Collaboration Takes New Look at Emergency Department Critical Care Environment, Seeks to Improve Doctor and Patient Experience During Life-Saving Moments
Multidisciplinary team will use observation, interviews, and design analysis to identify opportunities for improving how doctors and nurses utilize trauma space during critical activity.
The Business Innovation Factory (BIF), Item New Product Development (Item), the University Emergency Medical Foundation (UEMF), and Rhode Island Hospital (RIH) have announced a new project to better understand activity in an emergency department (ED) resuscitation or trauma "bay", the area of an emergency room where patients receive life-sustaining treatment after serious injury or a major medical event. It is in this area where doctors must seize an often brief opportunity to save a patient's life, making it essential that the environment be optimized for fast and effective treatment.
"When a patient comes into the ED resuscitation bay it is because he or she is in critical danger. Every move, every tool, and every communication in that space is critical to achieving a successful outcome," says UEMF's Dr. Nathan Siegel, who is an attending physician in the emergency departments of Rhode Island Hospital and The Miriam Hospital and Clinical Instructor of Emergency Medicine at the Warren Alpert Medical School of Brown University. "This project will give us a rich and rigorous description of how physicians, nurses, technicians, and patients perceive the resuscitation bay and operate within it. Our goal is to use this new understanding to radically redesign the experience doctors and nurses have working in the resuscitation bay, and in doing so, offer patients a higher standard of care."
The project team will use direct observation of the ED resuscitation bay, both when idle and in use, as well as focus groups and comprehensive interviews with those who use the space, to create a detailed visualization of how the resuscitation bay is designed and used today, and how it might be reconfigured and optimized for saving lives.
The team will evaluate the ED resuscitation workflow (from patient arrival to the resolution of resuscitation), conduct a thorough analysis of equipment and furnishings in the space, assess how information is shared and distributed and how human interactions are coordinated during a trauma event.
As a leader in technology and patient care innovation, Rhode Island Hospital is an ideal venue for this project. By conducting their exploration of the ED resuscitation bay environment at one of the most advanced healthcare institutions in the country, the team will have an unparalleled opportunity to identify the next frontiers of ED resuscitation bay design and utilization.
Seeking Greater Predictability in the Trauma Environment
The resuscitation bay is one of the most complex spaces in an emergency department. Despite its relatively small size, large multidisciplinary teams use this space to care for some of the sickest patients. These spaces, outfitted with a vast assortment of equipment and supplies, are neither standardized nor consistent across emergency departments. Many professionals have reported that ED resuscitation bays are generally awkward in their design and as more/new equipment has been added over time, they may be poorly organized for use in high-tension environments where speed, accuracy, and access are imperative.
Very little research has been conducted to evaluate the effectiveness of ED resuscitation bay design. An exhaustive Medline search of ergonomics and human factors research in the emergency department found only a handful of articles on the subject, with most focusing on computer interfaces. The lack of interest in understanding activity patterns in the ED resuscitation bay is surprising given the important nature of the services provided there.
"This project will move us beyond theoretical and anecdotal depictions of activity within the ED resuscitation bay and create an experience-based, systemic understanding of how health care workers interact with patients, each other, and the physical elements of the trauma bay," says BIF founder Saul Kaplan. "In creating an integrated understanding of the whole experience—its people, equipment and protocols—we will be in a much stronger position to design a trauma bay that is optimized to save lives."
Creating the Trauma Bay of the Future
The BIF, ITEM, UEMF and RIH team will use established industrial design research practices and a collaborative, experiential, systems approach to develop conceptual illustrations and models of the ED resuscitation bay's space, work flow, protocol and equipment. This activity will be driven by real-time observations of the resuscitation bay, both when idle and in use, and comprehensive interviews with those who use the space.
"Unlike deductive research that begins with the most generic assumptions about ED resuscitation bay design and usage, this study will begin with first-hand observations of the space, equipment and human behaviors that comprise the trauma bay environment," says Item Group Co-Founder and CEO Stephen Lane. "Rather than look at single products and protocols, we will assess how all of the component parts, human and non-human, fit together. Mapping out how the whole system responds to a critical care experience will be an invaluable first step towards designing solutions, interventions, and products that improve patient care."
The goal, says Lane, is to recreate the ED resuscitation bay environment so that it seems natural to the people who work in it. "This is not a theoretical exercise – our aim is to result in meaningful near-term opportunities and create real momentum for visionary action."
Looking at the environment from the perspective of the people who actually use it will reveal insights into the "human factors" that define activity within the space. Human factors-oriented design takes into account how people interact with other people, tasks, machines, computers and the environment. To understand the emergency department critical care environment from a "human factors" perspective, the team will create visualizations and descriptions of the ED resuscitation bay as a whole universe of interconnected components. The team will also take into account the unique psychology of the ED resuscitation bay environment (stress, extreme time sensitivity, lack of information, etc.), which has a powerful impact on activity in the area.
Most unique to the project is the collaborative, multi-disciplinary nature of the team, which is comprised of ITEM's industrial designers and commercial product developers, UEMF's emergency physicians and medical professionals, and representatives from BIF's collaborative innovation team. Significant emphasis will be placed on reporting out on project process and cataloguing how the team works together, how hurdles are cleared, and the challenges the project faces in integrating input from multiple stakeholders, experiences, and aspects of the ED resuscitation bay.
