What solutions are you working on now?

Santoro: I have research data for eight years that I collected on my own and I’m working on it with two nursing colleagues. It’s a study, with approximately 400 subjects, and it’s about the implantable loop recorder, a little cardiac monitoring device that goes under the skin.

I’m finding that some providers like to remove them prematurely and not let them stay in for the three-, four-, or five-year battery life as we are finding significant arrhythmias that have been detected. So, they're trying to pull them out sooner than they need to. When they say, “We need to leave them in only for six months to a year,” I’m finding life-threatening arrythmias in two-and-a-half years to three years.

So, stay tuned. There's more to come.