monitoring between pods, and decreased situational awareness of unit ... Map overview shows pod layout, can view patient ... Facilitated easy communication.
VitalPAD: Designing a mobile monitoring and communication application to support pediatric intensive care in a newly designed academic acute care centre K Taneille Johnson1, Cheryl Peters2, Nicholas West3,4, Luisa Flohr2, Shaylene Beaudry3,4, J Mark Ansermino3,4, David Wensley2, Peter Skippen2, Matthias Görges3,4 1) Faculty of Medicine, 2)Dept. of Pediatrics, and 3) Dept. of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; 4) Digital Health Innovation Lab, BC Children's Hospital Research Institute, Vancouver, BC, Canada
INTRODUCTION
RESULTS
» Intro The pediatric intensive care unit (PICU) is a complex environment with diverse communication and patient monitoring requirements1,2 » Data are gathered from multiple, often physically separated devices and records1 The physical layout of the PICU has important implications for team communication and patient monitoring3,4 Our previous PICU had an open-plan design » Facilitated easy communication » Allowed clinicians to be within earshot of alarms » Allowed continuous eyesight on patients Our new PICU (fig.1) is a closed-room design » Patients are organized in 3 pods » Situational awareness of the unit and team communication may be affected
Unit map overview with 3 pods
VitalPAD design based on previous PICU VitalPAD prototype (fig.2) developed using participatory design with PICU clinicians (MD, RN, RT)7 Unit vital signs overview
Unit map overview
Real-time vital parameters
Patient-specific messaging board
Individual pod map overview with patient-clinician assignments
Aims of this project: 1. Design VitalPAD, a tablet-based application for team communication and mobile display of real time data from monitoring and therapy devices 2. Adapt VitalPAD prototype to the new PICU layout
METHODS » Ethics board approval and informed consent » Application development based on ethnographic observations5 and participatory design with clinicians6 » After transitioning to the new PICU, informal semi-structured qualitative interviews with clinicians about communication and monitoring challenges in the new environment » Application design modifications according to clinician feedback and PICU leadership requests
Re-designing VitalPAD for new PICU layout Clinician interviews after transition to new PICU » Mixed sample: n = 5 (2 RN, 3 MD) Feedback » Large closed rooms (fig. 3), must still visit bedside for some information (eg. ventilator settings) » Difficult to monitor 2 patients unless side by side » Significant transit time between pods » Decreased awareness of overall unit Figure 3: room in new PICU, with some monitoring information available from outside
VitalPAD design adapted based on these considerations (fig. 4) Design considerations » Design adaptations Monitoring patients » Map overview shows pod layout, can view patient across multiple pods, data of patients located in neighboring pods. decreased awareness » Separate pod-specific overview maps of unit » Patient list Closed room layout
» Patient ventilator parameter page
Patient ventilator parameters
Figure 4: VitalPAD designs adapted to new PICU layout
Figure 2: Examples of VitalPAD designs based on previous PICU Figure 1: New PICU layout, with 3 separate pods
RT unit map overview with ventilator mode, patient ventilator parameters
CONCLUSIONS » VitalPAD prototype adaptation to new PICU is ongoing » New PICU challenges include: closed room layout with not all information available outside of room, difficulty monitoring between pods, and decreased situational awareness of unit » VitalPAD provides real-time ventilator and monitoring data regardless of clinician location, facilitating patient monitoring across pods » Future Work: design scenarios using real patient cases to assess app function as a clinical triaging tool
REFERENCES 1. 2. 3. 4. 5. 6. 7.
Donchin & Seagull. Curr Opin Crit Care. 2002;8(4):316–20. Koch et al. Int J Med Inform. 2013;82(8):665–75 Doede et al. HERD. 2018;11(1):101-118. Hadi & Zimring. HERD. 2016;9(4):35-49. Saleem et al. Int J Med Inform. 2015;84(7):500-11. Holtzblatt et al. 2004, Rapid Contextual Design, ISBN: 9780123540515 Flohr et al. IEEE J Transl Eng Health Med. 2018; 5;6:3000114
ACKNOWLEDGMENTS This research was funded by a Canadian Institute of Health Research project grant (PJT-149042). We wish to thank all participating healthcare team members at the BC Children’s Hospital PICU, Vancouver, BC, Canada.
