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All Homework Assignments will be uploaded here. Please comeback later for more updates.

Week 1 (8/21, 8/23)

  • First week's assignment

1) create a personal member pages, 2) upload your reflection piece - as web page or a pdf document (see below) for this week an anecdote about personal or family experiences in an ER would be a good place to start. 3) Take pictures of two closets - one should be yours and one of someone elses (please ask for permission). Upload both pictures to your personal Wiki page. Bring a print or some means to show your classmates your picutres to class on Thursday (8/23). Talk to the person whose closet you took a picture of and ask them why it is organized the way it is. Be prepared to share that information on Thursday.

  • Each member should write a blog of their reflections after each day's class, how what they have learned that day (either from the lectures, readings, or case studies or from their team members or other disciplines), write about what's interesting, and what needs more clarification. Each person should also use their personal wiki page to add interesting readings, or annotated bibliography, post their sketches and ideas as well. Process is important, not just the final product. ;-)

Week 2 (8/28, 8/30)

  • Take notes in the Site visits, and upload your report to the wiki site. You would present your observation Tuesday September 4th.
  • ER Episodes Post links to where class members can find episodes to Hulu

Week 3 (9/4, 9/6)

  • 9/6 Thursday 2 visit times for Grady ER, depart at 9 am and 4:30 pm @ HSI
  • 9/11 Tuesday Sept 11 @ 900-1000 Emory University Hospital
  • 9/11 Thursday Sept 13 @ 445-545 at Midtown
 Check out the Course Notes for EBD 101, Field Study guide and also site visit handouts.
  • Pecha-Kucha presentation of ER observation on Sep 11 th.
  • just google to find good Pecha Kucha examples!

Ljilja Kascak: File:PechaCucha ERVisit LKascak.pptx

Ben Cleveland: File:BC PP Grady PK.pptx

Jenny Liu: File:Liu Presentation.pptx

Janani Venugopalan: File:Grady ER Visit.pptx

Sanghun Lee: File:ER.pptx

Yash Kshirsagar File:Yash Grady Visit Observation PechaKucha.pptx

Eric Esposito File:Eric Esposito.pptx

Chen Feng File:HDF pechakucha CF 20120910.ppt

Laura Salisbury File:Petchakutcha laura final.pptx

Frank Crittenden File:Grady ED Visit - Crittenden.pdf

David Woods https://docs.google.com/open?id=0B_nw9XR129VgSFQ1QlJFaTlFVGs

Jelece Morris File:JEM Grady Emergency Department Visit.pptx

Week 4 (9/11, 9/13)

  • tour of Emory EUH ED Tuesday morning (leaving on the Emory shuttle at 815am (Atlanta/Ferst, in front of the Cherry Biology Building) returning at 1045am to the same place.
  • And Thursday afternoon trip to Emory Midtown after class (we are walking).

Week 5 (9/18, 9/20)

Please add your problem statements here by Thursday.

Ljilja Kascak

1. At the Department of Emergency Medicine, Emory University Hospital Midtown some family members stay at the waiting room during the patient’s stay at the ER. Since the only way of communicating patient’s level of acuity and health is done by the nurse, family can be left without any information for a long period of time. There is a need for a better way of patients-family and doctor/nurse-family communication during their stay at the waiting room.

2. Emory University Hospital Midtown’s ED is trying to enable and empower patients and family members to help themselves so they can get warm blanket, food, and drink. Transferring these and other activities to patients, family or friends, would make them feel more responsible and active during the stay at the ER.

3. As Mary Grace Albuna, Project Manager at the Department of Emergency Medicine, Emory University Hospital Midtown, stated, ED is visually cluttered space with information overload. Grady Memorial Hospital’s ED, being a public hospital with more than 300 patients a day, has many cluttered areas. Clean and organized space is needed in a hectic and busy Emergency Departments addressing the needs of the patients as well as ones of doctors and stuff.

4. Care Management Unit in the Grady Memorial Hospital’s ED has seven areas with curtains with little personal space to treat patients. Family members are allowed to stay inside these rooms, but the space does not provide enough room and seating area for families.

Ben Cleveland:

1. In the Grady Memorial ER and most emergency departments, room occupation and demand is uncertain and unpredictable leading to complete occupancy at times. At Grady, Some patients are kept on beds in the hallways visible to non healthcare personnel for prolonged periods of time. This exposure leads to a loss of privacy, possible patient embarrassment, and potential violations of HIPPA.

2. In most clinical decision units (CDU), patients are monitored for up to 23 hours. At Grady, patients in the CDU are separated by removable objects such as curtains and have little to no personal space. The space allotted to patients allows little privacy and does not provide enough room for families to stay with the patients comfortably.

