Acute Care Planning In Emergency Departments: A participatory design study exploring how to improve emergency department visits through a health information system

Research output: ThesisPh.D. thesis

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Abstract

Background
The nature of the Emergency Department (ED) is defined by an ever-changing environment with many professions working together under pressure, to provide an accurate diagnosis for each patient. The majority of the patients evaluated in the ED are discharged within 0-48 hours to recover at home. Patients and family members ask for improved person-centred communication, and involvement in treatment and care. However, healthcare professionals struggle to deliver what is requested, which affects the patients’ ability to manage their health after discharge. Technologies have shown great potential to mediate health-related matters on behalf of others. To develop successful technologies to improve clinical settings, it is recommended that the users of the field be involved. Limited research that takes a user-involvement approach exists on how to support patients and family members discharged from the ED.

Objectives
I:To explore and understand the needs and preferences of emergency care from the perspective of patients and family members discharged from the ED within 24 hours of admission.
II: 1) to investigate how HCPs in the ED perceive the needs of patients and family members discharged within 24 hours, and 2) to explore how these can be supported in organizing improved patient pathways.
III: To design and develop a health technological solution based on patients’, family members’, and HCPs’ needs.
IV: To gain knowledge about the usability and experiences of the newly developed Cetrea Clinical Logistics for patients before planning a full-scale implementation in the ED. 

Methods
Study I was a qualitative study. The study was conducted using field observational studies of patients and family members in the EDs at Odense University Hospital and Hospital Lillebaelt, Kolding. Semi-structured interviews with patients and/or family members were carried out after discharge.
Study II was also a qualitative study, gathering data from focus group discussions with healthcare professionals.
Study III was a co-design study that involved collaborative and innovative workshops. Two different types of workshops were carried out: 1) with healthcare professionals and designers, and 2) one-on-one workshops with patients and family members with follow-up interviews.
Study IV was a mixed-methods study combining a survey with the questionnaire ‘System Usability Scale’ and qualitative interviews with patients and/or family members. 

Results
Study I yielded 50 hours of field observational studies, 19 individual interviews with patients, three individual interviews family members and four joint interviews with patients and family members. From the analysis, four main themes emerged: (1) being in a vulnerable place – having emotional concerns; (2) having a need for person-centered information; (3) the atmosphere in the ED and (4) implications of family presence.
Study II: From three focus group discussions with healthcare professionals, three themes arose: (1) creating a trustful and reassuring relationship; (2) responding to family members: a bother or a benefit; and (3) working as an interdisciplinary team.
Study III: Four workshops and five one-on-one workshops were completed. A need for improved person-centered information was highlighted. An already implemented system was redesigned into a patient module that provides continually updated informative features into the hospital room.
Study IV: 104 patients and 16 family members (n=120) answered the questionnaire. Ten patients and three family members were interviewed. The System Usability score for CCL for patients was close to excellent, mean score 83.6 (SD 12.8). The system was considered easy to use and was reported to give patients and families a sense of control because the information was accessible.

Conclusion
There is a gap between what patients and family members need in the ED and what is currently delivered. There was illuminated descriptions of a lack of communication, reassurance, family involvement and interdisciplinary teamwork. In a co-design process, an existing system was redesigned into a patient information system, CCL for patients. The system provided timely and continuous information on person-centred activities. Translating ideas into technologies is complex; however, user perspectives can lead to identifying challenges before implementation. To involve the ED population, the approach must be flexible. CCL for patients is a highly usable system, which mediates valuable information to patients and family members in the ED; thus they feel in control and empowered. 
Translated title of the contributionForbedring af korte patientforløb i akutmodtagelsen: Et brugerinvolverende studie om, hvorledes akutte indlæggelsesforløb kan forbedres ved hjælp af et teknologisk informationssystem
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Lassen, Annmarie Touborg, Principal supervisor
  • Jensen, Charlotte Myhre, Co-supervisor
  • Dieperink, Karin Brochstedt, Co-supervisor
  • Coyne, Elisabeth, Co-supervisor
Date of defence26. Oct 2023
Publisher
DOIs
Publication statusPublished - 13. Sept 2023

Keywords

  • acute
  • participatory design
  • qualitative
  • health information
  • technology
  • emergency departments

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