Patient Pathway: Stage 1 Delivered

This project has been undertaken with staff in the AED at the Grafton campus, Auckland DHB. We have sought to understand and unpack the journey of a patient through the Emergency Department, and visually communicate to patients how the service works. This is of specific importance for patients and family who have to wait for long periods during their care, as other patients with more severe conditions may have been prioritised over them. With such a large number of care pathways that a patient could experience, the challenge has been to design a simple and understandable representation of the whole service. The goal of the project is that patients and families who have a clearer picture of why they must wait (for example, because staff resource is being tied up with a life threatening emergency) will have reduced levels of anxiety and frustration. Designing out complexity has been the main challenge of this graphic design exercise.

Project Mapping

Unpacking the AED Waiting room experience.

Designing Iconography and developing a visual language to represent different people and processes in the AED.

Iterating and refining a simple, high level map of how patients move through the AED.

The final design was achieved by working Collaboratively with AED staff.

The next stage of this project is to receive formal feedback from users and develop an animation for screens situated in the ED waiting room as well as flat vinyls at different points the AED.

Patient Pathway Development

Much of our recent work and collaboration with ED staff has focused on the development of the ED Signage and, as a result, development of the main project - Patient Pathway - has somewhat slowed. In order to give this project new momentum, we needed to get some real feedback on our current understanding of the Adult Emergency Department patient journey. We had developed a series of journey map iterations and a graphic/visual language, which we were able to present to the Facilities Nurse yesterday for discussion and feedback. This was the first opportunity to get some critical feedback from ED staff, and would allow us to test our initial assumptions/understanding and push the project forwards. Feedback regarding visual iconography:

• As clinicians, we have the responsibility to communicate more to patients
• Generally doctors in ED wear blue scrubs, surgical doctors wear teal, specialists wear mufti, nurses wear blue scrubs, charge nurses wear red, flow nurses wear green - overall, not very clear
• Coloured, detailed icons could be used to demonstrate/communicate different staff roles
• Medical equipment details could also be used to differentiate roles - e.g. clinical staff wear stethoscopes, non-clinical do not
• A colour key could help patients/families understand the different staff roles within ED
• Plain, white icons are quite good for keeping things neutral - gender/culture
• Would be useful/helpful to explain different triage categories
• Helpful to communicate and define department terminologies - Triage is a term we want to educate people around; it is internationally used and has an interesting historical background

Feedback regarding journey map:

• Walk-in patients and patients brought in by ambulance all come through triage
• Triage direct St John paramedics to different areas
• Triage is a key component of four stages: Arrival, Triage, Nursing Assessment, Medical Assessment
• Five main areas: Resus, Acutes, Monitoring, waiting room and APU
• No matter what location, each patient is assessed by a nurse
• As a patient story develops, their category/priority may change
• Tests generally happen before being seen by a doctor
• Not all cases are 'injuries' - may be medical or surgical problems also
• Final stage should simply be kept to 'Admitted' or 'Discharged'
• As for the location of the journey map, it was suggested we replace the large mat hung on the waiting room wall

With such a complex set a variable care pathways, it is tricky to refine a journey map down to a simple, coherent graphic. Our current line of thought focusses the journey map on a central ‘care cycle’ where tests as well as doctor and nurse assessments can take place in any order (as is often the case in ED).

ED: Patient Pathway

We are excited to be starting our first DHW Lab project for 2014, focusing on designing new ways to communicate the Emergency Department to help improve the experience for those arriving in ED at the ADHB’s Auckland City Hospital in Grafton.The waiting room of the ED can be a place of high anxiety, frustration, and sometimes aggression. Commonly visitors arriving to the service are uncertain about where to go, who to see, how long do they need to wait, and well as not understanding why some patients may be prioritized over others.

This first DHW Lab project asks how visual communication can be used to help patients to understand their pathway through the ED, in order to explore how design can be used to deliver new healthcare experiences

Currently, two Lab staff are working closely with staff from the ED, as well as the service improvement team to better understand the challenges associated with this busy and complex area of the hospital.  It is hoped that  new opportunities for design led solutions will be identified through this collaborative approach.

The team is currently undertaking secondary research and gathering primary data . See the current project map below and follow us as we design and learn…