Talk:Team TRANSFORMER

Finalized Problems and Project Ideas for Presentation

NOTE- THESE PROBLEMS WITH IDEAS ARE FLESHED OUT AT THE BOTTOM OF THIS PAGE!

1. There is not currently integrated physical space and technology for dealing with asthma through telemedicine.

2. Waiting room furniture is not flexible and does not address the needs of users. (needs= comfort, information, interaction, and disaster support)

3. There is a lack of accessible interactive educational materials at the child's level.

Homework 10/2/07

5 Principles of Design:

1. To foster a collaborative and patient-centered environment of respect and shared decision making.

2. To provide privacy and sense of security to all patients and families.

3. To guarantee quality and safety through research, education, evidence-based practices.

4. To provide equitable access and distribution of healthcare to all.

5. To achieve excellence in primary and specialized pediatric care by continuously adapting to the needs of patients.

5 Problems:

1. Patient history is repeated multiple times when changing caregivers.

a) “This study demonstrates that hospital charts contain many copies of the same information, such as medication lists, allergies etc. Due to manual replication of data fields, there is no mechanism to ensure that each copy of a data element within a chart actually contains the same information. This aliasing of data through manual duplication compromises the integrity of data within paper-based charts. Decisions and therapy based upon contradictory or inaccurate data are likely to lead to inefficient or erroneous care delivery; this has significant implications for hospital liability and quality of patient care”

Geiger G, Merrilees K, Walo R, Gordon D, Kunov H An analysis of the paper-based health record: information content and its implications for electronic patient records. Health Technology Group, Institute of Biomedical Engineering, University of Toronto

b) “Documentation quality ratings improved significantly with the introduction of the handheld device (p < 0.01) with respect to the correct assessment of a patient's progress and translation into ICD diagnoses. The preliminary data from this study suggest that handheld computers may improve the quality of hospital charts in orthopaedic surgery”.

Stengel D, Bauwens K, Walter M, Kopfer T, ekkernkamp A. Comparison of handheld computer-assisted and conventional paper chart documentation of medical records. A randomized, controlled trial.Clinical Epidemiology Division, Department of Orthopedic and Trauma Surgery, Ernst-Moritz-Arndt-University, Friedrich Loeffler Strasse 23b, 17489 Greifswald, Germany

2. The multi-bed emergency room design does not support patient privacy and safety.

• PRIVACY

- Evidence showed frequent breaches of auditory and visual privacy and confidentiality in areas with curtains compared to rooms with solid walls in emergency department (Mlinek & Pierce, 1997).
McKendrick, G. D., & Emond, R. T. (1976). Investigation of cross-infection in isolation wards of different design. Journal of Hygiene (Lond), 76(1), 23-31.
Case study: 5 percent of the patients in curtained spaces reported they withheld portions of their medical history and refused parts of their physical examination because of lack of privacy (Barlas et al.,2001).
Barlas, D., Sama, A. E., Ward, M. F., & Lesser, M. L. (2001). Comparison of the auditory and visual privacy of emergency department treatment areas with curtains versus those with solid walls. Annals of Emergency Medicine, 38(2), 135-139.

- The implementation of the Health Insurance Portability and Accountability Act (HIPAA) has influenced the design of NICUs due to the need to provide patient privacy.

Case study: Single room maternity care is the provision of intrapartum and postpartum care in a single room. It promotes a philosophy of family centered care in which one nurse cares for the family consistently throughout the intrapartum and postpartum periods. At B.C. Women's Hospital, a tertiary level obstetric teaching hospital in Vancouver, British Columbia, a seven-bed, single room maternity care unit was developed and opened as a demonstration project. As part of the evaluation of this unit, client satisfaction was compared between women enrolled in single room maternity care and those in a traditional setting. METHOD: The study group included 205 women who were admitted to the single room maternity care unit after meeting the low-risk criteria. Their responses on a satisfaction survey were compared with those of a historical comparison group of 221 women meeting the same eligibility criteria who were identified through chart audits 3 months before the single room maternity care unit was opened. A second, concurrent comparison group comprised 104 women who also met eligibility criteria. RESULTS: Study group women were more satisfied than comparison groups in all areas evaluated, including provision of information and support, physical environment, nursing care, patient education, assistance with infant feeding, respect for privacy, and preparation for discharge. CONCLUSIONS: Single room maternity care was associated with a significant improvement in client satisfaction because of many factors, including the physical setting itself, avoidance of transfers, and improved continuity of nursing care.
Patricia A Janssen MPH, PhC, Michael C Klein MD, CCFP, FCPS, Susan J Harris MD, CCFP, Jetty Soolsma MA, CNM, Laurie C Seymour BSN (2000), Single Room Maternity Care and Client Satisfaction, Birth 27 (4), 235–243.

