Allyn Rippin

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I'm a newly minted grad student in Architecture, Culture and Behavior.

(8/19) My definition of an ER: a designated area where people with critical (and often not-so-critical) injuries and ailments come to seek immediate treatment. People arrive in various states of physical and emotional (and perhaps economic) distress. Wait times are notoriously long and tedious.

Today's class confirmed that the ER is a revolving door of people with a broad spectrum of complaints and injuries. The ER staff really does see it all. It is interesting that two people with the exact same symptom (i.e. fever) can be in vastly different states of medical need. I'm curious about the process of triage--who gets treatment when. Jeremy helped dispel a few myths about what really goes on in the ER--"patients" who go into cardiac arrest on The Show are revived 70% of the time, whereas in real life it amounts to 5% or less.

Often on ER The Show we see a scenario where an individual becomes outraged that another individual has apparently received preferential treatment. How commonplace is this? Is there a design solution to ameliorate this? Make ER room more hierarchical or at least as a disguised hierarchy? In a similar vein, I'm interested in the idea that an individual's pain and suffering is very much his/her own, and the urgency and sense of entitlement that comes with it. Tricky placing a value/hierarchy on something so intensely personal and subjective.

Came across this disturbing article on yahoo today (8/20) about a mental patient who died after waiting 22 hours in an ER. http://news.yahoo.com/s/ap/20080820/ap_on_re_us/patient_death. How did this happen?

(8/21) Talked to Jeremy about this article after class: can take up to 72 hours for psych patients because of fewer beds; primary concern for admitting staff is the set of patients that haven't been seen versus the ones checked into the system (makes it easier for some to fall through the cracks?); patient condition can change after they are checked in.

The number one priority for patients: prompt care/being seen by physician asap. Yet there are nurse shortages, a decrease in available beds, many ERs have closed, not to mention a 26% growth in ED visits (due to increase number of uninsured, difficulty getting Dr appointment (people want on-demand service, not just in healthcare but many areas of modern day life). Not exactly a formula for prompt care. How do we fix!?

From Jim's presentation: Interesting analogy between the way we are designing hospitals now vs. the traditional model and the way doctors are treating their patients: more holistic (looking at organism as a whole rather then by "department", how systems are linked rather than how they work in isolation.) The function of the hospital also mirrors the human body: its amazing what a delicate ecosystem they are, the need for homeostasis and if one area fails it affects the operation of the whole. Amazing how the body and building/staff constantly juggle changing variables and conditions!

New entities in healthcare: retail mini-clinic; urgent care centers; freestanding ERs. I find these option a bit disturbing--the idea of drive-through healthcare. Yes, it may alleviate some burden from the ER, but doesn't this somehow put the patient at risk (i.e. they go to a (often under-equipped) clinic when they should go straight to hospital and lose time, and potentially their life?) I can't help but think these measures are just triage for the triage, and not addressing the root causes (which are larger social, economic, insurance, etc issues that obviously can't be tackled here....but they matter, too.)

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Field Observations (8/26) Media:Field Notes.doc