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From Emergency Room of the Future
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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:

  • Marylin
  • Statistics:
    • 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
    • Variables
      • Facility Size:
      • Operational Models: operation drives what Arch. ideas are used.
      • Technology:
      • Patient Safety:
      • Flexibility/Growth:
    • Examples:
    • Community Hospitals: needs & design
      • light
      • 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


Engineering Methods

  • Measure: Quantify problems, Can it be measured? Build relative value unit
    • Direct
    • Proxy
    • Complex
  • Models: Some way of Org. problem or situtation, relation btw. things in problem.
  • Solution
  • 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.
    • Saftey
    • 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
    • Access
    • Timelines
    • Patient Flow
    • Centeredness
    • Scope of Capabilities
    • Flexibitly
    • Surge


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


Joyce Bromberg

  • 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
  • Understand
  • Observe
  • Synthesize: Share research finding, discover insights, create design principles
  • Measure: conduct experiments, provide feedback, iterate & test