Future Anaesthesia Care
This is the result of my first term project of the masters. It is a communication system for hospitals and target the anaesthesia teams. The project is made in collaboration with Getinge that are specialists in ventilation and anaesthesia machines. The over all aim with this project was to design for professional use and to create a better work environment for the anaesthesia nurses in particular.
This project is set up as a classical interaction design project where we conducted interviews, observations, field and desktop research and co-creations. Followed by analysing our insights to find out the challenges the nurses face. We've been working in a human centered way and in close contact with the nurses throughout the project.
Screen inside operation room.
The communication system consists of three parts: one screen in the operation room, one personal device for the doctors and an earpiece. Enabling the team to use the interface in an hands free manner. Through the operation room system the user can share visual data about the patients status whilst simultaneously attend the patient. The external doctor receiving the call can then quickly judge if her presence is required or not.
What is anaesthesia?
Anaesthesia is the state of temporary loss of awareness. It includes paralysis, unconsciousness, and pain relief. During a surgery there is an anaesthesia nurse/doctor that is putting the patient to sleep and provides the patient with drugs for pain and paralysis. Putting a patient to sleep and waking them up are two very critical moments during an operation and can create a lot of stress for the nurses. If it is done wrong or something unexpected happens it can result in brain damages or suffocation.
Today’s work flow in establish contact
In a operation room today there is a lot of important communication in-between colleagues inside the operation room and outside. This is necessary for good teamwork and patient safety. But the system for contacting someone outside of the operation room is not designed for the medical context. Today phones and pagers are used which can easily be misplaced.
Often in Sweden the anaesthesia nurse needs to call the anaesthesiologist for advise or to receive authorisation for certain procedures. The anaesthesiologist takes care of multiple patients simultaneously and doesn't always have time to call back right away. In critical moments this can be crucial.
“If the anaesthesiologist is in an other operation, I need to wait for him to call back. During that time I try to phrase what to say, background and question, so that I can communicate as efficiently as possible.”
-Nils, anaesthesia nurse
"In the United States and Sweden anaesthesiologists take care of several patients at the same time. It’s because there is a lack of experienced anaesthesiologists."
"I write the number down on my scrubs to always have it."
-Nils, anaesthesia nurse
Understanding our persona
The most important person for our persona is the patient. Everything they do is to give the patient the best experience that they could possibly have. The majority of the work for a anaesthesia nurse happens in the beginning and the end of the surgery. During a operation it can be very calm, just observing and then suddenly a stressful moment and then it is important for the nurses to be able to go from a passive, observing mode to action instantly.
and design opportunities
As the flow chart above visualises there are many moments that can create bottlenecks in the information being communicated. The system used today is outdated and unreliable. We wanted to change this and create a more efficient system so that the nurses can have more time for the patients.
During operations the patients is connected to a anaesthesia machine and monitors that measure vitals such as blood pressure and blood oxygen level. This information is important to be able to judge the situation correctly. Today this is only communicated by voice and because of that information can easily get lost.
There is no way to communicate the urgency level in a situation when calling for help or advice. There is only the normal phone call/page to a specific person or the emergency call for everyone to go to the operation room. To be able to communicate the urgency level is something that is important for the doctor to be able to prioritise the different situations.
How might we communicate more efficiently and with Additional layer of information?
In operation room communication
The communication device inside the operation room is specific for the room and contains information about who to call in case of need or emergency. The speed dial calls are adapting to the patient and the type of operation.
Overview key screens
The Interface in detail
Set urgency level already at the start
When making a call the caller sets the urgency level before so that the receiver already from the start knows if she needs to answer or if another situation is more important. Because of the importance of efficiency we chose to have three actions on the physical button, urgency level, contacts and call. In one simple movement you can do all of these three actions.
Voice recognition to highlight keywords
The system is using voice recognition during the call to pick up keywords and suggest actions on what's being said. The users on both ends can then chose to act on it or not.
Instant information sharing
During the call the team can chose to share the information that is picked up by the system. It can be different vitals, medicines or amount of blood. It will then be visible for both the sender and receiver in both devices to keep track on the call.
Keep track on what to do next
If the caller wants to save their own information that's also possible. By moving the bubble to the right it is saved to act on later. Actions can for example be order more medicine or change the amount.
Improvements of future workflow
The old and future workflow.
Benefits with our concept
Always at the same spot
Focus at the patient at the same time as getting advice
Smart hacks and critical work flow
We got the opportunity to attend several surgeries. We where in the operation room for sometimes up to 5 h which allowed us to get a good understanding of the work flow, critical moments, smart hacks and social connections. But also how the nurses think of their profession and how much they care for and value the patient. The anaesthesia nurse is the last person the patient sees before the surgery and the first they see when they wake up, therefore the nurse has a big and important role in calming the patients down as much as they can before the surgery.
Interviews and probes
During interviews with the nurses we used probes to achieve deeper knowledge of the work environment and to challenge our own pre assumptions. The picture shows a nurse mapping out his mental stress level during a surgery.
We where surprised by his response about what moments are important and why. For example the most stressful situation is not during the most critical moment of performing anaesthesia but instead after, when the surgeon is starting to cut and it's getting obvious if the anaesthesia is working or not.
Role play and one shot videos
We used ideation methods such as role play and one shot videos through out the entire project. This was especially effective for communicating our personal experiences with eachother in the group but also to others. By doing a one shot video and acting out our scenarios we communicated what we wanted to say in a condensed and graspable way. We also remembered details about our observations that we wouldn't have by only talking about it. such as where the phone got lost and that the wrong number was called some times.
During the research phase we held a research workshop with representatives from Getinge, where we summarised all the insights we got so far and gathered deeper information and experiences of each area we found. We asked questions like: what is this for you and what if it was different and asked the participants to brainstorm new scenarios based on the information we presented.
From this we found out that good communication is key to reduce the stress in many of the most stressful and critical situations. This is an area that Getinge aren't yet developing but we see as an opportunity for them in the future.
Call for efficiency
During the process we produced many prototypes to explore how they fit into the users daily life. We had conversations and tested the different concepts we had with the nurses. We wanted to make the flow as efficient and usable as possible to handle in critical moments. The most important features like "speed call" and "urgency level" should be the fastest ones to get to.
We found out that starting to send a voice recording while waiting for the other person to pick up was not something that was perceived as faster and would only create more stress, even though in theory it would be the fastest way of establish communication.
"It’s important to be on the same page and agree on the same actions during communication."
User testing workshop with nurses
We tested the final concept in a workshop setting together with the nurses we've been working with throughout the project. We divided the concept in three parts that we tested: the urgency level with sound and amount of levels, the voice recognition system and where to place the device.
During this project I learned how important it can be to take decisions at the right time. A non-decision is also a decision and by making that you decide to not decide which takes time and that you need to deal with eventually.
This was a super interesting project to go deep into but no matter how much time you have there is not enough to learned every little detail. The challenge then is to decide where to put the focus and not open up again after closing unless it is necessary. This was the hardest part for us in this project but that I think we managed to make in a good way.