Transformation of Pediatric Care Spaces
--- Pediatric Design of the Future
TRANSFORMERS:
Marianna Jewell, Jamie Beyer, Jiten Chhabra, Hui Cai
Method
EVIDENCE
PROBLEMS
PRINCIPLES
The Plan-Do-Study-Act cycle was developed by W. Edwards Deming
(Deming WE. The New Economics for Industry, Government, Education.).
Five Principles
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.
Problems
1. Patient history is repeated multiple times when changing
caregivers.
2. The multi-bed emergency room design does not support
patient privacy and safety.
3. There is a lack of data and decision-support tools to provide
evidence based care.
4. Patients with chronic diseases have to make unnecessary
hospital visits, about issues which can be addressed by telemedicine.
5. Ignorance of physical and psychological needs of different
user groups.
6. There is no separation between front and back of house.
Evidences
1. Patient history is repeated multiple times when
changing caregivers.
“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 paperbased 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
“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
Evidences
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).
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).
Evidences
2. The multi-bed emergency room design does not
support patient privacy and safety.
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).
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).
Evidences
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. “
Evidences
4. Patients with chronic diseases have to make
unnecessary hospital visits, about issues which can
be addressed by tele-medicine.
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.
Evidences
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 area is
devoted to family space. Support resources for these family members
include a close-by and comfortable place to sleep, meals and
meditation rooms. Each floor offers additional family sleep areas, and
family quiet areas. Family lounges have kitchen and laundry facilities
and a fully equipped business center. (Richard L. Miller, FAIA, and
David C. Miller, 2005)
Evidences
6. There is no separation between front and back of
house.