Be patient
Innovative Emergency Department Service System for Improving Patients’ User Experience
Year
2013
Category
Service design/ Design research
Team
Lisa Huang
This project represented evidence-based design research aiming to enhance the overall visiting experience of the Emergency Department (ED). By means of background studies, user interviews, and collaborative co-design workshops, our team developed a service to improve the waiting process in ED.
3. Solution
With the co-design section, the design team developed a solution: a mobile device equipped with a health card reader for personalized purposes and an internal network connection for privacy concerns.
Showing as below
Full Research
Background study
Emergency Department
In the medical system nowadays, Emergency Department(ED) is one of the essential parts. It is a special department opening for 24 hours in the hospital; thus, we can say that ED is the frontline of hospital contacting with the whole society. In order to make everyone equally obtains an appropriate medical service in any time, there are four primary functions for ED: (1) providing medical service in 24hour and 7days a week, (2) addressing people whose conditions from different ages, specialists, and different levels of illness and injury, (3) generating the cause and the treatment in a short period, (4) assisting patients in finding the most appropriate solution including referral, consultation, being hospitalized, emergency surgery, and outpatient tracking. The above descriptions show the urgency and complexity of the emergency medical service. (Chen, 2011)
Situation in Taiwan
However, in recent years, there has been a critical problem in the Emergency Department in Taiwan- overcrowded. According to the statistical data from the Ministry of Health and Welfare in 2013 in Taiwan, the number of people who visit ED has gradually increased every year, and this increase causes overcrowded ( Ministry of Health and Welfare, 2013). This situation not only makes people wait for a long time but also enlarge the working loading of medical practitioners in ED. Usually, patients tend to amplify their condition subjectively while they are under illness and injury during the waiting time in the ED (Stuart, Parker, & Rogers, 2003; Gordon et al., 2010). Also, patients may feel that they are ignored by medical practitioners and produce other negative emotions such as anxiety, depression, or nerve(Dube, Teng, Hawkins, & Kaplow, 2002; Taylor & Benger, 2004). These subjective feelings from patients result in the different perceptions between patients and medical staff of how serious illness or injury is (Nyström, Nydén, & Petersson, 2003). With all those factors and the unfamiliarity of ED working flow, sometimes, the circumstance may be out of control and finally, it leads to violence. Therefore, this study tries to provide some possible solutions to improve patients' experience in the ED.
Current patient flow in ED
Design Process
Semi-structured interview
Interview purpose and questions
Interview purpose and questions
Interview purpose and questions
To understand issues within the current flow in ED, we conducted interviews with patients with ED experience. Interview segments included 3 aspects: past experiences, emotion, and information delivery (both content and format). These 3 aspects were based on Gordon's research about factors of affecting patients’ experience in ED in 2010(Gordon et al., 2010).
To understand issues within the current flow in ED, we conducted interviews with patients with ED experience. Interview segments included 3 aspects: past experiences, emotion, and information delivery (both content and format). These 3 aspects were based on Gordon's research about factors of affecting patients’ experience in ED in 2010(Gordon et al., 2010).
To understand issues within the current flow in ED, we conducted interviews with patients with ED experience. Interview segments included 3 aspects: past experiences, emotion, and information delivery (both content and format). These 3 aspects were based on Gordon's research about factors of affecting patients’ experience in ED in 2010(Gordon et al., 2010).
Emotion
Anxiety/ Nervous/ Confused/ Neglected
Those emotions were caused by unfamiliarity with the environment and the flow. Also with long waiting time, patients felt that they were playing vulnerable groups.
Information delivery
Content:
There were too much information and details at once, so patients were overwhelmed. Also, they could not access any progress while they were waiting for their examination.
Format:
Most information was passed by oral channels; patients could only passively get information through medical practitioners.
Additionally, part of the patients mentioned environmental factors, such as poor wayfinding clues or noisy background sounds affected their experiences.
Emotion
Anxiety/ Nervous/ Confused/ Neglected
Those emotions were caused by unfamiliarity with the environment and the flow. Also with long waiting time, patients felt that they were playing vulnerable groups.
