CORE Design Process Book

VCH Handoff Project

Yumi Simonson

April 18, 2012

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CONTENT

3-9 / introduction

10-19 / what is a handoff?

20-21 / site visit

22-24 / case studies

25-33 / literature review

34-41 / visual research

42-43 / toolkit

44-51 / interviews

52-54 / concepts

55-57 / personas

58-60 / sketches

61-71 / iterations

72-98 / final

99-100 / reflections

101-108 / annotated bibliography

Image: http://en.wikipedia.org/wiki/File:VGH-2.jpg

introduction

Image: http://nobaev.blog.com/tag/pharmacy-inventory-policy/

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Using primary and secondary research, co-creation, interviews, brainstorming, and concept development through prototyping and refinement, we were asked by Vancouver Coastal Health to come up with ideas that would improve the quality and success of the nurse handoff procedure.

project brief

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Working in self-selected groups of 3, and using a va-riety of techniques—primary and secondary research; co-creation; human-centred design; brainstorming; emotional probes; demographics; user testing; etc.—consider the problem as described above and particu-larly as briefed by the client. Using any of the tools and techniques of design research discussed in class (or others), consider solutions. Likely you will need to consider systems design. But as well, you may sug-gest forms (electronic or paper), formal verbal briefings, charts—the end results are not confined to any one solution. Think divergently and creatively. This complex problem has no single simple solution, it has many conflicting perspectives and requirements. Decide how you would proceed to solve the problem. You will be working with representatives from VCH, so consider best how to employ their time in reaching conclusions.

assignment

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the criteriaOur design criteria was to include the following:- primary and secondary research- user testing- prototyping- documentation of our process- final design and presentation to VCH officials

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the contextVancouver Coastal Health supervises many hospitals and serves over a million people in BC. They are doing a great job saving people’s lives. However, human er-ror is inevitable in any circumstances. 44,000 to 98,000 Americans die each year as a result of adverse events.

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My group consisted of Hailey Yang, Della Ma, and my-self Yumi Simonson. I did not know my other group members very well, but they seemed passionate about this project and I was very happy to work with them. Looking back on the project, each of my fellow group member contributed as much as they could and I am happy with the results. We were very agreeable and worked well as a team.

my group

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gantt chart

Image: http://info.med3000.com/resources/blog/?Tag=nurses

what is a handoff?

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At the beginning of the project we were introduced to the current handoff methods.

SBARsituation- what is the problembackground- pertinent informationassessment- clinincal staff’s assessmentrecommendation- what needs to be done

who: nurses

what: handoff, shift change, breaks, information passed from one person to another

when: end of shift, beginning of shift

where: nurse station, white boards, change rooms, hallways, patient bedside

why: conditions are stressful, time limited, sleep de-prived, illegible hand writing, unsafe abbreviations

how: tapes, verbal, written notes, reports, checklists

overall, inconsistent methods

http://news.sjhlex.org/safetyfirst-sbar/

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it takes an average of 133 people to take care of a patient.

some problems with the current handoff include:- illegible handwriting- look alike, sound alike words- unsafe abbreviations- unsafe high risk medications- not enough time (rushed)- interruptions- new nurses who are inexperienced- writing down too many times- stress and emotions- work place conflicts- not taking seriously/lack of ownership- afraid of legal issues- computers not available- loud noises/distractions

problems

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- Desktop computers do not support mobile work because they are static

- Paper charts support mobility, but lack stimultaneous access by multiple users

- Paper records are hard to store, not readily transport-able, may contain illegible entries, or may be unavailable due to simulltaneous users

- According to one study, paper charts may be missing 25% of the time they are clinically needed

problems

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site visit

A few weeks into the project, groups were given the opportunity to watch a hand off at a local hospital. I was able to go to the University British Columbia hos-pital. We were shown where the handoffs took place and given insight into the challenges improper procedures result it.

Image: Makiko Umezawa and Sabrina Ng

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Cabinets

Nurses Station

Floor Plan of where the shift change happens

In order to get a thorough understanding of the cur-rent nurse handoffs, We went to the UBC hospital on a Thursday night at 7 O’clock. The shift started at 7:30. The handoff happened very quickly. It was hard to tell when exactly it was going on. The nurses seem to be distracted, switching from a conversation about the patient to their plans for the weekend. There were also a lot of people coming and going through the nursing station. It was hard to tell who was there for the hand off and who was there to just ‘hanging out.’ When I had a chance to talk with a nurse and ask her how she thought shift handoff could improve, she did not think that there was anything wrong with the current method. When I mentioned the idea of using computer technology, she replied, “That is not going to happen in my life time…” From my point of view, the nurses are frustrated and tired of all the new handoff methods that people from the outside are trying to implement. They want to be involved and have their concerns heard.

case studies

Image: http://www.ausy.com/embed/reference-sciences01/

At the early stages of this project, our group decided to look into ways different people were tacking the nurse handoff. We looked at a handoff room redesign and Apple iphone apps.

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http://www.domeproject.org.uk/outputs.html#Handover

handoff room

One in ten hospital patients in the UK suffers unintended harm as a result of medical error. The Designing Out Medical Error (DOME) project aimed to design equipment and products which better supports these processes and therefore reduce instances of medical error.Information handover was listed as one of the five most error prone processes. The research found that the handover of patient information from one staff shift to the next of-ten took place in an unsuitable environment. DOME designed a room that uses space flexibly, featuring stowable seating, a fold away table, adjust-able light levels and a ‘do not disturb’ sign. The design allows the room to be used as a staff room when handover is not in progress.

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iphone apps

http://www.apple.com/iphone/business/profiles/memorial-hermann/

Apple iphone apps are being used in hospitals across the United States. “There’s no question that iPhone is making a difference in how patients are cared for […] iPhone[s] simply helps us deliver patient care in a more ef-ficient, productive manner.” Healthcare professionals are able to view live data, test results, email with their coworkers and search the internet for information at the point of care. Doctors “…access patients’ data whenever and wherever [they] want it. Knowing what’s happening with their drugs, radiology, laboratory values, microbiology results.”

literature review

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“Hospitals are complex and busy places involving constant shifts and movement of people and things that are distributed within different areas at different times for diverse requirements. (Prgomet et al.) Communication error is one of the leading contributors to inefficiencies in healthcare delivery, preventable injury, and frustrated staff. In order to better understand the current situation in hos-pitals and gain a framework and context for our third year design project in col-laboration with Vancouver Coastal Health, our group looked at a number of journal articles. We began our research by looking into current communication prac-tices in the hospital environment, and the advantages of implementing computer technology. Questions that we wanted our research to answer were: why is there communication error? Is it a lack of resources (technology), uneducated staff, or a combination of both? We also wanted to examine what technology hos-pitals around the world were utilizing to

solve communication errors and improve the quality and success of nurse handoffs.