Debra D. Harris, Mardelle McCuskey Shepley, Robert White, M.D. CHER, The Impact of Single-Room Neonatal Intensive Care on User's Health and Satisfaction,2006. http://www.healthdesign.org/research/reports/single_nicu_rooms.php
http://www.healthdesign.org/research/reports/single_patient_rooms.php

Chaudhury H, Mahmood A, Valente M. Nurses' perception of single-occupancy versus multioccupancy rooms in acute care environments: An exploratory comparative assessment. Applied Nursing Research. 2006;19:118-25.
This paper provides an excellent discussion of the literature on benefits of designing single patient rooms along with findings from a pilot survey of nurses.

• SAFETY

- Evidences indicate that infection rates are usually lower in single-bed rooms than in multi-bed rooms. (Gardner, Court, Brocklebank, Downham, & Weightman, 1973; McKendrick & Emond, 1976).
Gardner, P. S., Court, S. D., Brocklebank, J. T., Downham, M. A., & Weightman, D. (1973). Virus crossinfection in paediatric wards. British Medical Journal, 2(5866), 571-575.
McKendrick, G. D., & Emond, R. T. (1976). Investigation of cross-infection in isolation wards of different design. Journal of Hygiene (Lond), 76(1), 23-31.

Case study: Severe Acute Respiratory Syndrome (SARS) outbreaks in Asia and Canada highlighted the shortcomings of multibed spaces in emergency departments and ICUs for controlling or preventing infections both for patients and healthcare workers (Farquharson & Baguley, 2003).
Farquharson, C., & Baguley, K. (2003). Responding to the severe acute respiratory syndrome (SARS) outbreak: Lessons learned in a Toronto emergency department. Journal of Emergency Nursing, 29(3), 222-228.

- Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units.

J. Cepeda, T. Whitehouse, B. Cooper, J. Hails, K. Jones, F. Kwaku, L. Taylor, S. Hayman, B. Cookson, S. Shaw, The Lancet, Volume 365, Issue 9456, Pages 295-304

3. There is a lack of data and decision-support tools to provide evidence based care.

Evaluation of Internet-Based Clinical Decision Support Systems Karl W Thomas, MD; Charles S Dayton, BS, RPh; Michael W Peterson, MD

http://www.jmir.org/1999/2/e6

“Scientifically based clinical guidelines have become increasingly used to educate physicians and improve quality of care. The Internet has evolved as a potentially useful tool for guideline education, dissemination, and implementation because of its open standards and its ability to provide concise, relevant clinical information at the location and time of need.”

Patient-based health technology assessment: a vision of the future International Journal Of Technology Assessment In Health Care [Int J Technol Assess Health Care] 2007 Winter; Vol. 23 (1), pp. 30-5.

“In the ideal setting, a patient-based health technology assessment would promote patient knowledge by providing access to information and promoting an informed dialogue between patients and their healthcare professionals. “

4. Patients make unnecessary hospital visits. 1. The effects of clinical case management on hospital service use among ED frequent users. The American Journal of Emergency Medicine, Volume 18, Issue 5, Pages 603-608 R. Okin 2. Effectiveness of a Regional Poison Center in Reducing Excess Emergency Room Visits for Children's Poisonings. Pediatrics, Volume 72, Issue 2, pp 164-169.

