Transcript Transformation of Pediatric Care Space

Transformation of Pediatric Care Spaces
--- Pediatric Design of the Future
TRANSFORMERS:
Marianna Jewell, Jamie Beyer, Dr. Jiten Chhabra, Hui Cai
Problem 1
Patients with chronic diseases have to make unnecessary
hospital visits, about matters which can be addressed by
remote bio monitoring techniques
The ability of tele medicine to help children suffering from
Asthma is not being utilized to its maximum capacity
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What is Asthma
Increased responsiveness of lower airways to multiple stimuli;
episodic, and with reversible obstruction
Air flow obstruction
Airway hyper responsiveness
Airway inflammation
Etiology:
Allergic
Idiosyncratic
Numbers (2002)
8.9 million children
10.4 million outpatient visits
1.8 million ER visits
½ million hospitalizations
14.7 million school days were missed
$ 2 billion direct and Indirect costs
Facts (2002)
Asthma is the 3rd ranking cause of
hospitalization for children under 15 yrs.
Low-income populations, minorities & children living
in the inner city are more likely to have ER visits,
hospitalization and death due to asthma then the
general population.
Young children (<4yrs) had the highest rate of
hospitalizations; ( twice the rate than children of
the same age w/o asthma
Asthma Signs and Symptoms
History:
Wheezing, Coughing, Frequents RTI’S, Exercise
intolerance Nighttime worsening, Chest tightness,
Shortness of breath,
Examination: Tachypnea, Tachycardia, Use of accessory respiratory
muscles, Cyanosis, Pulsus paradoxus, Symmetry of
breath sounds, Wheezing, Prolongation of expiratory
phase, Hyperinflation
Investigations: CBC, IGE, Curschmann’s spirals, Charcot-Leyden
crystals, PFT
Classification
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
Treatment: - Acute vs Chronic
Adrenergic agonists, Methylxanthines Anticholinergics
Glucocorticoids, Cromolyn sodium and nedocromil sodium,
Leukotriene modifiers
Spirometry
Peak Expiratory Flow Rates
Evidence Based Medicine
1) The monitoring of peak expiratory flow (PEF) and maintenance
of a symptom diary have been proposed as means to monitor
asthma severity. Daily PEF variability in combination with the daily
frequency of beta-agonist inhalation is very useful in the
management and early detection of acute asthma
2) A program run by the San Mateo Medical Center in San Mateo
County, California helps children manage their asthma through the
use of cell phones. Over a one-year period, these children
experienced no emergency room visits or hospital stays due to
asthma and they rarely came into the clinic for asthma-related
medical treatment.
3) After six months of participation in the program, the
number of emergency room visits decreased significantly
and the activities of daily living were improved in the telemedicine group. Most of the patients in the tele-medicine
group were able to continue measuring and transmitting
peak expiratory flow (PEF) value successfully, and at six
months had noticed an improvement in PEF.
Our Proposal
1) Develop and implement a flexible and open ended
interface to receive, analyze and transmit pediatric
asthma specific information.
2) Research a new parameter, sub-auditory wheeze
frequencies as a remote monitoring tool for asthma
Problems addressed
1) Better care delivery
2) Reduce number of complications
3) Patient empowerment and involvement
4) Conserve national resources
5) Implementation in the hospital
Problem 2
Lack of accessible interactive educational materials at the
child's level in pediatric hospitals.
Evidence:
•Patients who had their medications electronically reconciled reported a greater
understanding of the medications they were to take after discharge from the
hospital, including medication administration instructions and potential adverse
effects.
•Misunderstanding prescriptions and dosages leads to adverse drug effects.
•Patients are encouraged to become "part of the health care team" along with their
physicians, nurses, and pharmacists, to prevent medication mistakes.
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Microsoft Surface COW for
Medication Education
Interactive surface easy to use and easy to clean using disposable plastic
skins
Place the medication on the surface and it will be recognized.
Tutorial of instructions, side effects, interactions, alternatives will be given.
 Videos and pictures for clear understanding
Information will be presented at age specific levels.
Choice of language offered.
Print out, email, or video to cell phone for home use
Technology will be more widely used and cost effective in 3-5 years
Flexibility for other applications proves a valuable investment.
Additional Problems Addressed
• Lack of complete knowledge of medications at
the care giver level.
• Lack of understanding on how to self medicate,
especially at the pediatric level.
• Errors due to allergies, interactions, incorrect
prescribing.
• Infections transmitted on highly used surfaces.
• Time of nurses and doctors better spent in other
place
Problem 3
Is waiting room simply for waiting?
Waiting room design does not address various needs of
users.
 Comfort
 Flexibility
 Information
 Interaction
 Disaster support
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Registration / Play area
Resource center
Business center
Learning center
Physical therapy space
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Proposal:---“Transformable space"
 Provide adjustable furniture, can provide different size of
chairs and even unfolded to universal bed that fits
different age groups;
Proposal: ---“Transformable space"
 Provide various options of separation that can
transform the waiting room into ED in case of
disaster; possibility to re-organize the zone of play
area, family-caregiver interaction area, resource
center and parents’ business area.
Problems addressed & Evidence
Flexibility and Disaster Preparedness.
Different consideration for different user groups
Children’s hospitals in urban settings or large,
academic referral centers must invest heavily in
creating a culture of readiness and a response
plan for any disaster, natural or otherwise, that
they may encounter (Karlsberger 2005).
Proposal---“Magic touch"
Proposal---“Magic touch"
Expedite the registration process for repeated
chronic patients. The fingerprint identification
allows the kids' self-registration
Incorporated with CPOE (Computerized
Physician Order Entry) systems and EMRs
(Electronic Medical Records) to retrieve patient
history
All ages of kids can enjoy creating their own art
pieces.
Easily cleaned and sanitized.
Problems Addressed & Evidence
Efficiency and fun
EMR /CPOE can improve clinician workflow,
reduce errors, and increase revenues through
reduction in billing delays. (Greiger G. et.al.
2003)
Patients’ perceived quality of care and
opportunity of interaction was significantly higher
in the more attractive waiting room settings.
(Becker & Parsons, 2007)