HOSPITAL COMMUNICATION

Enrico Coiera and Vanessa Tomb’s article, ”Communication behaviors in a hospital setting: an observational study” identifies patterns of communication behavior among healthcare workers. The subjects included both doctors and nurses who use, like Vancouver Coastal Health employees, radios, pagers and telephones. Coiera and Tomb state that healthcare systems suffer enormous inefficiencies because of poor commu-nication infrastructure and practices. An Australian survey found that, “…com-munication problems were the most common cause of preventable disabil-ity or death, and were nearly twice as common as those due to inadequate medical skill.” (Coiera and Tomb) We were interested to read that out of the observed healthcare professionals who answered their pagers, only three out of

literature review

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nine pages sent, were answered. Coiera and Tomb contributed this to the idea that healthcare professionals, “…rarely considered the effect that a telephone call or page would have on the other party.” They were thinking of their own tasks, before those of their colleagues. This finding was confirmed in our Vancouver Coastal Health interviews, as a number of nurses explained that many of their colleagues were only worried about, ‘saving their name’ if a legal issue arose. The author characterized these traits as habitual and selfish. From this article we gathered that it would be beneficial if the method of communication, be it pager, email, text, or phone call, was equip with something that indicated the urgency of the message. The authors explain that,

“When interviewed, some of the doctors indicated they assessed the urgency of a page by the number of times they were called and the origin of the call […] failure to get a reply to a page within a short period was often taken to mean that no answer was coming, with the caller moving on to another ward.” (Coiera and Tomb) If prompt communication is not

facilitated, a patient’s life can easily be put in danger. Failure to properly commu-nicate can also lead to duplicated orders, as healthcare professionals can quickly become unaware of each others actions. Through interviews, the author observed, “There seemed to be a need in such an event driven environment to deal with tasks as they arose.” (Coiera and Tomb) The healthcare professionals want to ‘tick’ the task off their list and get imme-diate acknowledgement of a message. Recommendations from this article include: the implementation of wireless technology to support mobility through the hospital, services that provide acknowledgement that the message has been read or acted on, caller’s identity, perceived urgency of task, and nature of task. This article gave our group a greater understanding of the challenges that current communication practices face and some useful recommendations. With this new found understanding, our research became more focused, looking into the advantages new technology could provide the hospital setting.

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ELECTRONIC CHARTING

“Development of electronic medical record charting for hospital-based trans-fusion and apheresis medicine services: Early adoption perspectives.” written by Rebecca Levy, Liron Pantanowitz, Darlene Cloutier, et al. describes the Tuft University School of Medicine’s process in implementing paperless medical records through an electronic charting strategy. They found that “…electronic charting eliminated illegible handwrit-ten notes, resulted in more consistent clinical documentation among staff, and provided greater real-time review/access of [medical] practices.” (Levy et al.) By moving from paper to computer based systems they found that data mining and monitoring activities improved. This is a stark contrast to the reality of paper charts that the author explains, “…may be missing up to 25% of the time when they are clinically needed.” (Levy et al.) The paper focused on the advantages of real time data, as “Users can rapidly seek, view, arrange and assemble laboratory information to support trend analyses and clinical decision making.” (Levy et al.) Overall, Levy et al. described how

electronic medical records help to, “…solve several problems with paper chart-ing: lost or misplaced charts, illegible writing and the existence of only one official copy of a handwritten chart note.” (Levy et al.) The author observed that electronic medical records result in less time duplicating information, as is the case with paper forms. Duplication of paperwork was one of the major issues that Vancouver Coastal Health workers noted as their frustration. We wanted our design solution, to eliminate unneces-sary paperwork by creating some type of automatic information entry system. Our group wanted to investigate different methods of electronic medical charting and decided to use iphones and station-ary computers.

THE USE OF MOBILE TECHNOLOGY

Coiera’s article pointed to digital com-munication as an answer for ineffective practices. In order to better understand the current situation, we looked at the different technological applications currently being used in the healthcare setting. Omar L. Gallaga’s article “Four technologies are helping hospitals better

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treat patients” briefly explains how com-puters are helping American hospitals save money and improve patient care. Gallaga describes how healthcare profes-sionals can check on their patients, “…using the same phone many use to post messages to Twitter or listen to music.” Our group wanted to introduce a com-munication system that healthcare pro-fessionals already had experience using, an iphone. The article noted how quickly doctors were able to use their phones to monitor the patients instead of having to thumb through piles of paper and files. One doctor described his experiences as, “I just log in. It’s so much faster […] I can tell when she’s off the monitor […] I can check on them in the middle of the night if I’m curious how they’re doing.” (Gallaga) Although mobile technology is very convenient for health care profes-sionals, there are set backs like security issues. Gallaga’s article explained that in this situation, the phones have a FDA-regulated app encrypted with security that protects the patient information. In 2010 mobile hospital technology, includ-ing iphone apps, was already in place in

200 hospitals around America. (Gallaga) Technology is also available for patients. Gallaga investigated a networked hospital TV equipped with internet services. “… At Seton Medical Center Williamson, a system it calls ITV provides not only [tv episodes], but other interactive services and information.” (Gallaga) Each patient has their own TV monitor as well as a wireless laminated keyboard. The patients are encouraged to navigate the menu with the keyboard or remote control and can communicate with their nurses. As well as providing entertainment, “… the goals of the system are to shorten hos-pital stays and teach patients about their ailments and medication […] reduc[ing] readmission rate.” (Gallaga) This article was packed with blue sky solutions to help hospital communication, however Vancouver Coastal Health does not have as much money as privately funded hospitals in the United States. Using the information gathered from this article, we decided to focus on mobile phone tech-nology and how it is currently used in the hospital setting.

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“The Impact of Mobile Handheld Technology on Hospital Physicians’ Work Practices and Patient Care: a Systematic Review” written by Mirela Prgomet, Andrew Georgiou, and Johanna I Westbrook; of the Faculty of Health Sciences University of Sydney breaks down the benefits of Mobile Technology in the hospital setting. The authors explain that mobility is a central feature of healthcare delivery because profes-sionals work in multiple locations with various people, both co-workers and patients. As it is today in VCH hospi-tals, “While desktop computers allow easy storage, searching, retrieval, and sharing of patient information, because they are static, they do not support many aspects of mobile work. In the absence of bedside terminals, physicians must search to find an accessible computer at a location away from the patient. Traditional portable paper charts, by con-trast, support the mobility of physicians, but are limited by inefficient information accessibility and their lack of simultane-ous access by multiple users.” (Prgomet et al.) The authors concluded that mobile technology combines the best of both

paper and computer systems. Benefits of mobile handheld technology include,

“enhanced productivity, improved infor-mation access, improved communication, reduced medical errors, greater mobil-ity, and improved quality of patient care.” (Prgomet et al.) This study examined the effect of mobile devices on; admin-istrative support, professional activities, documentation, decision support, and education and research. They judged their evidence based on the rapid response, medication error prevention and data management and accessibility. The study found that using mobile technol-ogy, a PDA instead of a pager, resulted in a lower average response time and,

“…failures to respond occurred less often.” (Prgomet et al.) Mobile phones also allow healthcare professionals to respond to a call directly compared to a one way communication pager where a healthcare professional must locate a phone to return a call. Another benefit of Mobile technology is point of care data entry. Electronically generated medical lists show, “…significantly fewer errors [8%]…compared with the hand tran-scribed lists (22%). The errors identified in

