design interventions in emergency rooms
service design concept
Through the two levers of patient flow control and transparency, we support patients in finding a suitable point of contact, make responsibilities and processes within emergency care understandable and thus create an appropriate level of expectation as well as reducing the burden on medical staff.
problem and goal
“Once created to quickly help patients in emergency and accident situations, the emergency room has now developed into a general and ‘uncomplicated’ point of contact for many patients with sometimes trivial aches and pains.” – Pförringer, V. F. D., 2019
The result: overcrowded and overloaded emergency rooms. In our bachelor project at the HfG Schwäbisch Gmünd, we dealt with this problem and explored what contribution we can make as designers. The approach within the bachelor project can be divided into five stages: research, analysis, synthesis, ideation and implementation. Individual excerpts are presented below.
secondary and primary research
Within the framework of secondary research, we defined central terms and obtained an overview of relevant topics in the contexts of emergency care and emergency admission. Accompanying this, we sought contact with various actors in emergency care as part of the primary research. In doing so, we conducted surveys and interviews and immersed ourselves in the real context through observations in emergency rooms.
Through various analyses, we gained new, more in-depth insights and examined individual aspects more closely. These include a stakeholder analysis, the analysis of the processes during the handling of an emergency and the communication and interactions during it, as well as the analysis of the requirements, needs and wishes of relevant stakeholders.
causes and consequences of overcrowded emergency rooms
First, we looked at our central problem of overcrowded and overloaded emergency departments and related the reasons for this. It is not that there are too many medical emergencies. We looked at who uses emergency rooms and found that only eight per cent of patients are actual emergencies (1.2 % triage level red and 7.0 % triage level orange). In about one third (31.6%), the situation could develop into an emergency. However, the majority (55.1 % triage level green and 4.9 % triage level blue) are people who subjectively see themselves as an emergency, but who could also consult other services such as general practitioners, specialists or the medical on-call service. These people are out of place in the emergency department and contribute to the problem of overcrowding and congestion. This problem and other reasons are shown in the following diagrams.
negative spiral in communication
Due to overcrowded emergency rooms, medical staff are generally very busy. Although interpersonal communication is a part of the medical staff’s job, it is not the core of the job and quickly fades into the background when the workload is high. The busier the medical staff, the less time they have to exchange information with the patients. If this exchange is no longer possible, patients remain or become insecure and impatient. They ask questions more often and become more unfriendly as the (unexplained) waiting time increases, which in turn leads to a greater burden on the medical staff.
information and knowledge gap
In synthesising our findings from the interviews and observations we conducted, we found that in addition to the negative spiral, there is an information and knowledge gap in communication between medical staff and patients, which is caused by various factors.
With the method of opportunity areas we summarised the problem areas. As we worked iteratively within the ideation process, new or (slightly) altered opportunity areas emerged with each successive run, within which we developed, tested and revised ideas. We divided the opportunity areas into three phases: the phase before the visit to an emergency room, the phase when the patient is in the emergency room and the phase after an emergency room visit. For each opportunity area, we formulated How Might We questions:
Since we did not want to design a single solution in our bachelor project, but wanted to address the problem of overcrowded and overloaded emergency rooms in several places with different design interventions, it seemed reasonable to us to define general design guidelines in the form of design principles.
The classification of causes and consequences carried out in the synthesis showed that the former are mostly of a political nature. For this reason, we wanted to start our interventions on the side of the consequences. The situation in an emergency room is a concrete point of reference and the phenomenon of the negative spiral in communication between medical staff and patients can be approached in a design-oriented way, as can the information and knowledge gap.
With the first concept we wanted to:
→ create an appropriate level of process transparency, i.e. the
processes behind the scenes of the emergency department visible
→ make the stay in the emergency room – and especially the
the waiting time – an opportunity for reflection and health education.
→ use information that is geared to the individual treatment path of patients to reduce existing uncertainties and to address medical procedures.
For the development of our first concept we used an adapted design sprint. In an iterative process we generated many ideas, tried them out and discarded them again.
To test our concept, we created a storyboard. The storyboard was intended to serve as a tool for the concept presentation and not to stand alone. Rather, it should illustrate what was said during the presentation and make it clear where the individual interventions are applied during the visit in an emergency room.
While the interventions in the first concept were in the area of the consequences of overcrowded and overloaded emergency rooms, with the second concept we wanted to move – in addition to the further development of previous ideas – in the direction of cause-fighting.
In concrete terms, we wanted to
→ reduce the number of patients with an urgency level of four
and five in emergency departments. This includes all patients with concerns that do not require specific personal or technological resources of the emergency department and can also be treated by other medical services.
→ Increase the health literacy of patients. Through health education, patients could be helped to better assess their current situation and also to know which health care provider is appropriate for their needs.
For our final concept, we combined the best of the interventions developed so far. For each of the four final interventions, we described on the one hand the idea behind it and on the other hand how the concept should look like.
We placed all interventions in the context of overcrowded and overloaded emergency rooms as well as in the decision-making process of a medical layperson in a (subjective) emergency situation.
Further we evaluated the impact of the four interventions.
visual design and information design
We defined the requirements for the visual design based on our broad target group and the defined design principles. They were to be translated into the interfaces through the choice of colour, typography, icons and animations. The guidelines for the information design also emerged in this way.
The step towards a model implementation of our project was a rather small one, as we already worked with mostly detailed prototypes in the ideation phase. Nevertheless, we thought about how to make the individual interventions – with the exception of the Google-linked snippet of intervention 1 – conceptually and visually coherent.
design can encourage new ways of thinking and solve problems
The problem of overcrowded and overloaded emergency departments is not a new one and, as we found out in the course of the project, is also being tackled from different sides. Political reforms are planned, new laws are passed and technological solutions are developed to make processes more efficient. From our point of view, design as a solution approach and discipline to deal with such problems has not yet been sufficiently considered in this context.
In the context of a project, we can only change the surrounding system to a limited extent and have to interact within a (for the moment) given political framework. What we can do and have done with our work is to develop design proposals for solutions. Identifying these is not always easy. Nevertheless, we are convinced that there is always an area within which design can improve and initiate new ways of thinking. In a way, anything can be designed if you just dig deep enough.
interested in the whole
nothing simpler than that
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