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Meet the ER doc who thinks like a designer – Philly.com

A heart attack one minute. Mysterious stomach pain the next. A steady stream of fevers, headaches, and shortness of breath. As the safety net of the American health-care system, hospital emergency rooms are expected to be crowded, loud, and chaotic.

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Bon Ku, an emergency physician at Thomas Jefferson University Hospital, thinks there has to be a better way.

For the last two summers, he has deployed teams of students with iPads inside Jeffersons busy emergency department, carefully mapping the movements of doctors, nurses, technicians, and patients. The goal of the project, a collaboration with the KieranTimberlake architecture firm, is to learn how emergency medicine could be improved through good design.

People ask me:Are you just trying to make the E.R. look prettier or polished, with the walls a more soothing color? he said. No. You can design spaces to change the behaviors of people.

Among the early results from the research: colorful heat maps suggesting that physicians spend too much time at computer keyboards at the expense of listening topatients, Ku said.

KieranTimberlake

A heat map shows the locations of five categories of people in the Jefferson emergency department over a 48-hour period: patients (red), doctors (purple), nurses (blue), other staff (green), and family/friends (yellow).

That was no surprise, and certainly not unique to Jefferson, which typically gets at least 65,000 E.R. visits a year. Doctors and nursesnationwide have griped about the amount of time spent entering patient information into electronic medical records. But it has gotten Ku and his colleagues thinking about ways to alleviate the problem. Placing easy-to-use keyboard stations inside patient rooms, perhaps. Or better use of scribes employees who document the care while the physician focuses on providing it.

Ku, who majored in classical studies as a University of Pennsylvania undergraduate and later earned a masters degree in public policy at Princeton, has no formal training in design. But he is determined to get medical students thinking about it.

The E.R.-mapping study is one of 10design projects now underway in the Vault, the basement of a former Federal Reserve building in the 900 block of Chestnut Street that Jefferson owns.The lab is directed by pharmacist Robert Pugliese.

Oneeffort involves using a 3-D printer to make plastic models of patients jawbones, helping surgeons to prepare for difficult reconstructive surgery. In another, student researchers use electronic wristbands to monitor the movements of children in playgrounds, in hopes of determining which structures are most likely to encourage physical activity.

The emergency-department mapping project began when Ku saw a KieranTimberlake presentation of research it had conductedat JFK Plaza: how people use the park, where they sit, and where they stand. Billie Faircloth, a partner and research director at the architecture firm, recalled that Ku approached her afterward.

He said, I need this in my emergency department, she said.

Architects are used to interacting with people who have no formal design training. Listening to clients needs is a core part of the job, after all.But in Ku, Faircloth and her colleagues found someone who was unusually insightful about the potential for good design.

He talked very clearly about what he hoped to achieve, Faircloth said. He is basically looking at design from multiple perspectives.

Jefferson did not hire KieranTimberlaketo renovate the space. The firm offered its services purely for research purposes. Ku and his students are still sorting out what the results mean, and how they might lead to improvements.

The hospitals emergency department treats about 180 patients aday and at least seven every hour, though there is a lot of ebb and flow. Mondays are busiest, with a logjam of untreated ailments that has built up over the weekend. Regardless of the day, volumes tend to be highest from lunchtime until 2 a.m.

The spaceis divided into two wings, and, therefore, could serve as a living laboratory for testing different approaches for providing care. The larger A side has the more traditional E.R. configuration, with one central station for doctors and nurses, surrounded by patient rooms. The smaller B side is decentralized, with nurses separated into pods each surrounded by a cluster of four patient rooms.

Ku likes the B side because it tends to be quieter. But neither side has a good spot for providers to decompress. Kus solution?

I go to the bathroom, he said.

Ultimately, he would like to test which seating arrangements and other design elements might improve patient outcomes.

A recentstudy funded by the Robert Wood Johnson Foundation suggests that better design can, indeed, have an impact. Among the findings: Hospitals with shorter distances between delivery rooms were less likely to deliver babies bycesarean section. When rooms were arranged in a compact cluster rather than strung out along a long hallway, providers could work more efficiently, apparently reducing the pressure to move patients through the system more quickly by performing C-sections, the authors wrote.

KieranTimberlake developed the iPad tool that was used to map the Jefferson E.R., and it was customized for a health-care setting with input from Ku and his colleagues.

Ku, the assistant dean for health and design at Jeffersons Sidney Kimmel Medical College, wants to eventually make the tool available to hospitals anywhere. From what he can tell, there is far too little study of hospital spaces once they are built.

The science of how we build new health-care facilities, he said, should be as rigorous as the science of how we develop new drugs or therapy.

JESSICA GRIFFIN

Bon Ku (center) and medical student Allison David (far left) are studying how to improve emergency medicine with better design.

