Many emergency departments are forced to place patients on stretchers in hallways in order to create more capacity. This can lead to suboptimal outcomes. When improving the patient experience in healthcare settings, efforts are usually placed on improving the patient experience throughout a journey, however, this critical moment is actually a huge key stage within that process where the experience can be improved, leading to more appropriate care for patients.
This project investigated the current practice of treating patients in ED hallway beds — a result of a partnership between the Michigan Medicine Emergency Department (ED) and the University of Michigan Stamps School of Art & Design, Masters of Design (MDes) in Integrative Design program.
Nationally, over 90% of emergency departments (EDs) experience overcrowding. In an effort to meet demand, EDs have resorted to providing treatment to patients in beds placed in hallways. Despite recognition that this temporary solution can lead to suboptimal care, use of hallway beds remains standard practice. Much research has been dedicated to finding a solution to ED overcrowding. However, minimal, if any, research has been conducted regarding how we might improve the care and experience of hallway bed patients. Over the course of four months, September to December 2017, MDes students engaged in design research — including 120 hours of observations within the ED, patient and staff interviews, and evaluation of survey data from both the ED staff and the Patient and Family Centered Care program — to formulate key insights and propose solutions to improve hallway bed care. Through this process, we have come to appreciate the interconnection of the patient and staff experiences and believe that creating positive outcomes for both is a mutually reinforcing cycle that ultimately leads to optimal care.
Observations: Our design research included 120 hours of observations within the ED. We considered hallway bed care at different locations, times of the day and week, as well as interactions between care providers, patients and others.
Affinity Mapping: We synthesized our observations, creating categories to understand relationships and identify major themes.
Patient-Staff Journey Map: Working from our observation notes, we mapped patient and staff “pain points” over time to deepen our understanding of the process of care and barriers that arise for both a patient and staff during the hallway bed experience.
Patient-Staff Pain Point Analysis: We considered the pain points collected in the Patient-Staff Journey Map in tabular form, according to the categories identified in the Affinity Mapping. This analysis assisted in determining the opportunity areas in which we believe interventions would have the most impact.
Staff Survey: Based on the observations and analysis, the staff survey was designed to obtain details regarding specific problem areas.
Ideation Evaluation: In the ideation phase, multiple ideas for solutions were generated through brainstorming sessions. Potential solutions were evaluated on a two by two matrix, mapping the possible impact and ease of implementation.
This chart considers the pain points according to the ED process we outlined in the Patient-Staff Journey Map (horizontal) and the three primary categories that arose in our Affinity Mapping (vertical). We found that most pain-points occur within the “communication about process” row and the “waiting” column. Patients do not know what to expect within the hallway bed process and staff are uncertain how to communicate to patients. This analysis helped us determine the opportunity areas in which we believe interventions would have the most impact.
Insight: Hallway beds feel out of place and disconnected from the ED operational flow. Given that hallways are transient by nature, beds placed in this context feel out of place. Haphazard wall-mounted supplies, often in close proximity to patient beds, add to the sense of dislocation. Patients mention difficulties directing family members to their hallway bed location or navigating back to it after using the restroom. This disorientation negatively impacts patient perception of care.
Opportunity: Create a sense of place and intentionality with signage that delineates and identifies a specific location. How it can be used Signage, fabricated in removable vinyl, can be added to the walls to delineate spaces for hallway beds. A system of color and number coding (ie., G3 = the third bed in the green area) creates a unified visual presence in the location and aids navigation. Calming colors and intentional design improve patient surroundings.