Blake Fenwick & Hugh Stehlik
Observation and Analysis of ICU Designs
University of Canberra
Observation and Analysis of ICU Designs
Beautifully executed design renderings that take a thoughtful and straight forward approach to solving the problems of the clutter and space management in an ICU. – Jesse
Fantastic analysis and documentation. Also had well executed and reasonable recommendations. Loved the vision for a bed of the future at the end! – Kate
Well presented research, insights, and recommendations—the proposed design seems like it would bring tremendous benefit to the ICU experience—for the patient, the medical staff, and the healthcare industry. It’s the kind of solution that hospitals should jump on—it would have an immediate fantastic impact. – Susana
Observation and Analysis of ICU Designs
This study aims to identify key areas for improvement in the Intensive Care Unit (ICU). The study focussed on bed-space layout and the interaction between individual pieces of equipment, patients and staff. Research was undertaken at Canberra Hospital and Calvary John James Hospital, both located in Canberra, Australia. The outcome for the project is a futuristic concept for the ICU bed-space that improves efficiency and usability for staff, and the quality of patient care.2. The Brief: Summarize the problem you set out to solve. What was the context for the project, and what was the challenge posed to you?
In the intensive care unit the lives of critically ill patients rest in the hands of doctors and nurses. Their expertise and the medical equipment at their disposal will make the difference between life and death. Concerns were raised by Dr. Balaji Bikshandi, head of the ICU at Calvary John James Hospital, that current ICU design is holding back staff members in their life-saving work.
A joint study by Harvard and Stanford Universities [Tucker et al 2008] found that 36% of all hospital failures are caused by problems with equipment or facilities. Poor room layout accounted for 8.5% of total failures and equipment error accounted for 4%. The Cost of these errors, both in human and financial terms are huge. Up to 98,000 people die each year in the US as a result of medical error with a cost to the US economy of up to $29 billion [Agency for Healthcare Research Quality 2007].
Solutions are needed to increase efficiency, improve the work environment for staff members and ultimately lift the quality of care that patients receive. Our brief was to create a vision for the future of the ICU that applied creative solutions to problems identified through research. We were also tasked to provide achievable solutions that could be implemented in the short term.3. The Intent: What point of view did you bring to the project, and were there additional criteria that you added to the brief?
Both researchers had no prior experience in the medical field before undertaking this project. This was both a help and a hindrance. The learning curve for understanding the technical aspects of the ICU was very steep. However lack of prior experience allowed us to see problems without bias or preconceived ideas about how the ICU should operate. This fresh point of view in several cases lead to us identifying issues that staff had learned to work around.
We were also able to approach known issues differently. In many cases staff were aware of problems but simply dealt with the results, trying to minimise the impact on themselves and other users of the space. In these instances we were able to find the cause of the problem and put forward solutions to stop it occurring.
An example of this is the problem of cords and tubes restricting access to the patient. A widely acknowledged problem that staff members ‘solved’ by either running tubes high so they could duck under, or running them low to be stepped over. In either case tubes soon become disorganised and usually wound up running low, high and in-between. Our proposed solution was to reposition the outlets used by the tubes so the tubes no longer needed to pass through the access space.
Our initial brief did not change greatly through the course of our research, although the focus on short term outcomes was scaled back to allow for a greater focus on the futuristic solution.4. The Process: Describe the rigor that informed your project. (Research, ethnography, subject matter experts, materials exploration, technology, iteration, testing, etc., as applicable.) What stakeholder interests did you consider? (Audience, business, organization, labor, manufacturing, distribution, etc., as applicable)
Given our limited medical experience the first stage of the project was an extensive literature review. This allowed us to understand, to a certain extent, the organisation of the ICU, the function of equipment and the tasks performed by staff. It also allowed us to analyse and benefit from existing research in the same area. We found that research typically dealt with either the large scale layout of the ward or the small scale of individual pieces of equipment. There were only a small number of articles published of the organisation of the bed and its immediate surrounds.
