Trends in Nursing Units Impact Patient Care and Technology
Research has shown that good design can impact length of stay (LOS), patient safety, and outcomes. Health Facilities Management published a round table discussion on Nursing Unit Planning and Design. Much of the discussion centered on traditional nursing units and how they’re crowded, noisy and chaotic. In response to this there is a trend to moving caregivers closer to the patients. A number of the participants also indicated that their hospitals were moving to in-room computers.
We have found success combining centralized and decentralized design. The centralized area is what we often refer to as the work and care area. It’s a place for physicians to talk with patients. It’s a place for the unit clerk, the social workers and the case managers, and it’s a place for folks to coordinate their care of patients. It’s the social aspect of what oftentimes the nurses and the physicians need to ensure proper communication.
Certainly, the decentralized area ensures that the nurses are not walking as far to fetch various things. They’re closer to their assignment areas, and getting away from stress, which is what we’re trying to mitigate in our architecture for the nurses, the patient and families, and the physicians.
So how do we do that? How do we mitigate the noise issue? In design, I struggle with how to balance that. I struggle with getting things close or farther away. I struggle with noise, equipment, beds that are moving around, things coming up on the floor. It’s a balance of doing both centralized and decentralized.
It seems that technology could greatly reduce nursing unit noise. Wireless communications devices like phones or Vocera badges would eliminate much of the overhead pages and shouting down the hall that occurs now. A nurse carried alarm notification device would minimize device alarm noise at the central station central station and remote annunciators.
These changes in work patterns will have a major impact on medical device design, especially central stations. If nurses spend much less time at the nurses station, the operating costs for central stations will go up as monitor techs are hired to cover for absent caregivers.
Mobile Phones Don't Interfere, Can Improve Patient Safety
First it was the Mayo Clinic, now it's Tan Tock Seng Hospital (TTSH) in Singapore who has published a study on the safety of cell phones in hospitals. Phones can be used anywhere in the hospital as long as they're at least 2 meters from a medical device.
TTSH's study found that doctors spend an average of 80 minutes a day
making return calls. Nurses spent between 40 and 200 minutes paging
doctors daily.
Nursing officer Abdul Kahar Sulong, 42, said he used to stand by the phone waiting for a doctor to call back after paging.
'Now, it's easier for the doctors and us,' he told the newspaper.
'Also if there's an emergency, we can call the doctor directly.'
Doctors will be informed automatically when patients' laboratory test results are ready later this year.
In another study published in Anesthesia & Analgesia, investigators showed that using mobile phones actually reduced errors by facilitating improved communications.
reported using pagers as their primary mode of communications and 17
percent said they used cellular telephones. Forty percent of
respondents who use pagers reported delays in communications, compared
to 31 percent of cellular telephone users.
He said the reported 2.4 percent prevalence of electronic interference
with life support devices such as ventilators, intravenous infusion
pumps, and monitoring equipment is much lower than the 14.9 percent
risk of observed medical error or injury due to a delay in
communication.
Interesting statistics. This is the first ever study on the potentially beneficial impact mobile phones have on patient safety. Let's hope more follow soon.
Texas Instruments Closes Chipcon Acquisition
Not one to be left out of the wireless sensor market, Texas Instruments has completed their acquisition of low power RF wireless transceiver company Chipcon. (Press release)
The Chipcon product line strengthens
TI’s position in ZigBee, a global standard for wireless monitoring and
control applications. Chipcon was the first company to launch a 2.4 GHz
IEEE 802.15.4 compliant and ZigBee-ready RF transceiver. The company
also introduced the world's first true System-on-Chip ZigBee-compliant
solution and recently added location estimation capability to this
product. Chipcon is the first company to offer three ZigBee-compliant
development platforms and provides a true one-stop-shop solution
including RF transceivers, the industry-leading Z-StackTM ZigBee
protocol software, development tools and proven reference designs.
Chipcon also offers a broad range of
proprietary low-power and high-performance CMOS RF-ICs for a large
number of wireless applications in the 300 to 1000 MHz and 2.4 GHz ISM
frequency bands. This product portfolio includes transceivers as well
as true System-on-Chip solutions. Unlike competing System-on-Chip
solutions, these products deliver everything the designer needs in a
single die without requiring off-chip memory and enable shorter
time-to-market, lower cost and smaller end products, due to the high
integration level.
FDA
I stumbled across this PowerPoint presentation the other day. John Murray at the FDA put together this presentation that spells out expectations regarding patching off the shelf (OTS) software used in medical devices. If you want to know the real story, check it out. The term guidance is in quotes because this is an informal communications, rather than a formal guidance document.
You can read previous posts on this issue here, here, and here.
Another Hospital Offers Patients Free Wi-Fi
The Richardson Regional Medical Center now provides free Wi-Fi Internet access to patients and visitors throughout the hospital. What started as a WLAN to support paperless charting became a broader deployment.
Today, the entire hospital is on a Wi-Fi system. The system
includes waiting rooms, patient rooms and associated medical office
buildings. Access is also available to clinical personnel and for
business functions.
The clinical and business operations are completely separate from
patient access so that no one can tap into the hospital's confidential
records, [CIO Ronald] Franquiz said. “We definitely have total control to make sure
that our business network and hospital network are not affected at
all.”
The system also facilitates attending physicians who want to access their own EMR in their practice from within the hospital. Pretty cool.