"In addition to our great enthusiasm for redesigning the ED resuscitation bay environment for greater efficacy, we are very excited to use this project as a model for collaborative innovation across the health care world," says Allan Tear, director of BIF's Experience Labs. "There are few models that demonstrate how to bring diverse partners together to solve big problems. We think this project will demonstrate the value of collaborative innovation while providing concrete insights into how to make these types of projects work."
"This project could not happen anywhere else," says Item's Stephen Lane. "The scale and interrelationships of this unique innovation partnership made-in-Rhode Island has created a tight, efficient team of motivated and aligned experts in a very short timeframe."
The project will be conducted over a nine to 12 week period, during which the team will:
- Conduct focus group sessions with physicians, nurses, technicians, and former patients.
- Interview hospital administrators and those responsible for procuring equipment and furnishing for the ED resuscitation bay space.
- Observe ED resuscitation bay operations and solicit insights for potential design improvements.
- Evaluate and map the ED resuscitation bay workflow (from patient arrival to the resolution of resuscitation).
- Assess and conduct a detailed inventory of all equipment and supplies over a cross section of ED resuscitation bay types, sizes and locations.
- Present a review of alternative solutions / environments in use nationally and internationally.
- Review relevant procedural data and trends to yield additional insights into opportunities for improving the ED resuscitation bay environment.
- Conduct a technical assessment of existing ED resuscitation bay products to identify primary cost drivers, and design improvement opportunities.
- Conduct multiple sessions focused on user needs and behaviors, equipment vacancies, enabling technology advances, and other potential user advantages that may surface during initial research. The team will aggregate the most promising concepts and identify those best poised for further development.
- Conduct a series of reviews with doctors, nurses and emergency department technicians to solicit feedback from users on project outcomes.
- Consolidate project findings and conceptual solutions into a series of presentations and workshops aimed at engaging stakeholders and building enthusiasm and support for follow-on phases of work.
Results from the project will presented at a public forum in September.
In addition to identifying opportunities to influence the design of the environment, equipment, and technology within the emergency department resuscitation bay, the project will also be a spring board for UEMF's efforts to create national standards for how an ED resuscitation bay should be configured in every hospital.
"Caring for critically ill patients, by its very nature, is stressful, even when one is working in a state-of-the-art emergency department. The promise of this project is to push the state-of-the-art forward significantly, by comprehensively examining current resuscitation bay design. We hope to eventually offer design solutions that minimize both physical and psychological stress for all the actors in the resuscitation bay for patients and staff alike," says Siegel, who has spent more than five years working in the emergency department.
About Item New Product Development
Item New Product Development is part of the Item Group, a leading, full service, product development enterprise offering expertise in research and strategic planning, industrial design, mechanical, electrical and manufacturing engineering and off-shore sourcing, assembly and packaging. With offices in Rhode Island and Hong Kong, the Item Group employs over 100 talented designers, engineers and strategists, and is one of the largest and most established product development companies on the east coast. Based out of an 80,000 square foot campus in Providence, Item works closely with RISD (Rhode Island School of Design) where both co-founders graduated over 20 years ago. Item works in a wide range of industries with Fortune 500 companies and start-ups alike delivering consistent and relevant innovation to propel each client to market success. The Item Group owns and operates Ximedica; a contract design, development and manufacturing company specializing in capital and disposable medical devices and instruments. Ximedica's extensive internal medical system and device experience will provide the project team with valuable, relevant expertise.
About Rhode Island Hospital
Founded in 1863, Rhode Island Hospital is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A Level 1, regional trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Its emergency department, ranked among the busiest in the country, is housed in a new building that opened in 2005, with capacity for 110,000 visits annually. Rhode Island Hospital ranks 15th among independent hospitals who receive funding from the National Institutes of Health, with research awards of nearly $27 million annually. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, orthopedics and minimally invasive surgery. The hospital's pediatrics division, Hasbro Children's Hospital, has pioneered numerous procedures and is at the forefront of fetal surgery, orthopedics and pediatric neurosurgery. Rhode Island Hospital is a founding member of the Lifespan health system.
About UEMF
University Emergency Medicine Foundation (UEMF) is an independent, nonprofit faculty practice plan of the emergency medicine physicians practicing at Rhode Island Hospital (including its Hasbro Children's Hospital) and The Miriam Hospital. All its Member physicians are faculty in the Department of Emergency Medicine at the Warren Albert Medical School of Brown University. UEMF staff also includes physician assistants and nurse practitioners. As the largest emergency medicine practice in Rhode Island, UEMF cares for 190,000 patients seeking care in the emergency
departments it staffs. As a practice plan, UEMF has supported the development of Brown's academic Department of Emergency Medicine by dedicating substantial resources, manpower and finances to its academic efforts in education and research. UEMF Faculty train the 48 residents and 10 fellows in emergency medicine and its subspecialties. UEMF Faculty are Principle Investigators and researchers are numerous federal and foundation grants and contracts.
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