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the handheld-generated lists all involved erroneous exclusion of medications, while transcription errors were elimi-nated.” (Prgomet et al.) In a fast-paced hospital environment, quick information access is a priority. “A handheld device offers greater portability and provides a greater scope of up-to-date information, including drug interaction information, that may be more rapidly accessed from any location. Thus, providing informa-tion and decisions support access at the point-of-need, which supports informed treatment decisions, improved patient outcomes may be achieved.” (Prgomet et al.) At this point of our research, our group was convinced that iphone tech-nology was the best solution for VCH hospitals, but we still had to keep in mind the needs of the clients because this is a human centered project. It was interest-ing to find out that given the, “…choice of input method-paper, fixed computer, or handheld device–some physicians pre-ferred to use a fixed desktop computer located away from the patients bedside rather than using a handheld device at the point of care.” (Prgomet et al.) As a result of this information, our group

decided to use mobile iphone technology in conjunction with stationary desktop computers which are already in place at the hospitals. Prgomet et al. concluded their article by stating, “…decisions-making may be compromised not only by incorrect data, but also data not entered in a timely fashion.” (Prgomet et al.) Hand held devices are most beneficial in hos-pital settings where time is of the utmost importance and quick response is crucial. Mobile devices allow healthcare profes-sional to view and add patient data at the point of care. We began to research dif-ferent methods that are proven to speed up information access time, one of these methods was voice to note technology.

VOICE TO NOTE RECORDING

Through our research, we became aware that a doctor in the Lower Mainland was using voice to note software in his general practice clinic. We decided to investigate this further and looked into voice to note technology in the hospi-tal setting. The idea of this technology sounded attractive, but we were worried that the high cost would be impracti-cal for use in Vancouver Coastal Health

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hospitals. Our suspicions were wrong as we discovered an article by Daniel I. Rosenthal, Felix S. Chew, Damian E. Dupuy, et al. of the Harvard Medical School describe the implementation of computerized speech recognition in their paper, “Computers in Radiology: Computer-Based Speech Recognition as a Replacement for Medical Transcription.” Their study consisted of one week of trial followed by three months of routine clinical use. The authors found that, “Speech recognition decreased the time until the report became available by 99%…” (Rosenthal et al.) Not only does the recognition software reduce the time spent waiting for reports, it also cost substantially less than traditional dictation methods. The average cost for human report transcription is $0.15 per line, or $8.00 per page. According to this study, “Conservatively assuming a 3-year life expectancy, the three units used for this trial would cost approximately $230 per week. The savings would thus pay back the original investment in about 1 year.” (Rosenthal et al.)The article also explains that voice to note reports can be digitally signed, which was important to

the aspect of history and ownership that we wanted to implement in our software design. We now understood that this technology was cost effective, but we were unsure about how easily it would be to implement into day-to-day prac-tice. Rosenthal et al. addressed this issue, explaining that healthcare professionals only need a minimal familiarity with the operating system, in this case, Windows NT. The authors believe that, “…speech recognition technology has crossed the threshold, passing from an interesting and promising technique to a clinically useful and economically inevitable tool.” (Rosenthal et al.) With the information that we gathered from this article, we decided to make voice to note recording one of the key features of our software system.

Further information regarding voice to note technology was found in

“Computer-based Speech Recognition as an Alternative to Medical Transcription” by Dr. Stephen M. Borowitz written for the American Medical Informatics Association. Borowitz begins the article by stating, “Computerized speech

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recognition may decrease the costs associated with creating transcribed documents and may lessen transcription delays.” (Borowitz) He outlines a study performed at the University of Virginia where hospital dictations were performed by human transcriptionist followed by three months of voice-recognition soft-ware. “For both computer-based and human transcriptions, all text was dic-tated in its entirety [and] formatted in an identical manner.” (Borowitz) Data was then compared and summarized. Most important for our research was the obser-vation that computer transcribed notes were completed on the day of the patient visit, compared to only 24% of human transcribed noted being completed within 48 hours of the visit. Although computer transcription took approximately 15% longer (to dictate and edit), “…[the] software computerized dictation can dramatically decrease delays associated with transcription and may substantially decrease the cost of producing tran-scribed documents.” (Borowitz)

From the research, we discovered that our suspicions were correct and a lack of technology combined with human error causes communication break down in the hospital environment. As our under-standing of the communication methods in hospitals expanded, so did our belief in the benefit to be gained by implement technology in hospitals. We decided to create iphone and computer software that would give healthcare professionals direct access to their patient information, history, and charts. We also created a messaging system between healthcare professionals, and possibly healthcare professionals and their patients. Our soft-ware would utilize voice to note recording which, cuts down on hospital transcrip-tion cost, reduces the time it takes patient information to be accessible, and elimi-nates the need to rewrite information. Our group believes it is important that our software includes previous shift reports so that healthcare professionals can take ownership of their decisions and provide the best possible care to their clients.

visual research

After our group decided to create hospital software, we looked at different software designs.

Image: http://www.scbh.org/health-care-services/acute-nursing-careobservation-ccu/

35healthcare apps and icons

36icon references and healthcare apps

37looking at different icons and dashboard layout

38existing healthcare websites

39healthcare app inspiration

40dentistry software

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Maintenance care is used by a number of Canadian companies including Seniors living homes in British Columbia. Although it is not used by healthcare profes-sionals, our group was interested in the combination of mobile and computer platforms. Maintenance care allows the user to see when jobs are accepted and completed. It also keep the history of all jobs so when a problem comes up, they can look back.

toolkit

This tool-kit is designed to assist and in-spire our 3rd year Communication Design research project at Emily Carr University of Art and Design. With the information gathered, we will be suggesting designs to make the nurse shift handover at VGH hospital more accurate and efficient.

Image: Della Ma

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From our co-creation workship we wanted to find out the following:

What other hospitals have you worked at?

How did their handoff work?

What makes a good handoff, bad handoff?

What do you need for a successful handoff?

Is there a specific place you do the handoff?

Where do you learn the handoff (school, hospital, trial and error?

Image: Della Ma

interviews

In addition to the hospital visits, we partic-ipated in co-creation workshops with the staff from VCH and various hospitals. We created a tool kit that helped to faciliate the conversation and spark ideas.

Image: Della Ma

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What does the current handoff look like?Every area is so different. It is hard to make something work universally.

Every ward has a different system because they have different priorities (legal sheets, cheat sheets)

(PCIS) patient care information system: where the patient is, home information, lab work, the doctor in charge of them, allergies.

Almost had a charting system on that computer system but funding ran out. The charting system is in the com-puter but is not used (used at UBC but everyone else uses paper).

Inter-ward transfer is fine, (all of Vancouver Costal Health is on PCIS), some inter-hospital is not (St. Pauls uses a different computer system) all files must be printed out or written out and faxed.

It would be nice if it were provincial wide systems. It is the expense of putting it in.

What about a redesigned form?It would have to be concise and simple (point form) but also legal. People will over chart because they are concerned that it is legal documentation.

interview one

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Where could you see the computers going?Computers on wheels with battery packs. A computer for every nurse.*hope for IPADS or IPHONE and ‘bump it’ to the next nurse.

What about a software system?Standard is information needed. Nurses want to know the most significant concern today. It should have trig-gers to remember to ask what they need to ask. (Name, allergies, medication, chronic history, diagnosis.) Nurs-es would also like the ability to change previous entries.Colour may be helpful for the important information (most important information questions on the left side).

