ICU Visitsat
Piedmont, Northside & Emory
CS-8803 HEF Adriana Fuentes, Akshay Joglekar, Geetanjali Ningapa, Jeff Jopling, Karsten Jensen, Lars Christensen, Luxmi Saha
An Outline
ICUs visited: Piedmont, Northside, Emory
Few Issues to deal with:
•Medical records•Medical equipment interfaces •Lighting•Noise level•Airflow •Family accommodations•Storage facilities
•Patient Room Layout•X-ray facility•Privacy•Visibility•Monitors•Water Supply
Medical Records Issues
• Most of the records are still on paper • Mandatory paper records: technology orders,
satellite pharmacies • Integration of medical records from the different
departments has not been achieved
Technology/Medical Records Issues
Due to the increase in technology, doctors seem to be spending most of their time in front of the computer. Not good communication with patients
Technology/Medical Records Issues
Problems:From past experiences at Piedmont, when a new software packet that is targeted to help healthcare operations has been implemented, it has not really improved or helped
Medical Records
Possible Solutions: • Have a centralized system which integrates data from all
the departments within the hospitals and from other hospitals
• Have a microphone that will put everything into a medical
record so that there is more communication between patients and doctors.
Medical equipment data
Problems:• The medical data generated by the electronic
equipment needs to be manually fed into the information system by the nurses.
• Manual data entry leads to waste of time as well as it increases the probability of human errors.
Possible Solutions:• All medical equipment should be designed to
automatically feed the generated medical data into the hospital information system.
Alarms
Problems:• Every equipment has its own alarms.• Difficult to distinguish between various alarms. • Sometimes it also becomes difficult to judge the
source of the alarm. Possible Solutions:• Standardization of medical equipment alarms. • A central terminal where all the equipment can
be connected.
Medical equipment interfaces
Problems:• Poor human interfaces for the medical equipment • Nurses spend lot of time using and adapting to the
equipment. • Poor interfaces lead to human errors e.g. entering
incorrect input parameters for IV pumps. • The various medical equipment do not talk to each
other.
Medical equipment interfaces
Possible Solutions:• More intuitive medical interfaces. • Focus on making data entry easier. • Compatibility between different equipment. • Establishment of a standard for equipment
communication.
Lighting
Problems:• Some rooms provided more light than others• Windows were small in some ICUs• Some windows were punctured and dirty• Others were half covered by "un-trimmed" trees• The light switch at Northside hospital was placed
right behind the door due to which it was not easily accessible and it was a single switch controlling 6 kinds of lights in the room.
Noise Level
Problems:• The noise level was high at the nurse station• There was a beeping sound during the entire
time• All the patient rooms were open. The noise level
might disturb patient's sleep• The noise and screams from one patient's room
might disturb other patients.
Noise Level
Possible Solutions:• Some kind of visual signal instead of beep sound to be
incorporated• Use of good acoustical materials
Noise level
Problems:• Noisy transportation
trolleys at the hallways
Possible Solutions:• Should the wheels be
exchanged/redesigned?• Or is it a maintenance
question?
Airflow
Problems:• Airflow is very crucial in a hospital group for the health of
the patient. A few rooms have to be positive pressure rooms, a few of them need to be negative pressure rooms while others can be neutral room (for contagious patients).
Possible Solutions:• Pre-planning must be done to accomodate these
conditions.• Airflow duct can be a good source of infection so
necessary precautions must be taken.
Family Accomodations
Problems:• The piedmont hospital had no family space in the
patient room• The family had no different entrance to enter the
patient room which meant more disturbance at the nurse station and other patient's privacy is not maintained well.
Possible Solutions:• Provide space to accommodate patient's family in
the exam room• Have a separate periphery entrance to the patient
room
Storage Facility
Problems:• Storage facility in patient room is redundant as the supplies are
rendered contaminated once they enter the patient roomo Supplies can not be used on the next patiento Supplies have to be disposed
Possible Solutions:
• Do away with any supply storage space• This problem was better handled at the Northside Hospital. The
ICU rooms had a supply storage rack in one of the walls facing the corridor and the rack had two doors on each side (one inside the ICU room and the other one opening on the corridor). In this way the supplies could be loaded from outside and kept safe in the store and used as and when required.