Research was carried out into room layout and the effects that it can have on both staff and patients. Emotional, physical and social factors were examined. Research was also conducted into the organisation of bedside equipment and the issue of wires and tubes surrounding patients and impeding care. Our research identified several areas where improvements were needed.
The second stage of our research was undertaken within the ICU environment. To ensure an appropriate sample size research was carried out at two different hospital ICUs. Research was undertaken over a three week period and consisted of 9 sessions of between 2 and 3 hours for a total observation time of 21 hours.
Direct observation was used to monitor the movements and interactions of people in the space. Our study identified a large number of users of the bed-space including doctors, nurses, patients, relatives, wardsmen, medical technicians and cleaners. We identified the needs of these users and in the case of conflicting needs, established which took precedent. During this observation we made particular note of any difficulty staff members had with the organisation of the space or operation of equipment.
Unstructured interviews were undertaken with staff members during the course of observation. We interviewed a cross section of staff consisting primarily of nurses and doctors. A total of 18 interviews were conducted, lasting between 5 and 15 minutes each. Interviewees were encouraged to talk about what did and did not work in the layout and organisation of the current bed-space, and what they would like to change.
Stakeholders in this project consisted of the two hospitals. The outcome of the project provided them with an innovative ICU concept that could be used to represent the advancements they are striving toward. The project was twice presented to hospital staff; once at the end of the research phase and again at the conclusion of the project.
We also considered the Hospital as a theoretical stakeholder in our development of the futuristic concept. In this regard the concept provides cost savings through efficiency gains and reduced risk of staff injury; this in turn leads to increased staff productivity and job satisfaction. Quality of patient care is also increased allowing for faster recovery times and reduced mortality.5. The Value: How does your project earn its keep in the world? What is its value? What is its impact? (Social, educational, economic, paradigm-shifting, sustainable, environmental, cultural, gladdening, etc.)
The value in this project is in driving innovation and improvement to the quality of patient care in the ICU. Our concept provides an ideal to be worked towards as well as solutions that can be applied on a more modest scale to improve the quality of care in the short term. The value of this solution lies in the gradual progression from today’s ICU to a futuristic concept in 20 years time. The concept has been designed around the idea of integrated systems that can evolve, adapt and improve over time. The extensive research conducted as part of this project ensures that the needs of users are placed foremost in the design outcome. The project also has value in highlighting the role design research and design thinking can play in driving innovation in the medical field. Despite the enthusiasm of the project initiator, Dr. Bikshandi, some hospital staff members were initially sceptical of the solutions we might come up with. At the projects conclusion results and outcomes were presented to the 48th Annual Conference of the Human factors and Ergonomics Society of Australia Inc. The project was very well received by an audience primarily consisting of researchers with a healthcare background. This helps increase the profile of design research and encourages further interdisciplinary research in the future.6. Did the context of your project change throughout its development? If so, how did your understanding of the project change?
The broad context of the project, relating to the ICU bed-space, did not change over the course of the project. However the focus of the project did shift from initially looking at individual problems and how they could be solved towards a more holistic approach. This development took place particularly during observation in the ICU. As we began to understand how the ICU operated it became increasingly evident that a truly innovative design would need to integrate different systems, equipment and procedures into one cohesive system. This presented a challenge but ultimately allowed our design to become much more innovative than it otherwise might have been. The focus of the project also shifted towards a more futuristic outcome through the process of product development. Initial concepts were quite conservative, dictated by the realities of what the design would need to incorporate. As this design was refined it became evident that it didn't meet the original brief of a futuristic concept. To rectify this we developed a new, more ambitious concept that incorporated the idea of a single, holistic system. Our design outcome uses a central hub to connect the patient to equipment, analyse all patient vitals and respond automatically to changes in patient condition. This achieves a better outcome for the patient and for health care professionals.