What about scheduling nurses to shift change throughout the day instead of only twice a day?They explained that this would never happen because the union would be against it and some nurses, who have children would not want to work odd shifts. It is hard to adapt the 3:00 shift to the lifestyle of the nurs-es. It is not a good idea because it would lead to more information being missed.

What about a handoff room?1. Facilities do not have the spaces2. Have to constantly go into the room3. Might be easier to have a cupboard in the nursing station with doors or blinds where it is more easily accessible and readily seen

interview one

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Overall problems that came coming up:1. There are no guideline on what to report on.2. Some nurses do not trust other nurses- some try and be quick, forgetting vital information3. New nurses have bad habits4. The system needs to make nurses accountable5. It is common for nurses say they “dont know” which wastes time because the new nurse needs to know the patient history

The hospitals currently have the PCIS system but it is not being used because of lack of computers and cost.

The responses that I got from the first interview session were not what I was expecting. I was shocked by the lack of technology that nurses had available to them. It was surprising that nurses were using paper for things like the cardex that gets changed so regularily. Some nurses said that when the cardex paper gets worn, they just stick a new pieces of paper over top of the worn area and continue to use the form. It was also interest-ing to find out that the nurses do not keep all of the handoff forms in the patient history to look back to.

interview one

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For the second session, we showed the healthcare professionals out software prototype. Some of the feed-back we received was:

Linking E-healthcare and Pharm-a-net with patient in-formation is a good idea, allows for an ability to better manage a patient.

Real time monitor: very unit specific/some people are not hooked up to a monitor, but it would be a good idea.

Patient/nurse messages: Nice because then they know they do not have to rush if it is something minor or how important it is to be there right away if it is an emergen-cy. It is also nice that there is a record of the patient’s needs and when and what was done.

Colour representing the level of emergency is a good idea.

Love the idea of verbal transcription (voice to note).

Add sections for: Pain level, medication, vital signs, tubes/ drains, fam-ily involvement notes, wounds/ surgical incision sites, psychosocial notes.

Add shift report tab in system.

interview two

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Make an overview page for all clients for the day.Nurses to write their own check list.

Handoff info needs to include:Vital signs, level of pain, dressing, surgery they had, when they returned to ward, what their IV is, if they have a PCA (patient controlled analgesic), oxygen satu-ration, respiration rate, drains, last BM, neurological issues, emotional issues, psychosocial issues.

Vital signs: blood pressure, heart rate, oxygen satura-tion, temperature.

Laws of patients viewing their own charts are strict. Charts are not open for the client or advocate to view. It may not be a good idea for the patient/ advocate to know about some of the records. Basically nothing is important for the client or advocate to know.

If left unattended, it should lock and need a code to log in. (sleep)

It would also be helpful to find the patient information according to their doctors name.

Add patient email for discharge paperwork.

It would be very helpful to see previous note sheets about the client (non-legal/ normally throw away sheets)

interview two

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interview twoOur group was very encouraged by the feedback we received this session. The nurses really liked the overall concept. They were particularly intrigued by the voice to note system. The nurses thought this was something that really could be implemented soon. They also liked the layout, colours, and type we chose. The nurses also gave us some good ideas about new tabs and naviga-tion.

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This image depicts one of the nurses from the hospital talking to us about the “cheat notes” they use for shift changes. This gave us the idea of having a note page for nurses to record what happened during the day.

Image: Della Ma

Image: http://henryford.libguides.com/lab

concepts

The following pages explains some of the early ideas that we had which led to our final prototype, other ideas were aban-doned.

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- handoff in the patient’s room- handoff room without distractions- digital forms- computers for each nurse- nurses get paid for handoff time- fire nurses who do not perfom handoff- better hiring, what to look for- overlapping nurse handoff times- team building exercises- mediation for nurse conflicts- set aside specific time for handoff- create a place for nurses to write “casual” information- nurses to brainstorm ideas of successful handoff- create handoff checklist- create handoff campaign

Solution Brainstorm

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At this point, we have some ideas for this project.

Database1. Users have to login and they will have a profile (like facebook).2. They can access patients’ information.3. Important pop ups and alerts.4. Nurses’ schedule and contact.

Room Redesign1. General meeting area.2. Something that is feasible.3. Set aside time to fill out the forms.4. Make them feel important with separate room.5. Less distractions6. Rooms with privacy and all things that are needed (scanner, etc).

Communication Campaign1. Remind nurses of the importance of handoff2. Visual reminders (sbar like) posters to use during handoff3. Posters to educate patients (questions to ask health-care professionals.)4. Booklet with facts about the handoff and what steps to go through, like a checklist.5. feasible6. visual reminder of (move up down body for handoff, not to use abbreviations, five steps for a successful handoff etc.7. maybe use the same visual identity as the core post-ers from last year?

personas

In order to better understand who we were design our prototype for, my group created personas.

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kim tonn

Kim Tonn is 42 years old. She has been working at Vancouver General Hospital for 10 years in the Inten-sive Care Unit. Kim has a medium level of technological expertise. She owns a cells phone, and a laptop com-puter that she surfs the webs and emails with. She also uses skype regularily to keep in contact with her family in England. In her spare time, Kim enjoys running along the sea wall and taking her children to their after school activities. She loves her job and hopes to continue to working in the healthcare industry for many years.

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kernveer sandu

Kernveer Sandu is 22 years old. She has been work-ing at Vancouver General Hospital for 3 months in the Neo-natal unit. Kernveer has a high level of technologi-cal expertise. She is always carrying her cellphone and updating her twitter status and personal blog. In her spare time, Kernveer likes to enjoy Vancouver’s night life and watch Canucks games with her boyfriend. She feels lucky to have gotten a job right out of university. Kernveer loves going to work and feels like she is learn-ing something new everyday.

Image: http://wallpaper.wallpedia.org/21__Colored_Pencil.htm

sketches

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Image: http://bgladd.blogspot.ca/2010_05_01_archive.html

iterations

Using all the information we had so far, we began brainstorming. First we addressed what we wanted to accomplish in our design, and then took the informa-tion that we had from our co-creation session and began trying to come up with approaches that would work solving the problems.

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We decided to create an online database for both patients and nurses. The following is our initial idea of the database. As the project goes, we added more features.

Patients & Hospital Log in Page

Nurses’ Profile Page Patients’ Profile Page

Example for nurses to log in

Nurses have access to patients’ information, and have schedule shown on the lower part of the page.

Patients can view their nurses’ profile, and they can also edite their own page.

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Our system is divided into two parts: Patient/ Advocate and Health Care. Initially, the system was designed for only computers, but as we researched further, we decided to add a cell phone component.

Computer Software Iphone Feature

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Healthcare

Patient / Advocate

Based on the idea we have before, we developed some other pages that would help nurses find the information they need. Nurses can search patients by name, level of emergency (colour), and assigned nurses or doctor

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Early Iteration Flow Chart

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1

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Once nurses log in, they will go to this page with patients’ basic information on it.

Nurses’ Profile Page

Nurses’ Profile Page, when there’s new mes-sages, they can open it in a drop down menu.

