Reflections

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In my work at Emory Hospital, I spend time in the Emergency Department, but have not yet spent time in the ICU. I am excited to see what projects we all come up with. From my time in the ED, I know that there are so many areas of improvement, including with the equipment and design of the space.

8/26 I was shocked when Dr. Ackerman was talking about the culture in the ED of not calling other doctors for advice. To me, it seems like doctors should be willing to overcome their ego in order to save more patients' lives.

8/31 Dr. Zimring's presentation gave me a lot to think about in terms of design improvements that can be made in hospitals. I can see why it is so difficult to do randomized controlled tests in hospitals, but those should really be a top priority in order to isolate the design changes that can reduce medical errors, infections, etc the most. Otherwise hospitals could end up wasting thousands of dollars making changes that are not very successful.

9/2 I learned a lot from seeing the actual layout of the ICU that Mr. Cowan designed. It helped me to understand more about what goes on in the space.

9/7 The presentations today were very interesting-- I am most interesting in lighting and sound, communications between patient and family, and Patient/Family centered care. I couldn't believe that a study showed families of deceased patients were more satisfied with the ICU care than families of patients who survived. Hospital-acquired infections in another area that I'm interested in-- I had no idea they created such a serious problem in the ICU.

9/14 I really enjoyed Ms. Bromber's presentation. It gave me so many good things to think about when making observations. It is very easy to get caught up in shadowing one person or focusing in on one thing without looking at the big picture. I think the field observation notebook will be a very good guide when I am making ICU observations.

10/5 My observations in the neuro-ICU and cardiac ICUs of Emory University Hospital were very insightful!! The field notebook helped me greatly in organizing my thoughts. The neuro-ICU was very quiet and spacious. Little ambient noise was heard. The patient rooms were quite large. I was amazed at how many cords and cables were everywhere. Talking with a nurse, he identified the plethora of monitoring devices as being a major problem, as none of the devices were interoperable. The cardiac ICU was in a U-shape, and one of its main disadvantages was that visibility into some of the rooms was very limited. Also, less than half of the rooms had windows. The rest just had natural lighting which seemed very dim.

10/12 My group has identified 2 problems were are most interested in addressing: lack of communication between family and clinicians, and lack of standardized presentation of vital signs. I am most interested in working on lack of communication between family and clinicians, as I think it can have huge implications for improved quality of care.

10/14 My new group has chosen to pursue the problem of lack of communication between family and clinicians. We see so many associated problems and symptoms, I think it will be difficult to narrow it down to one specific problem. Our initial ideas are (1)some kind of platform for clinicians to leave voice recorded updates of the patient's condition for family members to listen to online, or (2) an automatic text message/email this is sent to family members to give them updates on the patient's condition.

10/28 After talking with Dr. Ackerman, we realized that option 2 is not really feasible because there is no way for machines to assess the patient's condition just from vital signs. The heart monitoring equipment might get accidentally unplugged, and family members will think the patient has flat-lined. Also, family members won't really know what to make of vital sign measurements, they really need to hear an assessment from a doctor. In our initial feedback in class we were told to be more creative than our option 1 idea. So, we're back to the drawing board. It is really difficult to know what technology is already out there.

11/9 We've narrowed down our solution to a 2-way in-room communication device that would record family conference sessions between doctors and family members. After talking with another ICU doctor, we think maybe some kind of mobile video-conferencing station on wheels might be a good solution

11/23 Things are going well. We decided not to do the mobile station, our device will be an in-room touch screen device. We are discussing issues of patient privacy, as Dr. Ackerman brought up a good point that we could come across problems by having the video camera in the patient room. The problem is that most ICUs don't have any kind of space or room for family conferences. Doctors have to talk to the family members in the patient's room most of the time.

12/9 We just had the open house tonight. It was great! I was very pleased with how EduCare ended up. We got very positive feedback overall. Several people told us that ours was one of their favorite projects there! The doctors that came agreed that we had pinpointed a very big problem.

It was also nice to see the other projects. I really liked the Virtual Concierge project, I think that would be a big help to patients. The nursing uniforms with LED lights was also a great idea.

I enjoyed the whole design process in the class-- very different from all of my other health systems and ISYE classes. In the future though, I think we should have more time to work on the actual final product with our final group. I felt it was a little difficult that we didn't know our final groups until mid-October. If we'd had more time, we could have done actual coding on our project and really developed it further.