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Medical Gas Booms vs. Traditional
Headwalls
James A.Thomas, M.D., Associate Professor, UT Southwestern Medical Center
Deba...
• What is optimal for patient care?
• What are the differences between caregivers’ needsg
and wants?
• Is there a safety c...
Learning Objectives
• Identify what clinicians prefer between medical gas
booms and headwalls.
A hi h f id h d idi• Assess...
Acknowledgments
• Study participants, Children’s Medical Center of Dallas
• Getinge USA Inc for partial funding support• G...
Agenda
• Why the question
• Study methodology
• Assessment framework
• Definitions
• Caregivers preferences
• Family consi...
Why the Question
• Current drivers of
decision-making
• Problem definition
– Arbitrary decision-
ki– Early technology
adop...
Study Methodology
• Objectives
– Assess the relative
impacts of headwalls
• Simulation scenarios
– Admission
I t b tiimpac...
Methodology Cont.
• Hospital:
– Children’s Medical
Center of DallasCenter of Dallas
– 66-bed ICU has both
headwalls and ce...
Methodology Cont.
• Participants:
– 2 physicians
2 titi– 2 nurse practitioners
– 2 respiratory therapists
– 4 ICU nurses
•...
Assessment Framework
• Physical Elements
– Intravenous tubing
El t i l d
• Performance
Dimensions
Fl ibilit– Electrical co...
Flexibility
• Definition
– Conceptual definition
i h
• Measure
– Bed positioning
• Distance the bed could be moved
• Respo...
Ergonomics
• Definition
– Conceptual
M i i d ti it b
• Measure
– In a particular scenario, count measure
of the number of ...
Teamwork
• Definition
– Conceptual definition:
• Cooperation between those
• Measure
– In a particular scenario, count
mea...
Clinician’s Preference
2008 International Conference and Exhibition on
Planning, Design and Construction™
What Booms Change
• Booms reduce the area of restricted access• Booms reduce the area of restricted access
to the patient ...
Wh t B ChWhat Booms Change
• Booms mobilize area of access restriction
(Concept #2)
Restricted Head/Neck
A
Unrestricted He...
Physician
Flexibility Ergonomics Teamwork Comments
IV Tubing
El t i l Boom (+) in Boom (+) in Boom (+) in Majority of powe...
Nurse Practitioner
Flexibility Ergonomics Teamwork Comments
biIV Tubing
Electrical
Cords
Boom (+) in
situations needing
ac...
ICU Nurse
Flexibility Ergonomics Teamwork Commentsy g
IV Tubing Headwall & Boom:
Separate work spaces
for RN and RTs
possi...
Respiratory Therapist
Flexibility Ergonomics Teamwork Commentsy g
IV Tubing Headwall & Boom:
Separate work spaces
for RN a...
Med Gas Tubing andMed Gas Tubing and
Electrical Cords
Management
2008 International Conference and Exhibition on
Planning,...
TeamworkTeamwork
2008 International Conference and Exhibition on
Planning, Design and Construction™
Flexibility: BedFlexibility: Bed
placement;
Equipment
2008 International Conference and Exhibition on
Planning, Design and...
Ergonomics
2008 International Conference and Exhibition on
Planning, Design and Construction™
Clinician’s Comments
• Physicians:
– prefer the boom
• Nurse Practitioners:
P f h d ll d t i t d di t bilit– Prefer headwa...
Family Considerations
• Patient visibility
– In life threatening situations it
is secondary to clinicians’
• Access to pat...
Parent Circulation
Sightline to PatientSightline to Patient
Access to Patient
2008 International Conference and Exhibition...
When to invest in Booms
• Anticipated level of acuity
– Frequency of ECMO, High
Frequency Ventilator, Nitric
• Anticipated...
Some considerations
• Progressing reduction in invasiveness -
means more surgery in patient rooms.
• How important is care...
Shortcomings
• Small sample
– One simulation of each scenario, with
– Same subjects
• Day-to-day care delivery not include...
Further Studies
• Multiple sites and larger sample to
enhance generalizability
• Inclusion of medical gas columns
• Examin...