5. Ignorance of physical and psychological needs of different user groups.
Case study: Vanderbilt's recognition that having a child in the hospital puts an incredible strain on families, a third of the hospital's 616,785 square feet is devoted to family space. Most children cannot stay alone. Because some pediatric patients tend to be sicker and stay in the hospital longer, family members may spend days or weeks at the child's bedside. Support resources for these family members include a close-by and comfortable place to sleep, meals and a host of other resources, including meditation rooms. In addition to spacious family areas in each patient room, two critical care floors offer additional family sleep areas, and family quiet areas are available on all patient floors. Family lounges have kitchen and laundry facilities; a fully equipped business center is also available.
Richard L. Miller, FAIA, and David C. Miller, AIA, Children's hospital supports the whole family, December, 2099 issue of HFM Magazine.

6. There is no seperation between front and back of house.

Project Proposal 10/10/07

1. There is not currently integrated physical space and technology for dealing with asthma through telemedicine.

Project Proposal: Interactive database that monitors all asthma patients

• Easy-to-use interface and application
• Tracks wellness status of all patients (low concern, medium concern, high concern)
• Patients wear monitors (Jiten, what were the monitors again?) that report data
• Combinations of factors determine concern level
• Notify user when patient becomes medium or high concern
• User takes action to provide remote care for patients in concern
• Application located at an area of high traffic (nursing station)

Problems Addressed:

2. Waiting room design does not address various needs of users. (needs= comfort, flexible, information, interaction, and disaster support)

Project Proposal:
Flexibility---"Magic space"

• Provide adjustable furniture, can provide different size of chairs and even unfolded to universal bed that fits different age groups;
• Provide various options of separation that can transform the waiting room into ED in case of disaster; possibility to re-organize the zone of play area, family-caregiver interaction area, resource center and parents’ business area.

Efficiency and fun---"Magic touch"

• Provide "Magic Touch" to expedite the registration process for repeated chronic patients, especially for the asthma and sickle cell patients in Hughes Spalding Hospital. The fingerprint identification process is easy that allows the kids' self-registration.
• By incorporated with CPOE (Computerized Physician Order Entry) systems and EMRs (Electronic Medical Records), patient history can be pulled out immediately.
• Unique heat-sensitive film technology responded in different colors based on the temperature of kids’ hands. All ages of kids can enjoy creating their own art pieces.
• Easily cleaned and sanitized.

Problems Addressed:

• Flexibility and Disaster Preparedness. Children’s hospitals in urban settings or large, academic referral centers must invest heavily in creating a culture of readiness and a response plan for any disaster, natural or otherwise, that they may encounter (Karlsberger 2005).
• Patient history is repeated multiple times when changing caregivers. The manual replication of data fields input may lead to inefficient or erroneous care delivery. The combination of magic touch and EMR /CPOE can improve clinician workflow, reduce errors, and increase revenues through reduction in billing delays. It also saves the valuable time of nurse to provide better bedside care.
  

Evidence:

• “This study demonstrates that hospital charts contain many copies of the same information, such as medication lists, allergies etc. Due to manual replication of data fields, there is no mechanism to ensure that each copy of a data element within a chart actually contains the same information. This aliasing of data through manual duplication compromises the integrity of data within paper-based charts. Decisions and therapy based upon contradictory or inaccurate data are likely to lead to inefficient or erroneous care delivery; this has significant implications for hospital liability and quality of patient care”

Geiger G, Merrilees K, Walo R, Gordon D, Kunov H An analysis of the paper-based health record: information content and its implications for electronic patient records. Health Technology Group, Institute of Biomedical Engineering, University of Toronto

3. There is a lack of accessible interactive educational materials at the child's level. (Jamie)

Project Proposal: Microsoft Surface Computer on wheels for medication education.

• Place the medication on the surface and it will be recognized.
• Interactive surface easy to use and easy to clean using disposable plastic skins.
• Tutorial of instructions, side effects, interactions, alternatives will be given.
• Information will be presented at age specific levels.
• Choice of language offered.
• Print-out for home use will be produced.
• Mock up will be produced with a traditional computer and an RFID attachment.
• Will be more widely used and cost effective in 3-5 years.
• Flexibility for various other applications proves a valuable investment.

Problems addressed:

• Lack of complete knowledge of medications at the care giver level.
• Lack of understanding on how to self medicate.
• Errors due to allergies, interactions, incorrect prescribing.
• Infections transmitted on highly used surfaces.
• Time of nurses and doctors better spent in other places.