Supporting communication and collaboration with minimal interruptions in the ICU
Design a solution to collaboration and communication practices that aid patient management in the ICU
Designed and a tested prototype, PANI, that aids healthcare providers expedite the process of communicating and managing patient tasks and goals with minimal interruptions
Paper nominated for AMIA Distinguished paper award here
Paper summarizing the design guidelines that resulted from this work here
Collaboration and coordination are integral to medical work. This is particularly true in a hospital intensive care unit (ICU), where healthcare providers often work in multidisciplinary teams to accomplish the common goal of providing safe, effective, and efficient patient care. Awareness of individual and group activities is critical to successful collaboration in medical work, and Computer Supported Co–operative Work (CSCW) systems commonly support such awareness. Healthcare providers engage in several task management and communication practices, using both electronic and non–electronic information sources, as they continually inform themselves and fellow team members of evolving patient–centric knowledge, tasks, and goals. For instance, healthcare providers make paper–based notes to organize and accomplish individual tasks and goals (paper– based notes are “handed off” between healthcare providers during shift change). These paper–based notes serve as transitional artifacts that are later digitized to organize and coordinate team information, tasks, and goals. However, these paper notes are often not immediately digitized and shared, and only select information is synchronously communicated between select team members through mechanisms such as face–to–face or telephone conversations.
ICU healthcare providers are exceptionally skilled at working together to improve a critically ill patient’s condition. However, passive digital practices do not always inform the healthcare providers of the patients’ current condition. Healthcare providers must therefore make additional efforts to become aware of the (i) patient’s current condition and (ii) contributing factors to that condition. Lack of updated patient–situation awareness has been found to result in incorrect decisions that can lead to medical mishaps; these negative effects are further amplified by existing cognitive overload that healthcare providers experience. Given the mobile nature of ICU teamwork, passive digital and communication practices inhibit teams from effectively becoming aware of, and sharing perspective on, a patient’s dynamically changing condition and ongoing care. Further, the synchronous nature of communication in the ICU often results in notification interruptions to the healthcare providers’ ongoing activity (such as a phone ringing while a healthcare provider is busy rounding on a patient).
ICU healthcare providers
How it works
PANI (patient-centered notes and information manager) integrates the use of a mobile application, paper-based artifacts, and a wearable device in one system, which supports the management and communication of notes and action-items that are generated throughout a typical ICU clinical shift.
The paper-based component is loosely structured to include any form of paper artifacts, including printed patient EMR, rounding sheets, or blank sheets of paper. Hence, although PANI was envisioned as a mobile add-on tool to the existing patient EMR, healthcare providers could print off rounding sheets to refer to a patient’s history, while rapidly creating or disseminating action-items. This was done because the original goal of PANI was not to replace patient EMR, but rather to enhance patient-situation awareness through effective task management and communication. Given this, PANI was envisioned to also include a writing pad that is lightweight, easy-to-carry, fits ergonomically within a person’s hand, can be placed without difficulty in a lab coat pocket, and holds sheets or paper for easy note-making.
PANI includes a mobile device powered with a software application that digitally mediates task management and communication between ICU healthcare providers. To enable quick access to digital information while viewing or annotating the paper notes, PANI also includes a smartphone as the mobile device component.
PANI also includes a wearable device configured and paired with the smartphone application to provide tactile notifications while receiving a message from a colleague or to act as personal reminder alerts. FitBit, a commercially available wearable device, was used to represent the wearable component of PANI, since it had the “silent alarm” feature that can effectively provide tactile feedback that can only be felt by the person wearing the FitBit. In reality, FitBit may be replaced with any other wearable device capable of providing similar “silent” tactile feedback.
PANI helps organize healthcare providers’ notes, create and disseminate action- items within and between ICU teams, and provide anytime, anywhere access to patient information through a connection to the EMR. PANI includes the lean Kanban approach from Toyota.
PANI’s patient-enhanced notification comprise of --
visual cues delivered through color-coded “previews” on a mobile device screen
tactile cues delivered through a wearable device; both indicating the content and urgency of communicated message
I conducted two studies using different, yet complementary research methods
Patient vital signs, coupled with the text message, assist receiving ICU providers in deciding when to respond to a technology-mediate notification (TMN)
Presence of visual and tactile cues may improve the receiver’s understanding and awareness of the patient, eventually contributing to rapid decision-making about responding to the text message notifications
Providers reported feeling less interrupted when receiving PANI’s messages as compared with pager alert or phone calls, because visual and tactile cues helped providers perform cost-benefit evaluation for interrupting their ongoing activity to respond to the message
PANI resulted from my PhD dissertation research