Further Studies
• Association between ceiling booms and
adverse events (patient safety)
• Day-to-day care; bed repositioni...
Questions
2008 International Conference and Exhibition on
Planning, Design and Construction™
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PDC_2008_Headwall Boom Study

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PDC_2008_Headwall Boom Study

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PDC_2008_Headwall Boom Study

  1. 1. Medical Gas Booms vs. Traditional Headwalls James A.Thomas, M.D., Associate Professor, UT Southwestern Medical Center Debayjoti Pati, PhD, AIIA, Director of Research, HKS Architects Jennie Evans, RN, BS, Director of Clinical Operations, HKS Architects 2008 International Conference and Exhibition on Planning, Design and Construction™
  2. 2. • What is optimal for patient care? • What are the differences between caregivers’ needsg and wants? • Is there a safety component in the choice of medical gas delivery systems? 2008 International Conference and Exhibition on Planning, Design and Construction™
  3. 3. Learning Objectives • Identify what clinicians prefer between medical gas booms and headwalls. A hi h f id h d idi• Assess which factors to consider when deciding between the medical gas options. • Discuss the family considerations as it relates to the• Discuss the family considerations as it relates to the provision of the medical gas booms vs headwalls while in the ICU. 2008 International Conference and Exhibition on Planning, Design and Construction™
  4. 4. Acknowledgments • Study participants, Children’s Medical Center of Dallas • Getinge USA Inc for partial funding support• Getinge USA, Inc. for partial funding support 2008 International Conference and Exhibition on Planning, Design and Construction™
  5. 5. Agenda • Why the question • Study methodology • Assessment framework • Definitions • Caregivers preferences • Family considerations h i i b• When to invest in booms • Future directions 2008 International Conference and Exhibition on Planning, Design and Construction™
  6. 6. Why the Question • Current drivers of decision-making • Problem definition – Arbitrary decision- ki– Early technology adoption – Peer competition making – Absence of empirical data to support orPeer competition – Perceived efficiency – Perceived safety data to suppo t o refute contentions y 2008 International Conference and Exhibition on Planning, Design and Construction™
  7. 7. Study Methodology • Objectives – Assess the relative impacts of headwalls • Simulation scenarios – Admission I t b tiimpacts of headwalls and ceiling booms • Study Design – Intubation – Surgery – Code – Simulation runs of real life situations – ECMO 2008 International Conference and Exhibition on Planning, Design and Construction™
  8. 8. Methodology Cont. • Hospital: – Children’s Medical Center of DallasCenter of Dallas – 66-bed ICU has both headwalls and ceiling bbooms • Setting 1 ICU room with ceiling– 1 ICU room with ceiling boom – Headwall mock-up 2008 International Conference and Exhibition on Planning, Design and Construction™
  9. 9. Methodology Cont. • Participants: – 2 physicians 2 titi– 2 nurse practitioners – 2 respiratory therapists – 4 ICU nurses • Patient: – 1 pediatric manikin • Data: – Video recording; Notes 2008 International Conference and Exhibition on Planning, Design and Construction™
  10. 10. Assessment Framework • Physical Elements – Intravenous tubing El t i l d • Performance Dimensions Fl ibilit– Electrical cord – Medical gas tubing – Equipment – Flexibility – Ergonomics – Teamworkq p 2008 International Conference and Exhibition on Planning, Design and Construction™
  11. 11. Flexibility • Definition – Conceptual definition i h • Measure – Bed positioning • Distance the bed could be moved • Responsive to change; adaptable – Operational definition from the wall • Maximum turn angle achievable in relation to original position – Equipment • The ability to offer optimum layout of bed, caregivers and equipment for various levels of Equipment • # of equipment pieces affecting circulation in a particular scenario – Caregiverfor various levels of acuity and procedures Caregiver • # of caregivers accommodated in a scenario, without affecting circulation + patient access by caregivers and mobile equipment 2008 International Conference and Exhibition on Planning, Design and Construction™ g q p