Nurses have access to patients’ profile page, and also there are links to Ehealthcare, Phar-manet, etc.

Go to patients’ chart, get real time data.

67

1211

987

This is nurses’ schedule, it can be viewed as daily, weekly and monthly.

Weekly View of the Schedule Monthly View of the Schedule

10

Search engine for nurses to get information about other related patients by names, colour, nurses, and doctors.

Checklist for nurses Recommendation

68

Iphone Feature Rough Prototype

Mvoice allows healthcare professionals to record messages at the point of care. Mes-sages get transcribed using voice to note technology. Nurses can assign the level of emergency (using the color guide on the left).

69

mVoice mTimeline Checklist / Notes

Messages

Messages / Shift Report VCH Home Pharmanet

Shift Report

70

Patient / AdvocateLog in with ID and Password

HealthcareLog in with ID and Password

Messages

Schedule

Schedule by Day

Schedule by Week

Schedule by Month

Yesterday’s Nurse

Messages Messages are shown in the drop down menu

Go to the main profile page

Reply Button

Today’s Nurse

Notes

Tomorrow’s Nurse

Nurses’ Basic Information

Today’s Patients and their general information

Doctor’s Basic Information

Profile Button

Message Box

Go to the doctor’s profile page and click on contact button to leave a message to the doctor

Messages

Public

Home

Checklist

Notes

Private

Messages

Schedule

Reviewed by date

Information that can be reviewed by other nurses

Notes that only can be viewed by nurse him/herself

Go to the patient’s profile page

Edit My Profile

Patients’ names

Click on nurses’ names to Nurse’s profile page and click on contact button to leave a message to the nurse.

Colour Coded Level Bar

Schedule

Messages

Patient’s profile and detailed information

Basic information

Charts

Links to EHealthcare, Pharmanet, Patient Calendar

Edit Profile

Patients’ basic information

Schedule

Messages

Notes

Charts

Reply Button

Notes

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Enter Passcode

mVoice Recording voice message of patients

View recorded information by Day / Week / Month, and voice message is translated into text automatically.

Sending it to computer software

mTimeline

Checklist / Notes

Messages / Shift ReportMessages

Shift Report

VCH Home

Pharmanet

Public

Checklist

Private

Reviewed by date

Information that can be reviewed by other nurses

Notes that only can be viewed by nurse him/herself

Leave messages to other nurses, either type out or add voice notes

Patient’s basic information and a chart to fill out either by typing or voice recording

Go to VCH homepage

Go to pharmanet page

Image: http://www.singhealth.com.sg/EducationAndTraining/Residency/Programs/General-Surgery/Pages/curriculum.aspx

final

73

ENTER PASSCODE.

1 2 3

4 5 6

7 8 9

0

ENTER PASSCODE.

1 2 3

4 5 6

7 8 9

0

healthcare professional or patient/advocate sign in, for the prototype we focused on the healthcare professional point of view.

74

mTIMELINE

CHECKLIST/NOTES

MESSAGES/SHIFT REPORT

VCH HOME

PHARMANET

mVOICE

e-HEALTHCARE

MEDICAL DICTIONARY

DRUG CALCULATOR

A-Z

TOP

75

Katy Belote

Tanisha Trickett

Neva Toby

+

Katy Belote

Tanisha Trickett

Neva Toby

+

SENDING TO

like in the earlier prototypes, the nurse chooses the level of emergency and the patient name and can record a voice to note message.

voice to note messages get sent directly to mtimeline and are transcribed by the computer.

76

DAY WEEK MONTH

2012 MARCH 2 FRIDAY

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

ALL DAY

1AM

2AM

3AM

4AM

01:45

Amniotic fluid has broken/ Feeling contractions every three minutes.

MONTH

2012 MAR 2 FRI

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

ALL DAY

1AM

2AM

3AM

4AM

01:45

Amniotic fluid has broken/ Feeling con-tractions every three minutes.

MAR 1 THU MAR 3 SAT

DAY WEEK

the voice to note message can be edited through the mtimeline calendar. the nurse can read the message, or listen to it. the level of emergency is indicated by the colour.

mtimeline is a similar format to icalendar for apple products. the information can be arranged by day, week, or month

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2012 2012 MARCH

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

SUN

01:45

DAY WEEK MONTH

MON TUE

4 6

11

03:20

12 13

CHECKLIST PUBLIC PRIVATE

2012 MARCH 2 FRIDAY

talk to Katy’s mother / listen to what happened last night

mouthcare - Tanisha by 10am

weight measurement - Katy & Neva

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

+

nurses can also make check lists for each day.

78

PRIVATE

2012 MARCH 2 FRIDAY




2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

PUBLICCHECKLIST

+ 2012 MARCH 2 FRIDAY




2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

CHECKLIST PUBLIC PRIVATE

+

from the feedback we received, a notes sections was important. notes can be public or private. public notes are shared when other nurses look up the patient name.

TO:

SUBJECT:

MESSAGE:

ATTACH: share info add voice note

MESSAGES SHIFT REPORT

TO:

SUBJECT:

MESSAGE:



TO:

SUBJECT:

MESSAGE:


christi

Christina Cowia

the messaging system allows healthcare profes-sionals to communication with each other direct-ly. nurses can attach notes to their messages.

the messaging system can automatically fill in the recipients name saving the nurses time.

80

TO:

SUBJECT:

MESSAGE:



TO:

SUBJECT:

MESSAGE:


Christina Cowia

-

Hey, Christina. Here is Neva’s info; please check the attached info.

TO:

SUBJECT:

MESSAGE:



NAME

DATE

RM#

neva tNeva Toby

this screen show how nurses can search attachments based on name, date or room number.

TO:

SUBJECT:

MESSAGE:



NAME

DATE

RM#

Neva Toby - 120302 - 305

+

SEND

TO:

SUBJECT:

MESSAGE:



Christina Cowia

Kristy Orsen

Dr. Robin Izdebski

PM03:14 MONDAY

AM12:27 MONDAY

PM11:30 SUNDAY

Neva Toby PM11:17 SUNDAY

Hey, Christina. Here is Neva’s info; please check the attached info...READ MORE

Hey, Kristy. How’s Joy doing? Here is Neva’s info; please check th...READ MORE

Dr. Izdebski. Here is Neva’s info; please check the attached info...READ MORE

Hello, Neva. Here is Neva’s info; please check the attached info...READ MORE

the message now has a patient file attachment with a blue level of emergency (or low level of emergency)

here is an example of what the message page looks like. all of the messages are marked with the date and time they were send as well as colour indicating the level of emergency.

82

name: KATY BELOTEdate: 1 APRIL 2012rm#: N306

1. RETURN TO WARD @ ( 3 ) HOURS

2. VITAL SIGNS ___________________

3. RESPIRATORYO2________NP_________MASK_________O2SATS_____________R/A______________RESP ASSESS_______________________

4.CIRCULATIONIV________SL________ SITE OKAY D/CdCWMS_______________________________HGB_________________________________

RECORD TYPE/EDIT

name: KATY BELOTEdate: 1 APRIL 2012rm#: N306

1. RETURN TO WARD @ ( 3 ) HOURS

2. VITAL SIGNS ___________________

3. RESPIRATORYO2________NP_________MASK_________O2SATS_____________R/A______________RESP ASSESS_______________________

4.CIRCULATIONIV________SL________ SITE OKAY D/CdCWMS_______________________________HGB_________________________________

RECORD TYPE/EDIT


shift reports are located under the patient name, or date. information can be added by typing it out or using voice to note technology with commands.