3. Compared to the Emory University Hospital - Midtown (EUHM) ER waiting room, the waiting room at Grady was loud and communication was difficult between staff and patients. The excessive noise in the room could result in miscommunication of medical and scheduling information between staff and patients and cause discomfort to waiting patients.

4. At both Grady and EUHM, areas where patients stayed for long periods of their visit (clinical decision units, waiting rooms, exam rooms, etc.) were either dimly lit or contained no soft or natural light. Bright, fluorescent lighting has been shown to inhibit the brain's ability to relax, which may affect patient disposition and comfort during times of waiting or treatment.

5. In the Grady ambulance reception bay, patients are left to wait on stretchers lined up next to each other in a large open room where personal health information is communicated between EMTs and nurses. This configuration leads to a loss of privacy, patient discomfort or embarrassment, and potential violations of HIPPA.

Jenny Liu:

  • The transfer of medical information between EMT and triage nurses is important in the diagnosis of ER patients. Current non-electronic transfer of EMT records to Grady hospital can allow misinterpretations, loss of information, or increased transfer times of patients.
  • Providing information to patients about the general triage or treatment procedures is important for the patients’ well-being throughout their stay in the ER and upon leaving the hospital. Without important communication between hospital staff and patients (and family members), there may be a rise in patients leaving against medical advice (AMA) or without being seen.
  • The empowerment of patient and family care allows for family members to obtain minor supplies, such as blankets and water, for the patients, without the need to wait for a nurse’s assistance. This form of empowerment can, in turn, lower opportunity cost of nurses and provide more independence for patients.
  • The pod formation at Emory Midtown provides a centralized locale for dedicated teams of staff, allowing for ease of communication and uniform monitoring of patients. However, due to this centralization of medical expertise, the noise level of these stations can cause discomfort for patients ranging from monitoring alarms to general communication of patients’ personal health information.

Arun Padmanabhan:

  • The transfer of patient medical records to the ER from another health care facility where the patient was previously being treated involves some overhead. The steps involved in this process like authorization, cost, time taken to transfer and the ease of the process could be improved.
  • Patient Navigators in the ER provide personalized followup and guidance to patients with non-urgent complaints. While there are reasons which necessitate the introduction of this position, the number of patients that could be handled by a navigator and the cost involved to the hospital are items that could be tackled better.
  • Overcoming patient ignorance and fear of the ER process could lead to increased patient satisfaction and better care. Increasing the patient awareness level is a potential area of improvement that could be measured through surveys and their involvement in care.

Janani Venugopalan:

1. The navigator role in the emergency room allows continuum of care even after the stay at the hospital is over. An extension of this concept to other hospitals and other areas of the same hospital would be beneficial. This would however increase overheads and recurring costs. If some part of this role were automated with built in decision support, this would be allow scalabilty with limited costs.

2. Communication between the various stages at grady has been mentioned to be a problem during the visit. A solution to this must optimize the number of transfers and prevent errors due to multiple levels of data entry and handling.

3. During the visit to Grady, it was mentioned that communication between doctors was an issue and a purchase of specialized equipment for key roles was thought of. Current mobile technology and other devices have become so common place that they made provide a cheaper and more ubiquitous solution. The key is to explore the techologies available for the purpose before arriving at either option.

4. The doorways at Grady were all in different types and not all were wheelchair friendly. An analysis of usage must be done and a better design must be adopted

Sanghun Lee:

1. Even though the level of noise is one of main concerns of Greedy ER, they seem to just rely on the traditional way; each patient was called through the speakers. It leads a side effect that stress level of nurses and patients is steadily ranked in high. Patients have to pay attention on the speakers to get information they’d like to know such as name of Doctor, location and expected waiting time, and nurses are easily get stressed because of tremendous questions from patients. Thus, they need to break traditional way and find a solution to reduce both level of noise and stress.

2. In Emory Ed, because of the improper layout and the lack of signboard, patients are hindered to get to the examine room they assigned. When patients pass the main counter of Emory ED, for example, they would find one signboard and five doors. If one of doors remains open, the signboard will be hidden. Since Emory ED is suffering from nurse shortage, it is hard to take care of each patient, so it could be serious problem that derives decreasing patient satisfaction level and increasing average whole trip time (entrance to exit) of patients.

3. Emory ER places an order for necessaries when the inventory level is low. Due to the fact that many of nurses and doctors move stocks to their convenience location to pick and use it easily, sometimes Emory ER has to keep excessive inventories. It could be happened because stock manager only consider the level of inventories in the storage. Thus, Emory ER needs to oversee and track the flow of stocks to efficiently manage the inventories and catch a lot of waste such as inventory carrying cost, maintenance and administration cost.