  12. 12. Ergonomics • Definition – Conceptual M i i d ti it b • Measure – In a particular scenario, count measure of the number of times the following are obser ed in iolation of the criteria• Maximize productivity by reducing operator fatigue and discomfort – Operational are observed in violation of the criteria outlined in the operational definition: bending, stretching, reaching • The ability of caregiver to move about the space and attend to all tasks void of reaching greater than 70” AFF, reaching lower than 24” AFF reaching greaterthan 24 AFF, reaching greater than 30” from center of gravity and twisting of the spine. 2008 International Conference and Exhibition on Planning, Design and Construction™
  13. 13. Teamwork • Definition – Conceptual definition: • Cooperation between those • Measure – In a particular scenario, count measure of the number of time th f ll i h h t p who are working together on a task – Operational definition: the following happens when at least 2 clinicians are working together: • Losing time I i t f t l t f • Ability to work together, by virtue of the layout vis-à-vis patient bed, in an orderly, comfortable and safe • Inappropriate space for at least one of the clinicians • Inappropriate adjacency for at least one pair of the clinicians • Unsafe body mechanics for at least f th li i imanner, void of any time delays in accessing crucial services within the patient room. one of the clinicians 2008 International Conference and Exhibition on Planning, Design and Construction™
  14. 14. Clinician’s Preference 2008 International Conference and Exhibition on Planning, Design and Construction™
  15. 15. What Booms Change • Booms reduce the area of restricted access• Booms reduce the area of restricted access to the patient (Concept #1) Headwall Boom Boom or headwall Patient access area Bed 2008 International Conference and Exhibition on Planning, Design and Construction™ Area of restricted access
  16. 16. Wh t B ChWhat Booms Change • Booms mobilize area of access restriction (Concept #2) Restricted Head/Neck A Unrestricted Head/Neck AAccess Access Boom or headwall Patient access area Bed 2008 International Conference and Exhibition on Planning, Design and Construction™ Area of restricted access
  17. 17. Physician Flexibility Ergonomics Teamwork Comments IV Tubing El t i l Boom (+) in Boom (+) in Boom (+) in Majority of powerElectrical Cords Boom (+) in situations needing access to head of bed Headwall (-) Boom (+) in situations needing access to head of bed Headwall (-) Boom (+) in situations needing access to head of bed Headwall (-) Majority of power outlets are on the boom Medical Boom (+) in situations needing Boom (+) in situations needing Boom (+) in situations needing Could be addressed with gases on one Gases situations needing access to head of bed Headwall (-) situations needing access to head of bed Headwall (-) situations needing access to head of bed Headwall (-) with gases on one side of bed in headwalls Equipment 2008 International Conference and Exhibition on Planning, Design and Construction™
  18. 18. Nurse Practitioner Flexibility Ergonomics Teamwork Comments biIV Tubing Electrical Cords Boom (+) in situations needing access to head of bed Headwall (-) Boom (+) in situations needing access to head of bed Headwall (-) Boom (+) in situations needing access to head of bed Headwall (-) Majority of power outlets are on the boom Headwall ( ) Headwall ( ) Headwall ( ) Medical Gases Boom (+) in situations needing access to head of bed Headwall (-) Boom (+) in situations needing access to head of bed Headwall (-) Boom (+) in situations needing access to head of bed Headwall (-) Could be addressed with gases on one side of bed in headwalls Equipment 2008 International Conference and Exhibition on Planning, Design and Construction™
  19. 19. ICU Nurse Flexibility Ergonomics Teamwork Commentsy g IV Tubing Headwall & Boom: Separate work spaces for RN and RTs possible * *Boom design dependent Electrical Cords Headwall: adequate Boom: Less bending (+) Caveat: power outlets need to be ergonomically located at multiple locations Medical Gases Boom: conflict in some situations (-) Headwall: design dependent Boom: Less reaching (+) Headwall: Ergonomically challenging Boom: conflict in some situations(-) Headwall: design dependent Equipment Boom: allows more options in locating equipment permitting better circulation (+) Boom: allows more options in locating equipment permitting better circulation (+) 2008 International Conference and Exhibition on Planning, Design and Construction™
