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CASE STUDY | EMERGENCY WAITING

The Outcome

Comfort Hood improves comfort of patients in transition to being admitted. Pathway Booklet helps patients cope while in Emergency Department. FindCare app channels patients to correct care.

The Challenge

Improve the waiting experience in emergency departments through design solutions.


Waiting Case Study | American Hospital Emergency Department

Based on my research, I decided to focus on a specifically extreme* waiting environment, the hospital emergency department.

*Extreme*: meaning a waiting condition unusual to most waiting experiences. Where rules such as "first come first serve" do not apply.

WHERE: Rhode Island Hospital Emergency and Trauma Center and Christ Hospital Emergency Department in Cincinnati. 

PROBLEM

Overcrowding of hospitals in the U.S. has caused an imbalanced ratio of staff to patients and clean beds causing an increase in wait times, lower quality of care, decrease in patient satisfaction, even higher rates of mortality and longer waits. 

There were 41,256 admissions from the ED. Mortality generally increased with increasing boarding* time, from 2.5% in patients boarded less than 2 hours to 4.5% in patients boarding 12 hours or more.  *ACEP believes a “boarded patient” is defined as a patient who remains in the emergency department after the patient has been admitted to the facility, but has not been transferred to an inpatient unit.

- American College of Emergency Physicians, ACEP

WHY CARE?: Emergency Department is Hospital’s Front Door

Too many go to the Emergency Department for everything, including routine medical care. One of the main reasons for this increase is the number of uninsured patients in America. 

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Since its enactment in 1986 it has remained an unfunded mandate.

“43% of all hospital admissions originate in the ED”

- U.S. Department of Health and Human Services

“The emergency medical system is stretched beyond capacity. From 1994 to 2004, visits to hospital emergency departments increased from 93.4 million to 110.2 million-an 18 percent jump. Meanwhile, the numbers of hospitals, hospital beds, and emergency departments have declined significantly.”

- U.S. Department of Health and Human Service

 

METHOD

Contextual inquiry, user and stakeholder interviews, shadow doctors, nurses and technicians. in E.D. (Emergency Department)

In advance of site visit, I created a diagram of what I thought a patient’s journey would be depending on their condition and had staff correct and add to help me better understand the patients' touch points with staff and with out staff. 

 

 

 

 

 

 

USERS: I identified my user through research on historical waiting experiences and observations in the Emergency Department.

ECOSYSTEM

The users live within a network of locations and resources. Defining the ecosystem helps me better understand the relationships and potential effects of waiting interventions on the whole system.

 

 

PATIENT INTERVIEW:

I spoke with Virginia and Jerry, previous patients of Cincinnati Hospital, who said:

"Many times I feel like they have forgotten me and I don't know whats happening next or when I will see the doctor" - Virginia, 87

"A few times I have been stuck in the hall waiting to be transferred, my neck and back do not have enough support in their beds. There isn't someone to help, they look so busy, so I get sore in one position" - Jerry, 88

DOCTOR INTERVIEW:

"Many times I will wear my white coat even though its hot and the hospital will not wash it for me because patients respond better when they see it." - Dr. Rozzo

CARETAKER INTERVIEW:

" When the doctor comes in I'm usually pretty quiet, trying to jot down everything they say for my dad(patient)" - Patricia, 59

USER JOURNEY INSPIRED BY OBSERVATIONS

OPPORTUNITIES

PRIORITIES: I distilled the opportunities into categories to find what would be most viable, desirable, and feasible.

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IDEATION PROCESS

 

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