83

BACK TO MENU BACK TO MENU

voice to note has links to vch website home, and pharmanet

84

e-HEALTHCARE

MEDICAL DICTIONARY

DRUG CALCULATOR

A-Z

TOP

e-HEALTHCARE

MEDICAL DICTIONARY

DRUG CALCULATOR

A-Z

TOP

85

e-HEALTHCARE

MEDICAL DICTIONARY

DRUG CALCULATOR

A-Z

TOP

86

PATIENT/ADVOCATE

HEALTHCAREPROFESSIONAL

ID

PW

CHRISTINA COWIA

LOG IN

login page for patient/advocate or healthcare professional.patient/advocate receives id ad password upon admittance to the hospital

87

mTIMELINE/SCHEDULE

mVOICE

CHECKLIST/NOTES

MESSAGES/SHIFT REPORT

VCH HOME

PHARMANET

DRUG CALCULATOR

e-HEALTHCARE

MEDICAL DICTIONARY

MENU Welcome, Christina. MY PROFILEMY PATIENTSLOGOUT

HELP

NAME Christina CowiaUNIT Pediatric DepartmentPOSITION Clinical Nurse SpecialistSCHOOL University Of British Columbia

W 604 442 9182H 604 578 2910C 778 828 2124ADDRESS 1212 GRANVILLE AVE, VANCOUVER BC. V32 1J3

EMERGENCY CONTACT Mike SmithW 604 442 9182H 604 578 2910C 778 828 2124ADDRESS 1212 GRANVILLE AVE, VANCOUVER BC. V32 1J3

MY PROFILE

EDIT

MY PATIENTS

nurse profile page. navigation bar on the lefthand side.

88

Welcome, Christina.

Patient Overview

DAY

Tanisha Trickett (912122345)Pregnant

130/82mmHg36.6*C64BPM98%

mediumnone

Neva Toby (912144925)Pregnant

128/85mmHg37*C70BPM99%

highnone

BP:

TEMP:

HR:

SA02:

PAIN LEVEL:MEDICATION:

NOTES:

Katy Belote (91219385)Pregnant

125/98mmHg37*C62BPM97%

lownone

50

patient overview page. shows the assigned patients for the day and they key information. can navigate using the left hand bar. the nurse is able to edit the patient iformation at any time by simple clicking on the purple information.

89

Welcome, Christina.

Patient Graph Katy Belote

DAY

NAME: KATY BELOTE1212 Granville Ave,Vancouver BC.V32 1J3

BP: 125/98mmHgTEMP: 37*CHR: 62BPMSA02: 97%

H: 604 443 9182Email: [email protected] admitted: March 1, 2012

GENERAL

CONTACT

DOCTOR

NOTES

EMERGENCY CONTACT: Mike Smith1212 Granville Ave,Vancouver, BC.V32 1J3

GENDER: FemaleHEIGHT: 5”8WEIGHT: 130 lbsBLOOD TYPE: AB

DOCTOR: Rob Wilson2281 West Broadway St.Vancouver, BC.V4R 1@H

NOTES:March 1, 2012March 2, 2012March 3, 2012March 4, 2012March 5 2012

LINKS:EHealthcarePharmanetPatient Calendar

W: 604 442 9182H: 604 578 2910

ALLERGIES: PenicillinOTHER ILLNESSES: NoneMEDICATIONS: None

604 432 9185

when the healthcare professional clicks on the patient, they can see detailed information. by clicking on the left hand side bp, temp, hr, sa02the nurse is brougbt to the patient graphs/chart. the nurse can see previous handoff reports by clicking on the “notes” section.

90

Welcome, Christina.

Patient Graph Katy Belote

DAY

12 HOURDAYWEEK

BP: 125/98mmHgTEMP: 37*CHR: 62BPMSA02: 97%

H: 604 443 9182Email: [email protected] admitted: March 1, 2012

100

150

50

patient chart/graph. can change the content or date by clicking on the left hand panel.

91

Welcome, Christina.

mTIMELINE/SCHEDULE

1AM

2102 MARCH 2 FRIDAY

Katy BeloteTanisha TrickettNeva Toby

2AM

01:45 Katy Belote

Amniotic fluid has broken/ Feeling contractions every three minutes.

TODAY MONTHDAY WEEK

mtimeline functions the same way as the iphone version with voice to note recording. information is organized in day, week or month

92

Welcome, Christina.

mTIMELINE/SCHEDULE


TODAY MONTHWEEKDAY

93

Welcome, Christina.

mTIMELINE/SCHEDULE


TODAY DAY MONTHWEEK

94

Voice to Note software has been used in a variety of medical contexts including: radiology, emergency de-partments, endoscopy, and dentistry. It dramatically decreased the total time to complete notes and make them accessible on the computer (traditional methods of transcription can take more than 5 days). Healthcare professional need on average 50 min of training and minimal familiarity with the operating system. The com-puter recognizes two times of utterance:commands and dictions. Commands include phrases like: save as preliminary, or accept and sign. Complete and signed reports are available on the hospital information system less than one minute after the complete dictation and it only takes 15% more time dictating and editing than traditional dictation. Studies have shown that Voice to Note technology has accuracy of approximately 97%.

voice to note

95

- Autofill data (patient names, vital signs, etc.)

- Direct communication to other healthcare professionals (mes-saging system time stamped and you are notified when the recipient has been delivered and read the message)

- History and ownership (ability to look back at previous shift reports, notes, and checklists)

- Real time data and vital graphs (blood pressure, temperature, oxygen saturation)

- Mobility/portability (iphone technology and can access any-where in the hospital)

- Digital archiving (all information is stored in the database)

- Universal system British Columbia wide (no need to print out and scan documentation)

- Quick access to pharmanet and ehealthcare (able to access all medication and test results from iphone)

- Internet access to journal articles, reports (instead of having to go to a computer)

- Menu to medical dictionary and drug dosage calculator

- Voice to note recording

- Patient involvement (can message their nurse and receive email discharge forms)

- Builds patient nurse relationship (can read their patients history both formal and informal)

features

96

Linotype Universabcdefghijklmnopqrstuvwxyz ABCDEFGHIJKLMNOPQRSTUVWXYZ1234567890



CondLight

BasicRegular

CondMedium

typography

97

colour

R- 116G- 108B- 173

C- 62M- 62Y- 3K- 0

R- 186G- 202B- 51

C- 32M- 6Y- 100K- 0

R- 255G- 64B- 85

C- 0M- 88.55Y- 58.56K- 0

R- 247G- 146 B- 30

C- 0M- 51Y- 100K- 0 60% Black 25% Black

98

moodboard

reflections

image: http://www.chaosreignswithin.com/2010/12/alteryx-2011-new-features-keyboard.html