Yash Kshirsagar

1. As pointed out by Dr.Demestihas of the Emory University Hospital Midtown, the use of curtains in the Gold Pod rooms leads to lack of visibility for the caregivers to checking in on patients without actually visiting them. Sometimes the caregivers just need to visibly check the patient status by observing the patient's physical state. Use of glass would solve the visibility issue but give rise to privacy concerns.

2.The waiting rooms in an emergency department are generally noisy. Some sources such as medical staff movement and communication is noise that cannot be curbed. But some such as the Metal Detector at Grady's entrance, which made an annoying noise for every person walking through, can be dealt with. There is no need to notify everyone in that room that a person has a metal thing on him/her.

3. Rooms and hallways in the emergency department at Grady were generally low on daylight and nature view. As a study in Evidence-Based Design Research has shown that patient pain is alleviated faster in environments with more daylight and view of nature, incorporating this design methodology would result in quicker recovery which would in turn reduce the average duration of stay.

Eric Esposito

1. Sudden loud noises are prevalent within the ED. Many are unavoidable, but incorporating sound absorbing materials to reduce reverberation off hard surfaces may help. These loud noises dull the senses and reactions to sounds and alarms that should arouse immediate attention or become a nuisance.

2. WOW's are a great tool...when in use. When they are not, they become an obstacle in the corridors and other locations to dodge. This can be quite a problem for hospital staff when an emergency occurs.

3. The security is ineffective and underequipped. They are incapable of covering all the entrances to the ED. They're x-ray monitor is a nuisance than a safety measure. They patients, though almost completely oblivious to the fact, are at risk.

4. Way finding in the ED is a difficult task. A complete sense of disorientation can occur quiet quickly once a person gets into the ED just past triage. A great amount of corridors contribute to the underlying problem along with the poor signage.

5. The waiting room adjacent to the triage is improperly and under-utilized. It's a cold, unwelcoming environment. It almost arouses the feeling of impending doom rather than foster the feelings of care and healing.

Chen Feng

1) The posters and notes stick to the walls and whiteboards are lack of order and clarity in both of the Grady and Midtown Emergency Department, which not only preclude the care providers from getting the important and relevant information that they really need, but also could lead to visual distraction.

2) The signage system which guides the patients to the Emergency Department of Grady Hospital is not very satisfying, and could confuse the patient and delay the time of treatment.

3) The physician offices and break room in the Midtown ED is far and invisible from the working area where he or she spends most of the day, thus discourage them from getting there often and having rests.

Laura Salisbury

1.Many low income citizens use the emergency room as a primary care option. Due to this, emergency rooms in low income areas are often over crowded with patients who might be better served elsewhere. Because of this, a system must be developed to ensure the right patients receive the right amount of care.

2.A large percent of hospital errors take place in the transfer and tracking of patient files. RFID systems have been installed in Grady Hospital, but due to the fast paced environment of the ER, implementation of this system has been difficult. Because of this, a more streamlined and intuitive system for file tracking should be created.

Frank Crittenden

1. Arriving ambulance patients in the Grady ED are held in a large holding bay with no privacy or room for family to accompany the patient. This has potential impacts in the areas of infection control and patient confidentiality. Can we adjust the room design, and possibly the operational structure, of this area to reduce these risks?

2. In the Grady ED psychiatric patients are held in an area at the end of the red zone, with no separation between these patients and the general ED patient population. Behavioral health patients are often noisy and disruptive, but the red zone patients are the lowest triage priority and are thus typically more aware of their surroundings. They are therefore more likely to be disturbed by the noise from behavioral health patients, potentially affecting communications and patient satisfaction. Can we redesign, and/or relocate, the behavioral health holding area to reduce the impact on the general patient population?

3. Most of the treatment rooms in the general ED areas at Grady have little or no visibility from the corridor into the room, which leads to the potential for falls or other incidents in the room without staff knowledge. What level of visibility is needed, and how can we adjust the room to provide the needed level of visibility?

4. The Grady ED waiting room is one large space with no provision for any privacy or separation for waiting patients and family members. In any ED this separation can be beneficial in reducing stress among the waiting population. Given Grady’s widely diverse patient population there is an increased risk for more stress and for conflict among waiting persons. Can we adjust the waiting area to provide some separation for parties waiting for treatment to reduce stress and the potential for conflict?

David Woods

1. The transfer of patient files and medical records from the EMT's to the emergency department at Grady Memorial Hospital can result in delays and confusion. More streamlined means of communication could benefit this process by saving time, which could increase the patients' likelihood of recovery, and reduce the chances for error in the data transfer, which could save nurses time and ensure the physician has all the information necessary to make decisions.

2. Paper file folders are often left unattended in the hallways of the emergency department at Grady Memorial Hospital. This practice could result in HIPAA violations as well as loss of information necessary to make critical decisions. The system of information storage and handling should be optimized to prevent the exposure of files to the public.

