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Improving the Intensive Care Experience: Tablet Apps that Coordinate Data for Clinicians and Empower Patients and Families
Each day in a hospital, intensive care unit (ICU) doctors and nurses undertake complicated daily tasks caring for the critically ill, which include ensuring nearly 200 steps for each patient are performed to reduce preventable harm like blood clots or ventilator-associated pneumonia.
However, the multiple machines and technologies that monitor a patient’s status are not integrated. In order for clinicians to monitor a patient’s progress and ensure the patient is receiving all recommended treatments to prevent harm, the clinician must gather data from many different machines and combine the information to get a full understanding of the patient’s status.
Patients and families also face challenges in the overwhelming ICU environment — seeing a loved one surrounded by complicated equipment, hearing frequent alarms and feeling like they cannot do anything to help.
The Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine set out to redesign the ICU to eliminate the most common causes of preventable harm and to better meet the needs of patients, families and clinicians. Funded by a $9.4 million grant from the Gordon and Betty Moore Foundation, Project Emerge is redesigning the ICU workflow, culture and technology by bringing together 18 disciplines, including clinicians, systems engineers, bioethicists, human factors specialists and patients and their families.
Clinician Tablet App
The foundation of Project Emerge is a tablet application that coordinates and integrates all data from all monitoring equipment and information systems. Rather than scavenge medical records, devices and other sources to ensure patients receive all the appropriate care, clinicians can use the tablet app to quickly see all data in one location.
The tablet app also updates continuously a “harms monitor,” a simple diagram tracking hundreds of tasks for each patient separated into seven sections. The harms monitor tracks which preventative tasks were performed and alerts to situations when patients may be at risk.
Using a simple color chart, the app quickly shows clinicians the status of actions that need to be taken on a regular basis to prevent harm: red for current actions, yellow for upcoming and green for complete.
In June 2014 the Johns Hopkins Hospital’s Surgical Intensive Care Unit began piloting the clinician app. As the tablet app is refined, the Project Emerge team plans to implement the technology in additional ICUs starting with the Johns Hopkins Bayview Medical Center and the University of California, San Francisco Medical Center.
Patient and Family Tablet App
Project Emerge also aims to create an ICU environment for patients and families that is a less intimidating experience. The team developed an app specifically for patients and families available on a tablet right at the bedside. This technology empowers patients and families to ask questions directly to the medical care team, provide details about their care goals and learn more about each of the machines and monitors in the ICU room.
The app also includes a family involvement menu, where loved ones can select from 10 daily care activities they wish to assist the clinical staff with, such as brushing teeth or washing their family member’s hair. Families can also upload photos and list the patient’s favorite music and television programs to help staff know each patient on a personal level.
A pilot launch of the patient and family involvement tablet app began in the Weinberg Surgical Intensive Care Unit at The Johns Hopkins Hospital.
The Society of Critical Care Medicine awarded the concept of the family involvement menu with the Family-Centered Care Innovation Award at the 43rd Critical Care Congress in January 2014. The award recognizes novel, effective methods for providing care to critically ill and injured patients and their families.
In The News
- "Microsoft, Johns Hopkins Team to Make ICU Devices Communicate" (Med Device Online)
- "Meet the cancer patient in Room 52: His name is Joseph, but call him Joe" (The Washington Post)
- “Intensive Care Gets Friendlier with Apps, Devices” (The Wall Street Journal)
- “Ambitious Checklist App Comes as Hospitals Struggle with Basic Checklist” (Modern Healthcare)
- “Ensuring Respect and Dignity in the ICU” (Medical Xpress)
- "Improving Patient and Family Engagement in the Hospital Room" (The Huffington Post)