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How Four Master’s Students Used Design to Help One Haiti Emergency Room – The Bentley University Newsroom

Imagine walking into a crowded emergency room and having your symptoms recorded electronically, in order to minimize wait time and maximize care. That efficient scenario a dream of hospitals everywhere is newly underway at a hospital in Haiti.

In 2015, Boston, Mass.-based Partners in Health (PIH), which runs University Hospital in Mirebalais, Haiti, set out to develop an electronic triage system to replace its paper-based process.Their strategy was to expand on OpenMRS, the open-source medical record system implemented there. But this being relatively new territory for the PIH team, they sought additional experts to get the job done.

Tapping into a Learning Community

Enter Bill Gribbons, a leading authority on user experience who directs the Masters in Human Factors in Information Design (HFID) at Bentley University. PIH contacted Gribbons, who then reached out to his extensive network he calls it a learning community and received a flood of interest. He recruited another faculty expert, Roland Hubscher, to help advise a team, and four part-time graduate students eager for hands-on experience and excited to make a difference. All were willing to work on the project remotely, for no pay and no course credit.

I firmly believe some of the most meaningful learning happens outside the confines of a traditional classroom, said Gribbons. This type of project, one that requires in-depth involvement and makes an immediate impact on a product, is invaluable for students particularly for graduate students, who are looking to grow their careers and stand out in a crowded marketplace.

The HFID students were located in different cities and time zones and came from different professional backgrounds. Kim Forthofer, the team lead, was in Southwest Harbor, Maine, Mary Gribbons in Cambridge, Mass.; Truc Tokarz in San Jose, Calif.; and Dan Lopes in Toronto, Ontario. Though they were not able to work on site in Haiti, they used Google Hangouts to meet as a group on Wednesday evenings to stay on track.

We looked to Bentley because we knew that their graduate students would be accountable for their work and thoughtfully execute this project, said David DeSimone, business analyst at PIH. The students did not disappoint. They asked all the right questions and delivered a product that was immediately well received.

Designing a Product that Makes a Difference

Designing an electronic emergency intake form, from a remote location, is no easy task. The requirements were that the form permit easy scanning by a nurse and visually signal the urgency of a patients medical needs. To begin, University Hospital sent its typical paper intake forms to the Bentley team for analysis. This system, which ranked patients with a numerical score and a color based on severity, left plenty of room for mathematical error.

In addition to the technical parameters, cultural considerations were also essential. One of the biggest challenges for the team was coming up with a user-friendly design for a population that has limited access to computers, said DeSimone. Their initial designs used a keyboard only, with no mouse. But by the time we implemented the technology, we were able to train the nurses on Google Chromebooks.

A significant part of the design process involved user surveys and user testing. Due to the distance and lack of readily available technology, the Bentley team designed static mockups and used a cognitive walkthrough exercise where they asked nurses to role-play a patient-intake scenario.

This helped us better understand the human thought process behind the products use, said Forthofer. We knew it was possible that lives could depend on nurses understanding the new app as quickly as possible.

Life-Changing Experience

Despite the lack of credit or pay, the experience of acting as consultants had enormous value for the team. They improved the hospital experience for patients in Haiti, while also building their own skills and putting them into practice.

The project was much more like a real consulting gig instead of a realistic project done over a semester and graded by a professor. This provided us with real-world pressure as well as real-world confidence and experience, said Forthofer, who also gained reinforcement that she is in the right career, for the right reasons. I began my professional life as an environmental engineer and user experience is a second career for me, so challenges related to technical and scientific areas are the ones I continue to be drawn to.

This venture is a first for Partners in Health, in terms of developing a product that triages patients electronically in real time. They hope the intake form will be replicated at other facilities in Haiti and elsewhere. Anecdotally, they know that emergency room waiting times are lower and, more important, that prioritization has improved so the most critical patients are seen first. PIH has plans to gather data on the products effectiveness, but in the meantime, patients are getting better care and nurses and doctors are better able to do their jobs – a winning prescription all around.

Dedicatedto Preparing a New Kind of Business Leader

Bentley Universityis one of the nations leading business schools, dedicated to preparing a new kind of business leader with the technical skills, global perspective and ethical standards required to make a difference in an ever-changing world. Bentleys diverse arts and sciences program combined with an advanced business curriculum prepares graduates to make an impact in their chosen fields. The university enrolls approximately 4,000 undergraduate and 1,000 graduate students. ThePrinceton Reviewranked Bentley #1 in the United States in both career services and internships andBloomberg BusinessWeekranked Bentley a top 10 undergraduate business school.

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HB and Costa Mesa account for more than 1200 opioid-related ER visits in 4-year period in OC study – Los Angeles Times

Emergency room visits stemming from opioid use increased by 141% in Orange County from 2005 to 2015, with large numbers of patients coming from Huntington Beach, Costa Mesa, Anaheim and Santa Ana, according to a study released this week by the Orange County Health Care Agency.

More recently, between 2011 and 2015, 7,457 Orange County residents went to an emergency room for treatment of opioid addiction or overdose, according to the report.

Anaheim residents with 782 cases sought ER help most often during that four-year period. Huntington Beach, with 726 cases, was a close second. Santa Ana had the third-most cases with 631, and Costa Mesa was fourth with 559, according to the data.

According to the U.S. Food and Drug Administration, opioids are powerful pain-reducing drugs that include prescription oxycodone, hydrocodone and morphine, among others.

These medications can help manage pain when prescribed for the right condition and when used properly. But when misused or abused, they can cause serious harm, including addiction, overdose and death, according to the FDA.

