Field Observations

1. Field Observations Priyal Mehta Akash Shah

2. Piedmont Hospital • All Piedmont ICUs have intensivist and extenders on duty. • Digital record keeping for the most part, except patient consent forms and daily progress reports which are still paper based. • Hospital allows family to be present during resuscitation to understand the care being given and be a part of the healing process.

3. ICU Blue • The ICU has 12 rooms set in a rectangle. Distributed nursing stations with a computer and monitors and a clear view of the room. • Sinks in and between rooms. Compulsory to wash hands. • Narcotics/drugs kept at far end of room. Only accessible with authorization or prescription. Overrides for critical situations.

4. ICU Blue - Problems • Too many cabinets in the rooms! • Rooms quite spacious with enough space for caregivers to move around. However, they are not family friendly as there are no beds or even a seating place in the room. • To get more space in the ICU blue for families, the extra cabinets occupying a lot of space can be torn down and place made for a visitor chair/bed, use foldable beds, etc.

5. ICU Blue - Problems Privacy issues! Tried to provide curtains to separate the area, however that led to other issues such as infections. Problem could be looked into. For eg, using vinyl curtains which are easily washable

6. ICU Green The ICU had 10 rooms initially but got converted to 8 rooms to increase space. It is circular with each room on the outer periphery of the circle. Because of the circular design, there are too many sharp angles in different places in each rooms.

7. ICU Green - Problems Even the increased size of the room was much smaller. Lack of cabinet space was glaring Cannot build on top of this ICU as the foundation is not deep enough.

8. Step Down ICU • Very small rooms. However, they have ample natural lighting. • Centralized nursing station. Initially very small, but rooms tore down to increase space. • Bathrooms with concrete walls in each room, located between nursing stations and beds. So as nurses can’t directly see into rooms, cameras are kept in each room.

9. Patient Falls • Sign outside the ICU Blue which prominently displayed when the last fall was. This is a good measure and it constantly reminds the staff to keep patient falls in mind. • Also, special clothing used for patients likely to fall like green/red socks. • Cameras in rooms to monitor the patients continuously.

10. Infections In case of Central Line infections, hospital makes sure to do an analysis of the cause. Specially trained IV team in the hospital for all dressing Room pressure also used to fight against infections. Negative pressure rooms used for patients with compromised immunization and positive pressure rooms for patients already carrying air-borne infections/diseases.

11. Other Problems There is no interoperability between software packages used by different parts of the hospital - the emergency, ICU, normal hospital each has a different software package and these do not talk to each other. Nurses feel the whole computerization process did not yield all the promised benefits! Because some records are still kept on paper there may still be problems like interpreting handwriting Patients still complain when there are not enough ICUs available or when they don’t understand treatment

12. Solutions/Suggestions Investment must be done to either build a single package encompassing all features of each package, or to find out ways to tweak existing software to talk to each other. An information centre can be build in the visitor areas where the family can get more information about the patients problems and the care being given to them. Maybe a tablet like computer where the authorized visitors can check-in and see a summary of the progress of the patients care from the last time they visited.

13. Children’s Healthcare of Atlanta at Scottish Rite • Children are not delivered here, but are brought in case of emergencies. • Visited the NICU, PICU and CIRU at this hospital

14. Interior Design Patterns Overall hospital interior design has bright colors and includes a lot of natural elements. Use of more symbols than words Circles are used to designate areas of importance, such as food courts, information desks. In case of ICUs/rooms, they indicate the patient care area.

15. Problem: The overall color coded theme of the hospital is very efficient, even in cases when the parent is aggravated and trying to reach the NICU. However when they reach there, they could feel lost as there is no staffing outside the NICU

16. NICU • It has a Pinwheel design – open design, area is divided into patient centric quadrants. • There are 35 beds there and 2 isolation rooms • Central as well as individual nursing stations

17. NICU • Uneven surfaces are used to reduce the sound. • 3 color coded lights outside patient zone. Orange: alarm, White: patient request (less used), Blue: code blue (emergency)

18. Problem NICU interiors are quite dark so that babies do not stress out and are kept warm so that they do not shiver, hence conserving calories in both ways and promoting baby growth. However, this sort of an environment is a problem for the doctors and nurses.

19. Problem In patient area, only chairs are provided. There are family rooms and sleeping rooms, but they are outside the NICU. In order to encourage more parent/child bonding, flexible chair/bed configurations can be provided.

20. PICU • Overall movie theme-d rooms • Specifically, a field to mention the goal for the day. This could be very different from the parents’ perspective and the doctor’s. • Single person room. Natural lighting in the room – aids in recovery. Separate sinks in the rooms, but hardly used.

21. PICU Overall equipment in the room centrally wired. Equipment usually bought from the same preferred vendor. Negative pressure rooms also available. Other facilities for the parents/relatives include waiting & eating rooms, as well as grievement rooms.

22. Nursing Stations Nursing stations at regular intervals around the entire area of the PICU. Charts with name of attending doctor, therapist, nurse also maintained at each such station. As mentioned before, technology is used for all book-keeping. Problem: having so many nurse stations could add to the noise (talking amongst nurses, phones, etc)

23. Problem The design of the PICU area is such that for patients being kept in rooms towards the end, the family member will have to walk a long way from the entry to get there and this can get quite tiring. At least, there is a possibility to exit from the end

24. Thank you! Pictures courtesy of: Akash Shah, Wanlin Xiang, Paul Ocón