100

reflections

This was a very challenging project for me. I had no experience creating software or mobile applications and the idea did not interest me. I kept wanting to work on paper instead of creat-ing for an interactive platform. Organization was extremely im-portant for this project, and unfortunately my group had a hard time focusing on one idea. I also found it very diffcult to design-ing for a field that I knew nothing about. It was intimidating to show my work to the nurses because things that are so simple for them to point out took me days to research. It would have been beneficial to be assigned a specific hospital and a specific ward, because I do not think there is one solution for all of VCH. Having specific cost requirements and restrictions would have also created a more focused result. I am surprised at how politi-cal the healthcare system is. For the most part, the nurses did not see anything wrong with the current situation, but Vancouve Coastal Health identified problems. The nurses were very hesi-tant towards change. Although most nurses can see that the the future of healthcare lies in technology, they did not think that it was going to be implimented in their lifetime and seemed to disregard any ideas surrounding it. I was very interesting to see the inconsistencies between hospitals. It is extremely unfortu-nate that healthcare professionals are not given the tools to do their job to its potential. If I had the opportunity to do this project over again, I would enlist the help of an interaction designer early on in the process. I felt that having the designers visit us at the end of the semester was hard because there was not very much time to implement their ideas into our final prototype. I would have also stuck with my first idea instead of move back and forth between three. This project has given me skills to move forward in communication design and I am confident that the methods of research, team coordination, and software familiarity will help me create a stronger fourth year project than I would have with-out this class and project.

references

Image: Makiko Umezawa and Sabrina Ng

102

Bhabra, Gevdeep, Samuel Mackeith, et al. “An Experimental Comparison of Handover Meth-ods.” Royal College of Surgeons of England. (2007): n. page. Web. 18 Jan. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964745/>.

“An Experimental Comparison of Handover Methods” is report describing a study of which cur-rently used handover method is the most effective. The study compares verbal, verbal and note, and prepared sheet methods. The conclusion is expected, but the information can be used as a reference to reinforce the importance of printing out reports. The major flaw of this paper is that the patients used in the study are fictional and it was conducted in a semi-unrealistic environment.

Borowitz, Stephen M. “Computer-based Speech Recognition as an Alternative to Medical Tran-scription.” Journal of the American Medical Informatics Association. 8.1 (2001): 1-3. Print.

Written for the American Medical Informatics Association, Borowitz article explains the use of voice to note recording at the University of Virginia. The article describes the reduced amount of time and cost as a result of this technology. The findings are very encouraging, but since this article was published in 2001, the data does not fully express the use of voice to note today.

Coiera, Enrico, and Vanessa Tombs. “Communication behaviours in a hospital setting: an observational study.” BMJ. (1998): n. page. Web. 9 Apr. 2012. <http://www.bmj.com/con-tent/316/7132/673.abstractijkey=3afcca5b4c13b99bd766b1410c8eeff82ab4b04c&keytype2=tf_ipsecsha>.

“Communication behaviors in a hospital setting: an observational study” identifies patterns of communication behavior among healthcare workers. The authors observed the healthcare profes-sionals in various settings, and concluded that mobile technology would provide the best case of success. This article had a lot of information that was different from my previous sources and included psychological analysis of the healthcare professionals. Some of the conclusions are contro-versial as the authors at times, do not have a positive descriptions of the hospital environment.

103

Criswell, Dan F, and Michael L Parchman. “Handheld Computer Use in U.S. Family Practice Residency Programs.” Journal of the American Medical Informatics Association. 9.1 (2001): n. page. Print. <http://jamia.bmj.com/content/9/1/80.abstract?ijkey=f329ec419339c4a7040315dab5314e39caa3e584&keytype2=tf_ipsecsha>.

Criswell and Parchman’s article, “Handheld Computer Use in U.S. Family Practice Residency Program” is a brief summary describing the use of mobile computers in 2001. The article uses examples from the healthcare industry, and military fields. Information was gather via a mail out survey to residency programs throughout the United States. This article gave me a quick overview of mobile computer use. It would have been beneficial to know more about the study and have greater details.

Gallaga, Omar L. “Four technologies are helping hospitals better treat patients.” Statesman. 3 4 2010: 1-3. Print. <http://www.statesman.com/life/health-medical/four-technologies-are-helping-hospitals-better-treat-patients-518872.html>.

“Four Technologies are helping hospitals better treat patients” is a newspaper article written by Omar L. Gallaga providing a brief look into new technologies being utilized by hospitals in the United States. Although this article was very interesting and described tools that I was completely unaware of, most of the information had little to do with communication and nurse handoff.

Hauser, Susan H., Dina Demner-Fushman, Joshua L. Jacobs, et al. “Using Wireless Handheld Computers to Seek Information at the Point of Care: An Evaluation by Clinicians.” Journal of the Medical Informatics Association. 14.6 (2007): 807-815. Web. 9 Apr. 2012. <http://jamia.bmj.com/content/14/6/807.full.pdf html>.

“Using Wireless Handheld Computers to Seek Information at the Point of Care: An Evaluation by Clinicians” describes the effectiveness of handheld computers for obtaining online information in clinical environments. This article was full of proposed solutions which we implemented into our final prototype. Some of these suggestions include guidelines, online medical texts, article search and retrieval, and medical calculators. The information was detailed and the charts broke up the text and made it interesting to read.

104

Horsley, A, and L Forster. “Handheld computers in medicine: the way forward.” BMJ. (2005): n. page. Web. 9 Apr. 2012. <http://pmj.bmj.com/content/81/957/481.full.pdf html>.

Written by the Department of Respiratory Medicine, York District Hospital. This article outlines the usage of handheld computer in the United Kingdom. The author concludes that the main bar-riers to greater use of this technology were cost of software and poor applicability to UK practice. Some of the information highlighted in the study was not applicable, like the gender ratio of using handheld to computer to not. One of the most valuable aspects of this article was the discussion regarding what healthcare professional would like to see in their hand held computer. Answers included, wanting to see pathology results, to wanting a UK orientated clinical guide.

Levy, Rebecca, Liron Pantanowitz, Darlene Cloutier, et al. “Development of electronic medical record charting for hospital-based transfusion and apheresis medicine services: Early adoption perspectives.” Journal of Pathology Informatics. (2010): n. page. Web. 9 Apr. 2012. <http://www.jpathinformatics.org/article.asp?issn=2153-3539;year=2010;volume=1;issue=1;spage=8;epage=8;aulast=Levy>.

“Development of electronic medical record charting for hospital-based transfusion and apheresis medicine services: Early adoption perspectives” describes how healthcare professionals successfully integrated electronic medical records into the Tuft University School of Medicine. This article gave my group insight into the reasons for and against paper records. The information provided inter-esting statistics that could potentially translate into Vancouver Coastal Health hospitals.

Manias, Elizabeth, and Annette Street. “The Handover: Uncovering the Hidden Practices of Nurses.” Intensive and Critical Care Nursing. Harcourt Publishers Ltd., 2000. Web. 18 Jan 2012. <http://pages.cpsc.ucalgary.ca/~tangsh/documents/PhD/References/The handover-- uncovering the hidden practices of nurses.pdf>.

