Biomedical Innovations: Redesigning the ED

We could see there’s a problem with too many visitors in the patients’ rooms sometimes.”

Heads nodded.

“We’ve devised a badge system that will eliminate that overcrowding problem.”

The administrators jotted down the details.

“You definitely need another door at the triage desk.”

More heads nodded.

“The nurses told us there’s a flow problem with the storage rooms. You have to go to two different ones. If you had a universal storage system—one central room with two entrances and supplies shelved identically on either end–then you’d improve efficiency.”

People took notes.

One afternoon this week, fifteen seniors from McCutcheon High School presented their plan for redesigning the Emergency Department at IU-Arnett hospital to an audience of seventeen IU-Arnett nurses, educators, technicians, and administrators. The students are members of Mrs. Abi Bymaster’s Biomedical Innovations class, the fourth and capstone course in Project Lead the Way’s Biomedical Science sequence. One purpose of Biomedical Innovations is to give students a hands-on, real world experience designing an efficient—and thus, effective—emergency room. Mrs. Bymaster challenged her students to take the assignment to the next level—to work not in the abstract, but with a real hospital with a real problem. The IU-Arnett facility is only a few years old, but already, Emergency Department demand has exceeded capacity. The hospital will soon be hiring a professional design firm to develop a blueprint, but in the meantime, these high schools students offered, in an engaging and highly polished presentation, a plan whose details clearly resonated with the experiences of their audience.

The students commanded the attention of the hospital personnel, including the Director of the Emergency Department and the Director of Facilities, for an hour. During their presentation, not one student stumbled and not one seemed even uncomfortable.

The students had been oriented to the hospital by a representative from the Human Relations Department, who had come to their class at the high school on two occasions. In advance of their actual visits to the ED, the students were required to have a flu shot, verify that they’d had a schedule of vaccinations, and sign liability and HIPAA papers. Over a period of three months, the students–recognizable in the eggplant-colored scrubs which they’d chosen to purchase—were allowed to float and watch events unfold. When they arrived, the students checked in with the charge nurse who would assign them to someone on the emergency department team—a nurse or a technician—whom they interviewed and shadowed. In the end, each student visited the Emergency Department four to five times, at different times throughout the day.

Back at the high school, the students reported their experiences to each other in class discussions, drew preliminary designs on the classroom whiteboards, and conducted online research into the operations of other hospitals in Indiana and distant cities. They worked in teams to identify innovations that could be made in four areas: structural design, storage, communication, and security.

“We think the nurses could communicate with each other and with others in the hospital if they had iPhones instead of the bulky calling devices they’re using now. Those devices are loud and intrusive.” As if on cue, a nurse’s portable phone rang—loudly. And more than once. Everyone laughed, but the point was accentuated.

The students assured hospital administrators that the iPhones could be equipped with “parental controls” so that their usage would be limited to internal communications, and they offered suggestions for a number of useful apps that would increase the functionality of the devices: Evernote—to replace the notes they had seen nurses making on random slips of paper; Epocrates—to identify medicines; Medical Spanish—a spoken medical dictionary that can ask patients questions in Spanish; and Telemed IQ—a text messaging system that is HIPAA-compliant.

Asked about those cell phones in the Q-A session at the end of the presentation, the students explained that iPhones are being used now in some big city hospitals and that the apps are secure and HIPAA-compliant. The students had done their homework and anticipated the question.

No presentation, it seems, goes without a technology hitch, and although the one these students experienced was crushing, they didn’t miss a beat or even make a face. One of the students, who had a background in civil engineering classes, had created a CAD drawing of the architectural redesign, but a software licensing glitch prevented her from showing it to the assembled hospital personnel. However, she also had produced a blueprint, and at the conclusion of the presentation, explained the changes her team had envisioned to a group crowded around a table.

It was the students’ professionalism throughout the entire presentation that set the stage for serious consideration of their ideas. They were dressed professionally, first of all, and the presentation itself reflected every speech and language skill their teachers had ever stressed and which my colleague had clearly set as a fundamental expectation: not a stammer nor a hesitation in speaking, not a single distracting movement, only carefully chosen words–precise and concise. Even when the phone interrupted her speech, the student talking about the iPhones maintained her poise, merely smiling at the comic relief the noisy ring provided and then deftly using the opportunity to underscore her message: iPhones would be less intrusive.

At the conclusion of the presentation, the Director of Facilities remarked to the students: “I’ve seen college kids who were not so good. I was impressed with your logic—how you’d thought things out.”

The Emergency Department Director had just returned from a week-long training. She commented that that she hadn’t come away from that with so many ideas as the high school students gave her. “And your demonstration was perfect!” By pretending to be nurses picking up supplies, the students on the Storage Team demonstrated in real minutes the time that would be saved if the hospital implemented their design.
“I was impressed with your presentation and your ideas—you seem to have enjoyed the process,” the Emergency Department Manager said. “You have blown me away.”

Biomedical Innovations is an example of the project-based learning approach that characterizes Project Lead the Way courses: Students have the opportunity to design solutions to real engineering problems—in this case, in the health field industry. Project-based learning integrates learning, calls for teamwork in solving problems, and prepares students for the world of work.

“My boss isn’t going to give me a worksheet and tell me to get it done,” said the young woman who had created the CAD drawing. “He or she will give me a project instead.”

The students learned so much, they told me:

• The inter-relationship of technology, storage, and room arrangement
•  How necessary it is that the environment facilitates communication
•  The discovery that so many little things go into the big picture
• How much time and effort the nurses give to the patients
• All the work that goes into creating an efficient system

Most of the students in this class were already were thinking about a career in the medical field when they registered for the Biomedical Innovations course, but as one student said, “This program finalized that!”

At the end of the presentation, another student, a spokesperson for the group, thanked the hospital personnel for giving them so much help with this assignment. “Many of us want to go into medicine or a field related to medicine. Thank you for providing a positive experience for us.”

I began observing the students in the early stages of this project. Early on, I had asked their teacher what benefit there would be for the hospital: “Why would a hospital let a crew of teenagers shadow their nurses and interview everyone who works in the Emergency Department? That’s unheard of.”

“Well, they’ll get some free advice,” she said. Mrs. Bymaster went on to explain that she had worked closely with the hospital’s Education Outreach Department to design the assignment and establish its parameters.

Judging by all the head-nodding and note taking that went on throughout the hour, the audience heard more than just some gratuitous advice: They listened to a polished and thoughtful presentation that professional hospital designers are going to be hard-pressed to match.

More than that, the students gave current practitioners a glimpse of the future. Patients will be in good hands, whether these students ultimately become nurses, lab technicians, doctors, biomedical engineers, researchers, physician assistants or train for one of myriad other medical occupations. These future medical professionals understand the complexity of health care systems and know already that, along with compassionate care, efficient systems are critical in the mission to save lives.

Here’s the blueprint: IU Arnett 2d wc backup nov 12