Patient room Layout
Problems:• Some of the patient rooms were laid in a circular plan• The rooms were too small• The walls were at odd angles• No additional structure could be built over this
structure because of the shape of the building and foundations not being deep enough.
Possible Solutions:• Avoid small rooms and odd angles of walls• Always plan the designs for future expansions
X-Ray viewing Facility
Problems:The Piedmont had the option of viewing X-Ray's on any computer in the computer• The physician did not have to go the X-Ray room
to view them• However, the patient rooms did not have
computers. Hence the physicians have to go to the nurse's station to view the X-Rays
Possible Solutions:• Have computers in the patient room• Or, Have computers on the wheels that can be
moved all around the facility
Visibility of Patients
Problems:At the Piedmont hospital, some of the regular rooms are converted into ICU rooms due to shortage of rooms• No visibility of patient to nurse. Hence cameras are
used• The rooms are too small
Possible Solutions• Design patient rooms to provide flexibility in use• Assign enough area to accommodate the patient,
the doctor, the equipments, family etc
Privacy of the Patients
Problems:The Curtains around the W/C are taken out to avoid infections which might affect the privacy of the patient
Possible Solutions: Use of a better alternative to curtain
o should provide required privacyo should be quick and easy to clean
Privacy of the Patients
Problems:• The ICU room windows at Northside Hospital did
not have curtains to avoid contamination with infection
• The curtains were replaced with blinds placed between two layers of glass of the window.
• The control of the blinds was only in the hands of nurses sitting out on the desk.
• The patient may feel uncomfortable due to lack of privacy and the nurse can't keep the blinds closed since it would hinder monitoring the status of the patient from outside
Privacy of the Patients
Possible Solution:• Electronically controlled curtains can be installed
so that the patient as well as the nurse can control them.
• Video cameras can be installed inside the room so that privacy is not compromised.
Concrete Walls
• The old building at the Piedmont hospital has concrete walls, so it takes a lot of work to hide new cables, as their rules demands.
Remembering all the small things
Problems:• Everyday tasks like
putting intravenous lines into patients have a lot of small, but important, things the personal needs to remember
• Wash hands, sterilizing the skin, using sterile gown and gloves.
Remembering all the small things
Possible Solutions:• Packets with all the
sterile items • Checklist
No checklist
• Piedmont does not provide any checklist only a protocol
• Instead they follow up on
cases of infection
Water Supply
Problems:• Some pumps and other devices at the Piedmont
hospital are driven by water• A few years ago the water supply failed
Possible Solutions:• Storage tanks on the roofs
Vital Sign Display Monitors
• Current display paradigm is Single Sensor Single Indicator (SSSI)
• Old but functional design serves as basis for clinical decision making.
Monitors - Current State
Displaying waveforms per time
- Blood pressure - Heart rate - Oxygen saturation
SSSI paradigm (Single Sensor Single Indicator)
Monitors - History
History: • SSSI monitor paradigm was developed in the
1970's • Over last ~40 years progress has only led to
modifications of this existing paradigm.
Monitors - Problems
• Our understanding of physiology has changed greatly over the last 40 years.
• The problem:
o These advances in understanding are not reflected in the SSSI display paradigm
Monitors - Problems
• Normal physiology is not regular • Measuring with sufficient resolution, meaningful
variation can be seen in:
o intervals between heart beatso volumes of spontaneous breathso hormone secretion
Monitors - Problems
Nonlinear dynamics, complex systems, and the patho-biology of critical illness. Buchman, Timothy Current Opinion in Critical Care. 10(5):378-382, October 2004.
• Variability is lost as patients descend into critical illness
• Recovery from critical illness is characterized by recovery of irregularity in physiologic time series.
Monitors - Problems
• Intermittent collection of patient variables (e.g. hourly)
• Recorded as single numbers in paper chart or computer database
• No information about relationship between variables
Monitors - problems
Timescales:• Often the timescales of the display waveforms are not the same.
Monitors - Solutions
Working within the SSSI paradigm…
Could the interfaces be made more intuitive?
Or create a new paradigm?
With new data displays
Such as those falling within complex systems paradigm
Monitors - Solutions
Could the systems provide early alarms, from the monitored parameters?
e.g. By monitoring and intuitively displaying complex physiologic relationships…
we could predict when a patient will move from a stable state to an unstable one…
and intervene before the patient codes.
THANK YOU