Overview
Creating the Trauma Bay of the Future
In a small, often-crowded room in a hospital's emergency department, teams of doctors and nurses must seize a brief opportunity to save a patient's life after a serious injury or major medical event. These trauma or resuscitation "bays" are complex and critical environments that must be optimized for fast and effective treatment.
Even trauma bays in the best emergency rooms in the country are inhibited by generally awkward design, and as more/new equipment has been added over time, they may be poorly organized for use in high-tension environments where speed, accuracy, and access are imperative.
The Business Innovation Factory, Item New Product Development, the University Emergency Medical Foundation, and Rhode Island Hospital are collaborating to re-envision and re-design the resuscitation or trauma "bay".
Over the summer of 2007, a stellar multi-disciplinary team used a collaborative, experiential, systems approach to develop conceptual illustrations and models of the resuscitation bay's space, workflow, protocols and equipment., This activity was driven by over 200 hours of observation in resuscitation bays using established industrial design research practices, and comprehensive interviews with those who use the space.
This re-envisioning has identified opportunities to influence the design of the environment, equipment, and technology within the ED resuscitation bay, and will be a spring board for efforts to create national standards for how a resuscitation bay should be configured in every hospital.
History
Seeking Greater Predictability
The resuscitation bay is one of the most complex spaces in an emergency department. Despite its relatively small size, large multidisciplinary teams use this space to care for some of the sickest patients. These spaces, outfitted with a vast assortment of equipment and supplies, are neither standardized nor consistent across the thousands of emergency departments in the US. Many professionals have reported that ED resuscitation bays are generally awkward in their design and as more/new equipment has been added over time, they may be poorly organized for use in high-tension environments where speed, accuracy, and access are imperative.
In 2006, University Emergency Medicine Foundation (UEMF) emergency physicians recognized the opportunity to rethink the rescuscitation bay, and approached Item New Product Development to gain an outside perspective. In initial discovery, the partners found that very little research has been conducted to evaluate the effectiveness of ED resuscitation bay design. An exhaustive Medline search of ergonomics and human factors research in the emergency department found only a handful of articles on the subject, with most focusing on computer interfaces. The lack of interest in understanding activity patterns in the ED resuscitation bay is surprising given the important nature of the services provided there.
Over the next year, UEMF, Item, Rhode Island Hospital and the Business Innovation Factory assembled a partnership and a project to use real-world observation and a systems perspective to fundamentally redesign this life-saving space.
High Points
This is Not a Theoretical Exercise
The project team used direct observation of the ED resuscitation bay, both when idle and in use, as well as focus groups and comprehensive interviews with those who use the space, to create a detailed visualization of how the resuscitation bay is designed and used today, and how it might be reconfigured and optimized for saving lives.
All aspects of the environment were analyzed, including workflow from patient arrival to the resolution of a resuscitation, the equipment and furnishings in the space, how information is shared and distributed and how human interactions are coordinated during a trauma event. The team paid particular attention to the unique psychology of the ED resuscitation bay environment (stress, extreme time sensitivity, lack of information, etc.), which has a powerful impact on activity in the area.
As a leader in technology and patient care innovation, Rhode Island Hospital is an ideal venue for this project. By conducting their exploration of the ED resuscitation bay environment at the most advanced and busiest Level 1 Trauma Center in New England, the team had an unparalleled opportunity to identify the next frontiers of ED resuscitation bay design and utilization.
To rethink the emergency department critical care environment from a "human factors" perspective, the team created full size prototypes, as well as visualizations and descriptions of the ED resuscitation bay as a whole universe of interconnected components.
Significant emphasis was placed on reporting out on the project process and cataloguing how the team works together, how hurdles are cleared, and the challenges the project faces in integrating input from multiple stakeholders and experiences. Read the project summary here.
Results
This page will be updated throughout the project, so check back often.
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Methodology
Learn more about the methodology +
The first phase of the project was conducted over a 12 week period, during which the team did the following:
- Conduct focus group sessions with physicians, nurses, technicians, and former patients.
- Interview hospital administrators and those responsible for procuring equipment and furnishing for the ED resuscitation bay space.
- Observe ED resuscitation bay operations and solicit insights for potential design improvements.
- Evaluate and map the ED resuscitation bay workflow (from patient arrival to the resolution of resuscitation).
