Designing Out Medical Error [DOME] in surgical wards
File(s)
Author(s)
Anderson, Oliver
Type
Thesis
Abstract
Background
One in ten hospital patients are unintentionally harmed by their healthcare management. Healthcare professionals are often blamed for making mistakes that could be prevented if all the factors influencing human performance were addressed by designing the system to be safer.
Hypothesis
This thesis is part of the Designing Out Medical Error (DOME) project, which tested the hypothesis that a multidisciplinary team of designers, clinicians, psychologists and business analysts working collaboratively could design interventions to improve patient safety in surgical wards.
Methods & Results
We used a combination of observational techniques including Healthcare Failure Mode and Effects Analysis to proactively assess risk in surgical wards. We focused on five high-risk processes: hand hygiene, isolation of healthcare-associated infection, vital signs monitoring, handover communication and medication delivery. Patients and healthcare professionals were involved at every stage and helped co-design a suite of concepts to address risk in these processes. We progressed two prototypes: the Respiratory Rate Recorder and the CareCentre® (a bedside work table containing equipment including alcohol hand-rub) to simulated and clinical trials. The trials demonstrated that the accuracy of manual respiratory rate measurement and the adherence of healthcare workers to hand hygiene guidelines was significantly improved respectively, thus supporting the hypothesis.
Conclusion
Multidisciplinary collaborations that engage with the teams, processes and equipment of the healthcare system can co-design safer interventions. Better design can influence behaviour and improve the performance of healthcare professionals. The DOME project demonstrates a successful method for others to follow.
One in ten hospital patients are unintentionally harmed by their healthcare management. Healthcare professionals are often blamed for making mistakes that could be prevented if all the factors influencing human performance were addressed by designing the system to be safer.
Hypothesis
This thesis is part of the Designing Out Medical Error (DOME) project, which tested the hypothesis that a multidisciplinary team of designers, clinicians, psychologists and business analysts working collaboratively could design interventions to improve patient safety in surgical wards.
Methods & Results
We used a combination of observational techniques including Healthcare Failure Mode and Effects Analysis to proactively assess risk in surgical wards. We focused on five high-risk processes: hand hygiene, isolation of healthcare-associated infection, vital signs monitoring, handover communication and medication delivery. Patients and healthcare professionals were involved at every stage and helped co-design a suite of concepts to address risk in these processes. We progressed two prototypes: the Respiratory Rate Recorder and the CareCentre® (a bedside work table containing equipment including alcohol hand-rub) to simulated and clinical trials. The trials demonstrated that the accuracy of manual respiratory rate measurement and the adherence of healthcare workers to hand hygiene guidelines was significantly improved respectively, thus supporting the hypothesis.
Conclusion
Multidisciplinary collaborations that engage with the teams, processes and equipment of the healthcare system can co-design safer interventions. Better design can influence behaviour and improve the performance of healthcare professionals. The DOME project demonstrates a successful method for others to follow.
Version
Open Access
Date Issued
2015-09
Date Awarded
2015-11
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Hanna, George
Vincent, Charles
Sponsor
Engineering and Physical Sciences Research Council
Grant Number
EP/F064802/1
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)