Opioids also include the illegal drug heroin.

In line with national trends, Orange County has seen an increase in drug overdose deaths in the past 15 years, according to the health agency.

Drug overdose deaths involving prescription opioids have quadrupled since 1999, which is alarming, Orange County Board of Supervisors Chairwoman Michelle Steel said in a statement. There must be a community effort of individuals, private and nonprofit organizations and the government to reduce the number of people dying in this completely preventable manner.

Anaheim had 123 opioid-related deaths from 2011 to 2015, the most in the county, according to the study. Huntington Beach had 106, the second-most.

Santa Ana had 91 deaths and Costa Mesa 65, according to the report.

The majority of overdoses were accidental, and more than half the opioid-related deaths stemmed from overdoses of prescription medications. Deaths caused by illicit opioids like heroin accounted for 19% of overdose cases, according to the study.

Residents ages 18 to 34 were most likely to visit an emergency room because of an opioid overdose, the report states.

To review the report, visit bit.ly/2uMVpcM.

hannah.fry@latimes.com

Twitter: @HannahFryTCN

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HB and Costa Mesa account for more than 1200 opioid-related ER visits in 4-year period in OC study – Los Angeles Times

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Is it an urgent medical issue or one for the emergency room? – Pocono Record

Christine Meyer, CRNP, Ask the Doctor

Q: Ive seen lots of advertisements in the community for urgent care/immediate care centers. What is the difference between those and the emergency room, and how do you know which one to go to?

A.:Many of us can relate to these scenarios or ones like them: Its early on a Sunday morning and your 7-year-old daughter comes into your bedroom crying with ear pain. Your pediatricians office is closed. Or, youre walking down the stairs carrying a bundle of laundry when you take a tumble. Now your ankle is really sore when you try to walk on it. In these cases, it may be the perfect opportunity to visit an immediate care or urgent care center rather than the emergency room.

Here are some ways to be sure you should go there instead of seeking a higher level of care in an ER:

When its not a true medical emergency but needs to be treated today

In a study by the Centers for Disease Control, 48 percent of U.S. adults visited the ER because their regular doctors offices werent open. So, judging by the data, it appears as though many patients visit the ER to receive care for minor illnesses or injuries when there are other options options that would free up space in the ER for critically ill patients who truly need the highest level of care.

As a general rule, immediate care or urgent care centers such as Lehigh Valley Health Networks ExpressCARE Centers located throughout Monroe County help bridge the gap when youre unable to see your primary care physician but cant wait for treatment. Just be sure the sudden illness or injury is something you normally would have spoken with your regular doctor about and does not appear to be life-threatening.

Some non-urgent reasons to visit an ExpressCARE include:

Common cold

Allergies

Sinusitis

Cough, sore throat

Ear pain

Bronchitis

Minor fever

Rashes, including poison ivy

Animal bites (rabies vaccine available at Lehigh Valley HospitalPoconos Mattioli Emergency Center)

Minor headache

Back pain

Broken bone without an open wound

Nausea

Common sprain or strains

Shallow laceration

Flu/flu shots.

When its time for the emergency center

On the flip side, emergency centers provide the highest acuity of care around the clock and are equipped with both staffing and services to treat and stabilize patients with even the most serious of injuries. For example, Lehigh Valley HospitalPoconos Mattioli Emergency Center treats numerous medical conditions that are considered true emergencies and require rapid and advanced treatments, such as heart attack and stroke. In addition, LVHPocono is a Level III Trauma Center the only trauma program in Monroe County and has the resources to treat traumatic injuries resulting from car crashes and other serious accidents. Some examples of medical emergencies that need to be treated in an ER include:

Persistent chest pain accompanied by sweating, vomiting or shortness of breath

Heart palpitations

Fainting, balance problems, state of confusion, sudden difficulty in speaking, sudden vision changes or seizures

Weakness on one side of the face or body or sudden, severe headache

Breathing problems

Coughing up blood

Severe pain of any kind

Severe pain the abdomen or starting in the lower portion of the back

Severe burns of any kind

Baby less than three months old with a temperature of 100.4 degrees or higher

High fever or fever with rash

Vaginal bleeding during pregnancy

Broken bones with an open wound or head or eye injuries

Serious falls while on blood thinning medication

Deep lacerations that wont stop bleeding

Persistent, severe vomiting or diarrhea

Suicidal feelings

Sudden pain and swelling of the testicles.

When in doubt, go with your gut

If you, a family member or friend is experiencing a medical issue and youre unsure about how to best seek medical care, trust your instincts. If you feel its warranted, dont hesitate just go to the nearest emergency room. Most importantly, there are some cases when its best to call 911. If you or a loved one is experiencing heart attack or stroke symptoms, severe bleeding, or faintness or dizziness, never attempt to drive to the hospital. Calling 911 can mean the difference between life and death, as emergency medical services providers are equipped to provide life-saving treatment on the way to the hospital.

When to wait to see your regular doctor

In some cases you can wait to see your primary care physician, such as when you begin to experience gradual symptoms of a recurring problem. Many times, its worth it to wait for an appointment with your doctor since they know medical history and the treatments that have been successful in the past.

In all cases, use your best judgment and when in doubt, head to the ER. Life is too precious to leave the health and safety or you and your loved ones to chance.

Christine Meyer, CRNP, is a family nurse practitioner with ExpressCARE, part of Lehigh Valley Health Network, with five locations throughout Monroe County in East Stroudsburg, Bartonsville, Brodheadsville at the West End Health Care Center, Tobyhanna at the Mountain Health Care Center and at the Health Center at Blakeslee.

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