Written by students at the University of Melbourne, “The Handover: Uncovering the Hidden Prac-tices of Nurses.” describes the factors that influence the handover process between nurses. Influ-ences includes: hierarchal structure, time worked, level of expertise, and previous experience. The information was recorded through observations, journaling, and interviews. This source was very interesting because it explained the dynamic between shifts both positive and negative and gave suggestions to improve success and accuracy. For an outside reader, this article brings you into the reality of working in a hospital.

105

O’Connor, Chris, Jan O. Friedrich, Damon C. Scales, et al. “The Use of Wireless E-Mail to Im-prove Healthcare Team Communication.” Journal of the American Medical Informatics Associa-tion. 16.5 (2009): 1-10. Print.

“The Use of Wireless E-Mail to Improve Healthcare Team Communication” describes the current communication practices in hospital; pagers, over head announcements, etc. It concludes that email communication is a viable solution to communication interruptions. The article includes the finding from a trial which allowed healthcare professionals to use wireless email. It found that the majority of participants (87%) wanted to continue using wireless email after the completion of the study.

Prgomet, Mirela, Andrew Georgiou, and Johanna I Westbrook. “The Impact of Mobile Hand-held Technology on Hospital Physicians’ Work Practices and Patient Care: A Systematic Review.” Journal of American Medical Informatics Association. 16.6 (2009): n. page. Web. 9 Apr. 2012. <http://jamia.bmj.com/content/16/6/792.full>.

Written for the Journal of American Medical Informatics Association, this article thoroughly went through the advantages and disadvantages of mobile handheld technology by way of literature review. The information gathered from this article was very interesting and was presented in an organized and rational manner. Subheading of this article included hand held technologies ability to provide: rapid response, medical error preventions, data management and accessibility.

Rosenthal, Daniel I., Felix S. Chew, Damian E. Dupuy, et al. “Computers in Radiology: Comput-er-Based Speech Recognition as a Replacement for Medical Transcription.” American Journal of Roentgenology Online. (1998): 23-25. Web. 9 Apr. 2012. <http://www.ajronline.org/con-tent/170/1/23.full.pdf>.

“Computers in Radiology: Computer-Based Speech Recognition as a Replacement for Medical Transcription” compares voice to note software with traditional human transcription. It examines the cost, the ease of use, and the accuracy. The authors, association with Harvard Medical School develop a speak recognition software and performed a three month trial. This article had a lot of valuable data regarding the advantages of voice to note software.

Safety and Quality Council, . “Clinical Handover and Patient Safety.” . Australian Council for Safety and Quality Health Care, Mar 2005. Web. 18 Jan 2012. <http://www.health.gov.au/inter-net/safety/publishing.nsf/Content/AA1369AD4AC5FC2ACA2571BF0081CD95/$File/clinhovr-litrev.pdf>.

Created by the Australian Council for Safety and Quality of Health Care, this report is a review and summary of handover processes inside and outside of the hospital. The report looks at factors including the hiring process, nurse communication, and handoff tools. The report is broken down into factors that allow and prevent a successful handover, these including: system variables (infor-mation tools and systems), organization, nurses’ interpersonal relationships (communication abil-ity and willingness to share info), and individual factors (skills and attitude). This source is dense with information and is valuable because if also includes examples of handoffs used in fields other than medicine.

Sexton, Amanda, and Connie Chan. “Nurse Handovers: Do we Really Need Them?.” Journal of Nursing Management. Department of Nursing University of Wollongong, 2004. Web. 18 Jan 2012. <http://publicationslist.org/data/m.elliott/ref-10/Nursing handovers - do we really need them.pdf>.

Developed by the Department of Nursing University of Wollongong, “Nurse Handovers: Do we Really Need Them?” is a thought provoking article which tests the standard practice of nurse handovers. The report questions the accuracy of current handovers and explains that most of the information discussed is already documented. This happens because there is a lack of consistency and formal outline. The article suggests reducing the amount of time allocated for handovers by streamlining. This article makes sense in theory, but might take time to implement in a hospital environment.

Strople, Bernadette, and Patricia Ottani. “Can Technology Improve Intershift Report? What the Research Reveals.” . Journal of Professional Nursing, 2006. Web. 18 Jan 2012. <https://depts.washington.edu/respcare/public/hmc_files/journal_club/articles/20090406/Can_technology_improve_intershift_report.pdf>.

“Can Technology Improve Intershift Report? What the Research Reveals” written for the Journal of Professional Nursing examines whether of not technology and wireless communication can im-prove patient safety and accuracy through handovers. This report explains the existing technology of paper charts, computerized records and personal report tools. Each of the findings was backed up by multiple sources which added to the validity and professionalism. This source covered a wide range of topics explaining everything from how much time and money is spent on shift change to the content and legal implications of failures.

107

Tang, Charlotte, and Sheelagh Carpendale. “Healthcare Quality and Information Flow dur-ing Shift Change.” . Department of Computer Science, University of Calgary, 2006. Web. 18 Jan 2012. <http://innovis.cpsc.ucalgary.ca/innovis/uploads/Publications/Publications/Tang-2006PHC.pdf>.

Charlotte Tang and Sheelagh Carpendale’s project sponsored by the University of Calgary proposes that technology will improve the nurse handoff process. The essay provides an overview of the ex-isting handovers explaining tools currently being used by the hospital, the existing floor plans, and challenges. Tang and Charpendale are also interested in the mood of nurses that is observed during the handoff. Although the information provided is interesting, this sources has the least amount of useful information on the chosen topic.

Tang, Charlotte, and Sheelagh Carpendale. “Supporting Nurses’ Information Flow by Integrat-ing Paper and Digital Charting.” . University of Calgary, 2009. Web. 18 Jan 2012. <http://innovis.cpsc.ucalgary.ca/innovis/uploads/Publications/Publications/Tang2009ECSCW.pdf>.

Tang and Carpendale’s “Supporting Nurses’ Information Flow by Integrating Paper and Digi-tal Charting” is a continuation from their previous paper “Healthcare Quality and Information Flow during Shift Change.” The paper explains how their prototype design integrates writing and technology to improve the quality and ease of nurse handover. Tang and Carpendale describe the strengths and weaknesses of their new system and make suggestions for the future. This paper is a good resource for readers that need to create their own design proposals.

University of Virginia, . “Handoff of Care Frequently Asked Questions.” IHeal. University of Virginia, n.d. Web. 18 Jan 2012. <http://www.healthsystem.virginia.edu/internet/e-learning/handoff_faq.pdf>.

The University of Virginia published “Handoff of Care Frequently Asked Questions” as an educa-tional tool to summarize how handoffs are handled. The report is structured as question and an-swers. As an introductory source, this is very useful. It familiarizes the reader with the jargon used by nurses and is organized in an easy to read format. Although it includes the steps for a successful handoff, it is focused on an American health care system, and the information might not be totally applicable in the Canadian system.

108

Zafar, Atif, Marc Overhage, and Clement McDonald. “Continuous Speech Recognition for Cli-nicians.” Journal of the American Medical Informatics Association. 6.3 (1999): 1-12. Print.

Written for the Journal of the American Informatics Association, “Continuous Speech Recognition for Clinicians” explains the advantage of voice to note software. The article compares the accuracy and cost of human vs. computer transcriptions. The article also explains how the software works.

Documents

CORE Design Process Book