3. According to Dr. Demestihas, there are a number of spaces at Emory Midtown that have been assigned programs that do not make the most efficient use of the space. Spatial and programmatic reconsideration should be given to ensure that the limited area of the emergency department is being optimally utilized.

4. The waiting room at Grady Memorial hospital is functionally and programmatically not ideal for relatives of patients who are required to spend extended time there. Ensuring the comfort and safety of individuals in the waiting room is imperative, but finding ways to empower them may have psychologically beneficial effects that are presently not being taken advantage of.

Vinay Bharadwaj

Grady ER:

1) Most of the patients are seated in the waiting room (I saw about a hundred of them) near the registration desk. Not only was there a lot of chaos due to noise, there were not enough seats to accommodate all the patients. Many people were standing or walking around. This is especially bad because the person behind the registration desk cannot attend to incoming patients effectively. If there were a huge number of patients coming through the door, they would have to stand in a queue to get to the registration desk! Also, there was only one person at the desk. The ratio of patients to number of people attending to them at the desk is very high.

2) The average waiting time for triage as told to us was around 27 minutes. This too is high because if number of patients build up at the waiting area, there is no sufficient accommodation to seat them all.

3) The triage room corridors too are very narrow. There were people seated right at the door and there were only 4 seats. Although in general the triage rooms were good, one of the triage rooms had trash, unsterilized clothes and used syringes lying around. This is a significant bio hazard for the patients as well as the nurses/doctors.

4) The other issue I found at Grady was at the ambulance entry. Again here, the nurses attending to the patients were not sufficient. One of the patients at the entrance to the red zone was suffering and there was no one to attend to her.

Jelece Morris

1. Patient information protection: HIPAA mandates industry-wide standards for health care information and requires the protection and confidential handling of protected health information. Grady’s Emergency Department has working areas that do not protect the privacy of patient information on computer screens. There is an opportunity to revisit how patient information is displayed on screens when others are not using the computers and how viewable the patient information is from a distance.

2. Equipment placement: Computers on Wheels are meant for medical personnel to track patient admissions and records. They are equipped with EMR and DSS systems with the intention of being able to access and update patient information without being at a stationary location. Currently at Grady Memorial Hospital, the positioning of COWs once they are done being used presents a safety hazard for hospital pedestrians. Through reevaluating the placement of COWs, we can make them more accessible to staff, reduce the risk of collisions in the hallway and enable patient care to be delivered at a quicker pace.

3. Noise control: High noise levels negatively impact patient and staff health and well-being and may slow the process of healing among patients. Loud sirens from metal detectors, multi-patient occupied rooms and transporting equipment all contribute to the increased noise levels in Grady’s Emergency Department. A further evaluation of the current acoustical environment and exploration of decreasing patient room occupancy will contribute to rectifying the abundance of noise in the healthcare environment.

4. Overcrowding/Patient Flow: At Grady Memorial Hospital, patients are currently seen on stretchers in the patient care area hallways and ambulatory drop off areas either waiting or receiving care. Emergency department overcrowding in the United States has become an emerging threat to patient safety and public health. There is an opportunity to reevaluate patient flow in the Emergency Department and identify ways to control and refrain patients from receiving care in the hallways.

Week 6 (9/25, 9/27)

Each team please upload 2 problem definitions at the http://www.hsi.gatech.edu/er2012/index.php/Project#Phase_1_Problems_and_Issues

also add related literature as well. We will discuss this week, and each team present at least 1 slide for each problem next Tuesday - Oct 2nd.

Week 7 (10/2, 10/4)

Please add your problem description here (a title and a few words of description), revised if you want to respond to class evaluation. Use this format:

Title Brief Description Sign up sheet 1. [student name] discipline 2. etc

Reducing Anxiety due to Overcrowding in ED’s Ambulance Lobby There is a need to reduce patient’s anxiety due to overcrowding in the ED’s ambulance lobby. Patients with anxiety at ED report decreased satisfaction with the treatment of pain. Anxiety sometimes leads to aggression and even violence, increased risk of clinical deterioration, ambulance diversion, patients'LWBS (Leave Without Being Seen), inflated staff workload, and more. 1. Ljilja Kascak, MID 2. Mothusi Phometsi, 3. Erxi Liu,

Week 8 (10/9, 10/11)

Week 9 (10/16, 10/18)

Week 10 (10/23, 10/25)

Week 11 (10/30, 11/1)

Week 12 (11/6, 11/8)

Week 13 (11/13, 11/15)

Week 14 (11/20, 11/22)

Week 15 (11/27, 11/29)

Week 16 (12/4, 12/6)

Final presentations (VIP & Public Open House)