Transformation of Pediatric Care Spaces

1. Transformation of Pediatric Care Spaces --- Pediatric Design of the Future TRANSFORMERS: Marianna Jewell, Jamie Beyer, Jiten Chhabra, Hui Cai

2. Method The Plan-Do-Study-Act cycle was developed by W. Edwards Deming (Deming WE. The New Economics for Industry, Government, Education.).

3. Five Principles • 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.

4. Problems • 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 tele-medicine. • 5. Ignorance of physical and psychological needs of different user groups. • 6. There is no separation between front and back of house.

5. 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 paper-based 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

6. “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.ClinicalEpidemiology Division, Department of Orthopedic and Trauma Surgery, Ernst-Moritz-Arndt-University, Friedrich Loeffler Strasse

7. 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).

8. 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).

9. 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. “

10. Evidences 4. Patients with chronic diseases have to make unnecessary hospital visits, about issues which can be addressed by tele-medicine. • 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 • Effectiveness of a Regional Poison Center in Reducing Excess Emergency Room Visits for Children's Poisonings. Pediatrics, Volume 72, Issue 2, pp 164-169.

11. 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)

12. Evidences 6. There is no separation between front and back of house.