  20. 20. Respiratory Therapist Flexibility Ergonomics Teamwork Commentsy g IV Tubing Headwall & Boom: Separate work spaces for RN and RTs possible * *Boom design dependent Electrical Cords Headwall: adequate Boom: Less bending (+) Caveat: power outlets need to be ergonomically located at multiple locations Medical Gases Boom: conflict in situations needing suction (-) Headwall: design dependent Boom: Less reaching (+) Headwall: Ergonomically challenging Boom: conflict in situations needing suction (-) Headwall: design dependent Equipment Boom: allows more options in locating equipment permitting better circulation (+) Boom: allows more options in locating equipment permitting better circulation (+) 2008 International Conference and Exhibition on Planning, Design and Construction™
  21. 21. Med Gas Tubing andMed Gas Tubing and Electrical Cords Management 2008 International Conference and Exhibition on Planning, Design and Construction™
  22. 22. TeamworkTeamwork 2008 International Conference and Exhibition on Planning, Design and Construction™
  23. 23. Flexibility: BedFlexibility: Bed placement; Equipment 2008 International Conference and Exhibition on Planning, Design and Construction™
  24. 24. Ergonomics 2008 International Conference and Exhibition on Planning, Design and Construction™
  25. 25. Clinician’s Comments • Physicians: – prefer the boom • Nurse Practitioners: P f h d ll d t i t d di t bilit– Prefer headwall due to consistency and predictability of equipment location across all patient rooms – Perceive the benefit of boom over headwall as ‘low impact’ in high acuity scenarios ICU N• ICU Nurses: – Prefer booms, because it is movable and all the gases come off from one central place. Reduces figuring out which gas is plugged in where and less tripping over cables and connectionsover cables and connections. • Respiratory Therapists: – Prefer booms owing to ergonomic advantages and flexibility in equipment location 2008 International Conference and Exhibition on Planning, Design and Construction™
  26. 26. Family Considerations • Patient visibility – In life threatening situations it is secondary to clinicians’ • Access to patient – In life threatening situations it is secondary to clinicians’ needs. – In lesser acuity situations no difference in visibility Ci l i i / f needs. – In lesser acuity situations no difference in visibility Wh th hild i t bili d• Circulation in/out of room – Patient population and acuity affects family circulation in and out of the room – When the child is stabilized a pathway could be made in either scenario for parents to access their children and out of the room – Not significantly affected by headwall vs boom 2008 International Conference and Exhibition on Planning, Design and Construction™
  27. 27. Parent Circulation Sightline to PatientSightline to Patient Access to Patient 2008 International Conference and Exhibition on Planning, Design and Construction™
  28. 28. When to invest in Booms • Anticipated level of acuity – Frequency of ECMO, High Frequency Ventilator, Nitric • Anticipated head access frequency – Frequency of 1) Intubation, 2) Oxide ventilator, and Intracranial Pressure Monitoring A ti i t d i l q y ) ) Cervical spine precautions and care, and 3) EEG monitoring i i d b d• Anticipated surgical procedures – Planned surgical procedures in the patient room • Anticipated budget – budget limited, but encounter some or all of the critical scenarios listed in this slidein the patient room scenarios listed in this slide 2008 International Conference and Exhibition on Planning, Design and Construction™
  29. 29. Some considerations • Progressing reduction in invasiveness - means more surgery in patient rooms. • How important is caregivers’ perception of flexibility?y 2008 International Conference and Exhibition on Planning, Design and Construction™
  30. 30. Shortcomings • Small sample – One simulation of each scenario, with – Same subjects • Day-to-day care delivery not includedy y y • Generalizability: – Decision matrix could be generalized– Decision matrix could be generalized – Adult bed used to expand inferences to adult ICUs 2008 International Conference and Exhibition on Planning, Design and Construction™ ICUs
  31. 31. Further Studies • Multiple sites and larger sample to enhance generalizability • Inclusion of medical gas columns • Examine headwalls with sufficient number• Examine headwalls with sufficient number of duplicate medical gases 2008 International Conference and Exhibition on Planning, Design and Construction™
  32. 32. Further Studies • Association between ceiling booms and adverse events (patient safety) • Day-to-day care; bed repositioning; impact of view 2008 International Conference and Exhibition on Planning, Design and Construction™
  33. 33. Questions 2008 International Conference and Exhibition on Planning, Design and Construction™

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