Class Blog

8/19

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.

8/21

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

8/28

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

9/2

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

9/11

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