Published: September 7, 2017 3:01 AM EDT

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In A Houston Emergency Room, It Was A Week Like No Other – NPR

Dr. Winston Watkins, an internist at St. Joseph Medical Center in Houston, volunteered to do a shift in the ER to give his colleagues a break. Rachel Osier Lindley/KERA hide caption

Dr. Winston Watkins, an internist at St. Joseph Medical Center in Houston, volunteered to do a shift in the ER to give his colleagues a break.

St. Joseph Medical Center is downtown Houston’s only hospital, located just down the street from the convention center where thousands of evacuees have been staying since Harvey hit.

As of Friday, some doctors and nurses have been on the clock for almost a full week.

Trent Tankersley, director of emergency services at St. Joseph Medical Center in downtown Houston, had a very long work week, as did many of his colleagues. Rachel Osier Lindley/KERA hide caption

Trent Tankersley, director of emergency services at St. Joseph Medical Center in downtown Houston, had a very long work week, as did many of his colleagues.

When you’re working in an ER during a major natural disaster, nothing is routine. Trent Tankersley, director of emergency services at St. Joseph Medical Center, describes one tense situation after another in the hospital this week.

“We had a lady who the only vehicle heavy enough and strong enough to get to her through the floodwaters was a dump truck. She was pregnant. She was in labor. She was brought to the hospital in the dump bed of a dump truck, soaking wet.

“As we were getting her over to the women’s building to get taken care of, we had a trauma come in. Shortly after that, we had a young man [who] came in that was having a stroke.”

Tankersley showed up to work Saturday, and hasn’t had what you’d consider “a break” since.

“Finally got to go home last night for a couple hours and do some laundry and then came right back. So it’s been an interesting five or six days.”

Some staff haven’t been home since before Harvey struck

Kristen Benjamin, an associate chief nursing officer, has been right beside Tankersley.

“I think we’re all working on adrenaline right now. We’re working shift by shift. Some people are doing 15-, 16-hour shifts. We let them go off and sleep. They come back in.”

Kristen Benjamin, associate chief nursing officer at St. Joseph Medical Center, says many employees hadn’t been home to see if their houses were flooded. Rachel Osier Lindley/KERA hide caption

Kristen Benjamin, associate chief nursing officer at St. Joseph Medical Center, says many employees hadn’t been home to see if their houses were flooded.

They’ve seen more than 600 patients in the first five days. At times, they saw more patients in a few hours than they usually would in a whole day.

Many staffers have been stuck at the hospital, with no clear path to their homes. As floodwaters recede, their coworkers can finally come back.

“We’re going to start transitioning staff out to get home so that they can check on their homes,” Benjamin says. “Because some of them don’t even know what’s happening at their house right now because they haven’t been home since Friday. So I don’t even really have an idea if their house has been flooded or not.”

His first day working in the ER

Among those staffing the ER are doctors from other departments pitching in, and even medical students, like Diana Johnson. She and her classmates are using a Google spreadsheet to organize shifts to help.

She’s in her third year at Houston’s McGovern Medical school. She’s assisting Dr. Winston Watkins, an internist on his first day in the ER.

“One of the first patients that came in happened to be one of my own patients from my practice, and he came in with his foot hurting,” he says.”So Diana evaluated him and it turns out he has gangrene of his right fourth toe. And so we’re going to admit him to the hospital.”

“Some of them don’t even know what’s happening at their house right now because they haven’t been home since Friday.”

His house is underwater

Nurse Aaron Padron says he’s never seen such a wide range of emotions in the ER.

“A lot of laughter crying yelling, tears,” he says. “People that you work with you think that wouldn’t crack just put their head in their hands and take a second to cry to themselves, or not to themselves, and wipe away the tears and get back to work.”

He’s been working here for most of the last week, except Saturday night.

Aaron Padron, an emergency room nurse, says hospital employees were much more emotional, reflecting the stresses on everyone in the city. Rachel Osier Lindley/KERA hide caption

Aaron Padron, an emergency room nurse, says hospital employees were much more emotional, reflecting the stresses on everyone in the city.

“I went home on Saturday to sort of rescue my family before the floods got too high for me to get in or out,” he says. “And then I came back Sunday and I’ve been working and sleeping here ever since.”

Neighbors say his house is underwater. He says several others working in the ER saw their homes flooded. In a way, he says, it’s all been a transformational experience.

“I think times of crisis, in times of emergency, in times of stress really have a way to bring people together and create a lot of camaraderie and really can push people to excel at what they do,” he says.

Once reinforcements come in, he’ll be able to rotate off his shift and find out just how much his family lost.

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In A Houston Emergency Room, It Was A Week Like No Other – NPR

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