Hospitals by design: Solving the problem of medical information overload

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Scott OpenshawHospital environments are stressful scenes: blaring alarms, beeping machines, busy monitors, and endless tubes and wires all vie for doctors’ and nurses’ attention and overload their senses. “Alarm fatigue,” the phenomenon whereby health professionals get overwhelmed by and ignore the constant cacophony of alarm sirens has become a national problem. One study at Johns Hopkins Hospital found staff were exposed to nearly 1,000 alarms a day—one every 90 seconds. That overload of information takes its toll mentally on practitioners, and medically on patients. A Boston Globe report found that in a five-year period, at least 200 deaths were linked to a failure to respond to alarms, and a survey of doctors and nurses by ECRI Institute identified alarm fatigue as the number one safety concern facing hospitals.

The hospitals, doctors’ organizations and the Food and Drug Administration have all focused on tackling the problem and information overload in general, both through technological fixes, such as reviewing medical devices in order to weed out unneeded alarms, and through behavioral changes, such as increasing training and putting procedures in place to institute more breaks for staff.

While these changes are part of the necessary response, the problem of medical information overload can also be overcome by design. Alarm fatigue is only one part of the equation; equally important as reducing the overall amount of information is designing a hospital environment that allows the information to be more easily synthesized and interpreted so that health workers can focus on what is truly important. At Continuum, a global design and innovation consultancy, we have partnered with many different medical device firms to design more sanity and efficiency into the hospital setting. We have found that in order to do that, medical designers must keep in mind three principles:

  1. Hierarchy
  2. Differentiation
  3. Redundancy

Hierarchy
In a medical environment where seconds can count in making proper diagnostic decisions, whatever information is most important needs to stick out most. That must be done by creating hierarchies that cognitively make sense, at the same time allowing users to dig for supplemental information when it is needed. For example, Continuum helped design the Mindray V series monitor, the first monitor that features a vertically oriented, portrait-style display, which shows the most important information in larger, bolder fonts, and less critical information in smaller, lighter typeface. Fonts and colors were evaluated for legibility and clarity at greater distances. The concise, easy-to-read format allows the viewer to interpret a patient’s condition and respond more rapidly, and makes efficient use of the available space in crowded patient rooms where space is at a premium.

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Differentiation
Differentiating alarms by pitch and pattern can help identify which is a warning, which is a critical event, and which is an indication of a properly functioning device. But alarm notifications are only part of the equation in creating more safety and efficiency in a medical environment. A 2009 report by the FDA found hundreds of cases of accidental deaths in hospitals from missed tubing connections—such as connecting an external feeding tube to a tracheal connection or an IV. Those events can’t be entirely blamed on health worker negligence—with dozens of tubes in a hospital room that all look alike, it can be extremely difficult in a fast-paced hospital environment to find the right one. Continuum has worked on projects to address the differentiation issues that the nonprofit Association for the Advancement of Medical Instrumentation (AAMI) and FDA have made a priority. Good design of differentiation can be the difference between life and death.

Redundancy
Different people learn in different ways. Having devices that convey the same information simultaneously through sight, sound, and touch can ensure proper messages are delivered. For example, in the Mindray V monitor, LED alarm lights in the rim surrounding the display remain hidden when not needed, but illuminate when an alarm event is triggered. When that happens, the device posts an alarm message within the respective information parameter on the screen to which the alarm pertains, focusing the user’s attention to where it is needed most urgently. We have also created redundancy on other devices we’ve helped create for the hospital environment, for example, by differentiating buttons on a medical device using different lights, icons, and tactile shape to ensure correct use.

All of these techniques are important in helping manage medical information in a hospital setting. Just as important is that they are integrated into a comprehensive system that holistically helps doctors and nurses make sense of the information in real time. Using all of these techniques will not necessarily reduce the amount of information flying around a busy hospital environment, but it will help health professionals better use and manage the information — leading to better healthcare.

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Scott Openshaw

By Scott Openshaw

Scott Openshaw, Ph.D., is a Senior Human Factors Engineer at Continuum, a global design and innovation consultancy.
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