Friday, February 3, 2012

CultureLab - Designs for eradicating medical mistakes

Catherine de Lange, contributor
(Image: Royal College of Surgeons, photographic unit)

A few years ago, my brother was rushed to the emergency room with appendicitis. As the doctor on duty came round to carry out final checks before the operation, he explained to my brother that he needed to conduct a test, “just to check it really is the appendix and not your ovaries.” On seeing the confusion and panic on my brother’s face, he quickly corrected: “kidneys, I mean kidneys.”
Just moments before going under the knife, the last thing you want to hear is that your doctor is confusing your kidneys and your ovaries, especially when you’re an otherwise healthy young man.
At the time, I assumed the incident was a freak occurrence involving an overtired or inexperienced medic. But generally speaking, when we put our lives in the hands of doctors and nurses, they tend not to mess things up too much, right?
Not so fast. According to a new project led by an interdisciplinary team from Imperial College London, the Royal College of Art, and St Mary’s Hospital in London, something goes wrong in one out of every 10 hospital admissions in the UK. That’s pretty shocking, particularly when you learn that most often problems arise from the poor design of hospital kit, which simply doesn’t work when coupled with real life human behaviour.
For instance, the most common cause of medical errors is in administering medication. An unexpected interruption during the drugs round, for example, and a nurse might well forget to give a patient their full dose. A common and terrifying result of that error is that patients can end up going into surgery without the proper drugs - for example those vital to stabilising their heart rate during the op.
But nurses are busy, they are short staffed, and they will always have to drop what they are doing and re-prioritise in the case of an emergency. It’s a simple problem, but a serious one. Fortunately, simple problems often have simple solutions. Could well-designed products help medical staff to avoid the most common errors?
That’s the question underlying Designing Out Medical Error (DOME) a three-year project funded by the Engineering and Physical Sciences Research Council, has now culminated in an exhibition at the Hunterian Museum in London.
According to Oliver Anderson, a clinical research fellow in the surgery department at Imperial, when hospital kit is designed normally, the designers are rarely aware of the space in which their product will be used. To counter that, all the members of the DOME team - scientists, designers, and hospital staff - had to be in on all the stages of the process.
With designer Jonathan West, from the Helen Hamlyn Centre for Design at the Royal College of Art, Anderson spent months in St Mary’s, observing how doctors and nurses went about their jobs, noting the kinds of situations where they made mistakes and trying to understand why that happened. Their remit was a broad one, says Anderson: “to attack the wards and make them safer.” From their observations, the team identified key areas in which the most mistakes were made - from using antibacterial hand wash, to handing over patient information between shifts.
The designers then set about trying to find solutions to the problems, drawing insights from other industries to see how they got round similar issues. They also made detailed plans from their observations of how daily life plays out in the hospital, to make sure any future designs would fit with the behaviour of busy staff.
When it came to handover of patient information, for example, the transfer was happening in the break room, where there wasn’t proper space to exchange notes and nurses were often interrupted by people coming in for their break-time snack. The solution is simple, but neat - a redesign of the same space to include a foldaway table, variable lighting and a do not disturb sign.
Several such simple designs are on display at the Hunterian exhibition. Some have yet to be trialled, but the most successful product - an infection control station for the end of a patient’s bed, equipped with hand-wash, gloves, aprons, and a touch-free bin, as well as a built-in medicine cupboard - has been taken to market. Also on display is a vital signs unit to measure blood pressure, temperature and oxygen saturation at the patient’s bedside, a new logo and campaign to encourage hand sanitation and a new kind of blister pack which should help ensure patients are take the correct medication. An iPhone app that can be used to help measure patients’ respiratory rates is currently being tested in hospital trials. Taken together, these proposed solutions offer an inviting glimpse of the hospital ward of the future.
Step back out into the main museum space, and you’ll find the bed and disinfectant spray used by Joseph Lister more than a century ago. In the late 1800s, Lister came up with vital experiments to scientifically measure the effectiveness of tools for use in medicine, most famously the use of carbolic acid as an antiseptic. Why shouldn’t designs for today’s medical equipment be subject to the same scientific method?
After all, as DOME aims to demonstrate, well-designed trials of thoughtfully designed equipment have the potential to save lives. Then all patients would have to worry about is whether their doctor knows the difference between their kidneys and ovaries.
Make it Better: Designing Out Medical Error runs at the Hunterian Museum until Saturday.

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