From Emergency Room of the Future
Facts & Thoughts:
- Emergency Care:
- Chance of surviving cardiac arrest between 70% - 90%
- Patient examination rate 2.4/hr.
- Emergency care is Federally mandated for everyone
- Due to lack of communication and Federal Law, ER can't refuse ambulance once on permises.
Facts & Thoughts:
- 114,000+ # of ED visits/yr
- 26% Growth in ED visits
- 500,000/yr # of Diverted EMS pt.
- Emory Emory University Hospital:
- 30,000 visits/yr
- One of the highest acuity hospital in the US
- Time from being admitted to reach admitted bed 6HRS!!
- Time from being admitted to reach admitted bed 72HRS!! (Psych)
- ER & YOU!!
- Mid-Level Providers: order labs, xray, casts without Physician signiture or approval
- Average nurse age 46!! shortage in nursing field.
- Lean tech., eRescue, Residency Programs, Patient & Family centered care.
- Perkins & Will (Jim & Arvenna) - Functional Adjacencies
- Facility Size:
- Operational Models: operation drives what Arch. ideas are used.
- Patient Safety:
- Community Hospitals: needs & design
- seperate spaces (staff vs. public)
- labs can go anywhere (tube system, point of care testing "bedside")
- Operation drive the design.
- Critical Access Hospital: "Outpatient Facility w/Beds"
- Short stay, limited capacity (41 beds)
- New Entities in HealthCare:
- Retail Mini-Clinic
- Urgent-Emergent Care Centers: free standing, had ED level capabilities
- System-Based FreeStanding ED
- Only ED, no inpatient beds, labs, ..etc
- Need to be open 24/7
- Talk to EMS and let them know what's available (not be bypassed)
- Independent Emergency Hospital
- Does contracts with several hospitals, to find available bed for their ED admission
- Privilage problem at cross hospitals
- Transfer protocols developed with local hospitals
- Measure: Quantify problems, Can it be measured? Build relative value unit
- Models: Some way of Org. problem or situtation, relation btw. things in problem.
- Improvement: Making existing solutions better
- IOM: Institute of Medicine. Has 6 AIMS:
- Effective: Improve outcome.
- Efficient: Reduce waste.
- Equitable: Equal across the board.
- Timely: Reduce time to recieve medical care.
- Patient Centered
- Donabedian: Describe quality in 3 different components:
- Process: How procedres are done (Moving patient from exam room to operation room)
- Structure: Quantity of resouces (Rooms, XRay Machines, # docs, # nurses)
- Outcome: What the results.
- Key Issues
- Patient Flow
- Scope of Capabilities
Facts & Thoughts:
- Perkins & Will: Practical Innovation
- Marvina: likes P&W because she's part of the design
- High Aquity
- Increased Census
- Holds in the ER: not enough room, patients can't be placed
- Disaster preparedness
- How to prevent contamination
- How to shut down part of the ER so it doesn't spread to the rest of the department
- Financial Burden: Not always in the red, bring in $$ from different services
- Staffing shortage: help with recruitment.. think of designing for the staff.
- Patient throughput: length of stay (avg. 3.7 hrs)
- Inpatient Ancillary Support
- Staff & Physician Productivity: less time, more work
- Financial: look at alternatives (barcode systems) ..etc
- Look at operation & design: hand in hand
- Look at Lean solutions: allows you to rethink and visiaulize the ideal process
- Work Space Futures: Arch. & Interior designers & Techno Wheenies (EE, ME, MS)
- What we do: Study workers & work places using User Centered Design with Universities, Corps.
- "Ba" The concept of explicit & tacit knowledge: people & Co. have two ways of knowing things:
- Discussing: each step in driving a car told by a person.
- Tacit Knowledge: observing someone drive a car.
- Three methods to do a study/observe/design:
- Ask: To reveal the explicit
- Observe: To reveal the tacit
- Engage: To reveal the latent
- Synthesize: Share research finding, discover insights, create design principles
- Measure: conduct experiments, provide feedback, iterate & test