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 lt 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.Clinical Epidemiology 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.

1. 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
2. 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.