- Assess and conduct a detailed inventory of all equipment and supplies over a cross section of ED resuscitation bay types, sizes and locations.
- Present a review of alternative solutions / environments in use nationally and internationally.
- Review relevant procedural data and trends to yield additional insights into opportunities for improving the ED resuscitation bay environment.
- Conduct a technical assessment of existing ED resuscitation bay products to identify primary cost drivers, and design improvement opportunities.
- Conduct multiple sessions focused on user needs and behaviors, equipment vacancies, enabling technology advances, and other potential user advantages that may surface during initial research. The team will aggregate the most promising concepts and identify those best poised for further development.
- Conduct a series of reviews with doctors, nurses and emergency department technicians to solicit feedback from users on project outcomes.
- Consolidate project findings and conceptual solutions into a series of presentations and workshops aimed at engaging stakeholders and building enthusiasm and support for follow-on phases of work.
Results from the project will presented at a public forum in September.
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Project Partners
Most unique to the project is the collaborative, multi-disciplinary nature of the team, which is comprised of ITEM's industrial designers and commercial product developers, UEMF's emergency physicians and medical professionals, and representatives from BIF's collaborative innovation team.
Learn more about the project partners +
About the Business Innovation Factory
As an independent, non-profit organization, the Business Innovation Factory has created a unique platform for bringing public and private sector partners together to focus on projects that transform how value is delivered across all sectors of our economy. Through the BIF Experience Labs, BIF uses its open innovation methodology to help collaborative teams from across industries and disciplines design and test innovative solutions in real world environments and transfer what they learn back into their organizations. This platform enables innovators to test strategies to successfully design new business models, prototype innovative approaches and provide proof-of-concept findings, speed the larger scale roll-out of a new idea by understanding implementation realities, learn how others face the challenges of innovation and implementation and justify the return on innovation investment.
About Item New Product Development
Item New Product Development is part of the Item Group, a leading, full service, product development enterprise offering expertise in research and strategic planning, industrial design, mechanical, electrical and manufacturing engineering and off-shore sourcing, assembly and packaging. With offices in Rhode Island and Hong Kong, the Item Group employs over 100 talented designers, engineers and strategists, and is one of the largest and most established product development companies on the east coast. Based out of an 80,000 square foot campus in Providence, Item works closely with RISD (Rhode Island School of Design) where both co-founders graduated over 20 years ago. Item works in a wide range of industries with Fortune 500 companies and start-ups alike delivering consistent and relevant innovation to propel each client to market success. The Item Group owns and operates Ximedica; a contract design, development and manufacturing company specializing in capital and disposable medical devices and instruments. Ximedica's extensive internal medical system and device experience will provide the project team with valuable, relevant expertise.
About Rhode Island Hospital
Founded in 1863, Rhode Island Hospital is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A Level 1, regional trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Its emergency department, ranked among the busiest in the country, is housed in a new building that opened in 2005, with capacity for 110,000 visits annually. Rhode Island Hospital ranks 15th among independent hospitals who receive funding from the National Institutes of Health, with research awards of nearly $27 million annually. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, orthopedics and minimally invasive surgery. The hospital's pediatrics division, Hasbro Children's Hospital, has pioneered numerous procedures and is at the forefront of fetal surgery, orthopedics and pediatric neurosurgery. Rhode Island Hospital is a founding member of the Lifespan health system.
About UEMF
University Emergency Medicine Foundation (UEMF) is an independent, nonprofit faculty practice plan of the emergency medicine physicians practicing at Rhode Island Hospital (including its Hasbro Children's Hospital) and The Miriam Hospital. All its Member physicians are faculty in the Department of Emergency Medicine at the Warren Albert Medical School of Brown University. UEMF staff also includes physician assistants and nurse practitioners. As the largest emergency medicine practice in Rhode Island, UEMF cares for 190,000 patients seeking care in the emergency departments it staffs. As a practice plan, UEMF has supported the development of Brown's academic Department of Emergency Medicine by dedicating substantial resources, manpower and finances to its academic efforts in education and research. UEMF Faculty train the 48 residents and 10 fellows in emergency medicine and its subspecialties. UEMF Faculty are Principle Investigators and researchers are numerous federal and foundation grants and contracts.
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