Information delivery
Content:
There were too much information and details at once, so patients were overwhelmed. Also, they could not access any progress while they were waiting for their examination.
Format:
Most information was passed by oral channels; patients could only passively get information through medical practitioners.
Additionally, part of the patients mentioned environmental factors, such as poor wayfinding clues or noisy background sounds affected their experiences.
Conclusion
The design team concluded that the root cause of above issues was insufficient or limited access to information. Based on this finding, the team discussed with ED practitioners to assess what type of information could be made available to patients while still preserving their privacy.
Here was those information:
-
Working flow in ED: Patients understood the process and progress of their status.
-
Waiting time for each stage: Patients could arrange their time with meaningful usage rather than just sitting there and doing nothing.
-
Indoor navigators: This helped patients become familiar with the environments in a short time frame.
Co-design workshop
With insights and features from the interview, our team hosted a co-design workshop for ideating the format.
Evaluation criteira
Design ideation
Wearable device
Information station
Paper check list
Smart device with IC chip reader to catch information from health insurance database.
( final decision)
Here is the framework of some scenario for our service
Scenario 1 showing personal flow in ED
Users could check their flow progress from this feature; also system indicated if they finished it or not through color. There was a progress bar at the button that could provide a quick view of what stage they were at.
Scenario 2 showing waiting progress for examination
Waiting time occupied patients most time in ED and to prevent their number passed patients only could sit in the waiting room and do nothing. Therefore, with this feature, patients could arrange their time effectively.
Scenario 3 indoor navigator
Improve the patient's wayfinding experience by providing a navigation system in ED.
Scenario 4 Notification for paying bill
Once patients reached the discharge stage, the system would pop up a notification about paying bills and showing the location of the cashier in ED.
Reference
-
Britten, N., & Shaw, A. (1994). Patients' experiences of emergency admission: how relevant is the British government's Patients Charter? Journal of Advanced Nursing, 19(6), 1212-1220.
-
Burström, L., Starrin, B., Engström, M.-L., & Thulesius, H. (2013). Waiting management at the emergency department – a grounded theory study. BMC Health Services Research 2013.
-
Canadian Association of Emergency Physicians, C., ,. (2003). from http://caep.ca/resources/position-statements-and-guidelines/ed-overcrowding-2003
-
Crowley, J. J. (2000). A clash of cultures_A & E and mental health. Accident and Emergency Nursing.
-
Dube, L., Teng, L., Hawkins, J., & Kaplow, M. (2002). Emotions:the neglected side of patient-centered care and quality management The case of emergency department patients waiting to see a physicial. Advances in Health Care Management.
-
Gordon, J., Sheppard, L. A., & Anaf, S. (2010). The patient experience in the emergency department: A systematic synthesis of qualitative research. Int Emerg Nurs, 18(2), 80-88. doi: 10.1016/j.ienj.2009.05.004
-
Lewis, K. E., & Woodside, R. E. (1992). Patient satisfaction with care in the emergency department. Journal of Advanced Nursing.
-
Nyström, M., Dahlberg, K., & Carlsson, G. (2003). Non-caring encounters at an emergency care unit – a life-world hermeneutic analysis of an efficiency-driven organization. International Journal of Nursing Studies, 40(7), 761-769. doi: http://dx.doi.org/10.1016/S0020-7489(03)00053-1
-
Nyström, M., Nydén, K., & Petersson, M. (2003). Being a non-urgent patient in an emergency care unit—a strive to maintain personal integrity. Accident and Emergency Nursing, 11(1), 22-26. doi: 10.1016/s0965-2302(02)00135-2
-
Stuart, P. J., Parker, S., & Rogers, M. (2003). Giving a voice to the community a qualitative study of consumer expectations for the emergency department..pdf. Emergency Medicine, 369–375.
-
Taylor, C., & Benger, J. R. (2004). Patient satisfaction in emergency medicine. Emerg Med J, 21(5), 528-532. doi: 10.1136/emj.2002.003723 ChenWei-gong. (2011). Management of emegnecy department. San Min Book Co.,Ltd.