Alpha Final Project Suggestions (10/2)

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5 Principles

1. Become the Center for Excellence for the three specialty care areas.

2. Improve patient satisfaction to increase retention and volumes.

3. Design space and processes to cater to patient and family demographics

4. Implement solutions that result in very low infection rates

5. Improve care coordination and continuity to decrease patient anxiety and reduce errors.

Problems:

    Travis:
    -- Poor hand washing practices lead to higher nosocomial infections.
    -- Inconvenient sink locations and forgetfulness are barriers toproper hand washing behavior.
    Elaine:
    --Patients and visitors have high levels of anxiety, stress, and frustration in hospitals due to lack of
      transparency of care information and physical environment.
    --Wayfinding is costly for a hospital mostly due to staff time helping patients and visitors locate their destinations.
    Diane:
    -- Adults and children are different and hospitals often don't take into consideration these differences 
       when designing and planning the wayfinding systems.
    -- Environmental stress and anxiety affect how visitors and employees are able to navigate in hospitals.
    David:
    -- Waiting times in the ED are often in excessive.
    -- Poorly designed ED processes cause longer percieved waiting times.

Evidence/Benchmarks:

    Travis:
    -- Hand washing compliance rates are typically 15-35%.
    -- There are 2 million nosocomial infections per year in the US.
    -- Alcohol-based hand-cleaners at bedside increase hand washing compliance.
    Elaine:
    -- As floor plan complexity increases, wayfinding performance decreases. Graphic signage produces 
       the greatest rate of travel in all settings, but textual signage is the most effective in reducing
       wayfinding errors, such as wrong turns and backtracking.
    -- The addition of signage resulted in a 13% increase in rate of travel, a 50% decrease in wrong turns, 
       and a 62% decrease in backtracking across the five settings.
    -- The annual cost of a wayfinding system was calculated to be $448 per bed per year in 1990 because it
       occupied 4,500 staff hours which is more than two FTEs.
    Diane:
    -- Younger children (second-graders) have substantial difficulties estimating direction, when compared to
       older children (sixth-graders) and adults.
    -- Younger children need more attempts (as compared to older kids and adults) in order to learn a specific
       route (to successful find their way), regardless of the existence of landmarks.  Children orient
       themselves at a 'start' position more often and turn around more frequently than adults.
    -- Stress can both improve and decrease memory: 
       * It can improve short-term memory because people are able to process 'easy' information faster. 
       * For things that involve more processing, stress can lower the working memory capacity, thus decreasing
       memory
    -- Grid structure enhances route accuracy but has little effect on memory for the actual place locations or
       spatial order.
    -- Landmarks don't influence route learning very much, but they do help with comprehension of place locations.
    David:
    -- Perceptions regarding waiting time, information delivery, and expressive quality predict overall patient
       satisfaction, but actual waiting times do not directly do so.
    -- 85% of left-without-being-seen patients identified “more frequent updates on wait time” as a reason they left.
    -- Nearly 50% of the time spent in an inner city hospital ED was spent in the waiting room (4 hours waiting of 
       8.4 total hours). 
    -- With progressive check-in processes in place, there was a 9.3% reduction in average waiting time
       over a period of 28 weeks.

References:

    Travis:
    -- "The Impact of the Environment on Infections in Healthcare Facilities (healthdesign.org)
    -- Association of Professionals in Infection control and Epidemiology (apic.org)
    Elaine:
    -- Michael J. O'Neill.  Effects of Signage and Floor Plan Configuration on Wayfinding Accuracy.  
       Environment and Behavior, 1991. Vol. 23, No. 5, 553-574.
    -- Ulrich, Roger and Craig Zimring.  The Role of the Physical Environment in the Hospital of the 
       21st Century: A Once-in-a-Lifetime Opportunity.  Center for Health Design for the Designing the 21st
       Century Hospital Project.  September 2004.
    Diane: (all can be found by searching in PsycInfo, with access via the GT Library online databases)
    -- Jansen-Osmann, P., & Fuchs, P. (2006). Wayfinding behavior and spatial knowledge of adults and children
       in a virtual environment: The role of landmarks. Experimental Psychology, 53(3), 171-181. 
    -- Cornell, E., Heth, C., & Alberts, D. (1994, November). Place recognition and wayfinding by children and
       adults. Memory & Cognition, 22(6), 633-643.
    -- Jansen-Osmann, P., Schmid, J., & Heil, M. (in press). Spatial knowledge acquisition of adults and
       children in a virtual environment: The role of the environmental structure. European Journal of
       Developmental Psychology. 
    -- Evans, G. (1984, December). The effects of pathway configuration, landmarks and stress on environmental
       cognition. Journal of Environmental Psychology, 4(4), 323-335.
    David:
    -- "Effects of Actual Waiting Time, Perceived Waiting Time, Information Delivery, and Expressive Quality on Patient
       Satisfaction in the Emergency Department" David A Thompson MD, Paul R Yarnold PhD, Diana R Williams MD and Stephen
       L Adams MD. The Annals of Emergency Medicine. March 1996.
    -- "The effect of in-room registration on emergency department length of stay" Marc H. Gorelick MD, MSCE, Kenneth Yen MD
       and Hyun J. Yun PhD. The American Journal of Emergency Medicine. August 2004.
    -- "The left-without-being-seen patients: What would keep them from leaving?" Katherine W. Arendt MD, Annie T. Sadosty
       MD, Amy L. Weaver MS, Christopher R. Brent MHA and Eric T. Boie MD. Annals of Emergency Medicine. March 2003.
    -- "Impact of waiting room times on patient satisfaction in an era of emergency department (ED) overcrowding" Virag J.
       Shah, MD. Presented at the APHA meeting 2007.

Questions: (as posted on the Q&A page)

    Travis: 
    -- At your hospitals, what incentives are offered for staff who follow proper hand washing procedures?
    -- Are there any penalties for staff who do not follow proper hand washing procedures?
    -- How is this accountability measured or enforced?
    Elaine:
    -- What does the wayfinding system consist of at your hospital?  (ie. electronic and paper mapping, 
       external building directions/cues, information desks, interior design layout, location of entrances, etc.)
    -- Have you noticed patients and visitors experiencing problems due to wayfinding?  Do these people seem to
       have increased stress and anxiety about not understanding their physical environment?
    Diane:
    -- Does your building employ the use of 'landmarks?'  If so, how have they been made 'landmarks?'  Is it
       because people continually visit them, or because they are nodes of activity, or because they have special
       labels? (ie. themes, animals, colors)
    -- Are there items/signage/wayfinding systems at the 'level' of children?  For example, are all the signs and
       wayfinding devices placed at adult eye-level?  If so, do the children seem to use these
       strategically-placed systems?
    David:
    -- What is the average wait time for your Emergency Department?
    -- What is the check-in process for your Emergency Department? Is it all-at-once when the patient arrives?

Final Slides

This is the PDF version of our presentation: File:TeamAlphaPres2.pdf