Speaker Presentation from U.S. News Healthcare of Tomorrow leadership summit, November 2-4, 2016 in Washington, DC. Find out more about this forum at www.usnewshot.com.

1. © The Johns Hopkins University and The Johns
Hopkins Health System Corporation, 2011
© The Johns Hopkins University and The Johns
Hopkins Health System Corporation, 2011
Project Emerge: Systems Engineering the ICU
Adam Sapirstein
Armstrong Institute for Patient Safety and Quality
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A Collaboration of The Armstrong Institute – Applied
Physics Lab of The Johns Hopkins University & The
Gordon & Betty Moore Foundation

2. The ICU – a Microcosm of Challenges in
Medicine
• High Technology
• High Costs ~ 1 % of GDP
• Increasing Complexity and Burden of Illness
• High Rate of Errors and Complications
• Provider Stress
• Family Stress
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3. Does ICU Care Require a Mr. Spock?
“...[People] seem to assume that we are like
Star Trek’s hyperrational Mr. Spock. [That we ]
…can compute everything, compare all options,
and always choose the best and most
appropriate course of action.
But what if …we are limited in the way we use
and understand information? What if we are
more like…Homer Simpson..?”
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The Upside of Irrationality – Dan Ariely

4. Emerge 7 Harms and Problem
Statement
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5. Is this the “As Is” of the ICU?
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6. Systems Approaches Align People,
Processes, and Technology
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7. Emerge: Engineering Solutions from
Need to Deployment
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8. Emerge: Care Team Portal
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9. Emerge: Condition Specific Display-
VAE
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10. Emerge: The Patient Family Portal
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11. Engineered Systems: From
Awareness to Control
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12. Concept of Operations
Operational View

13. Armstrong Institute for Patient Safety and Quality
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14. Model System
Armstrong Institute for Patient Safety and Quality

15. Hypothesis
• A Systems Engineering Approach Can
Improve Quality, Safety, and Efficiency of
Patient Care in the ICU
– Primary Outcome: Establish an Integrated
Clinical System
– Secondary Outcome: Improve Care through
Targeted Reduction in Harms to Patients
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16. Transformative Healthcare Delivery
Model – Systems Approach to a Harm
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DVT
VAP
Sepsis
VAP DVT Sepsis …
Patient, Family,
Society Value
Patient Risk
Implementation
Science
Human Factors
Engineering
Systems
Integration
Learning/
Accountability
VAP
Patient, Family,
Society Value
Views of “life support”, recovery and
rehabilitation; place VAP in context of overall
condition
Patient Risk Intubated, mechanically ventilated
Implementation
Science
Standardization e.g. oral care, ETT suction, SBT,
HOB, Subglottic suction
Human Factors
Engineering
Identify performance barriers, improve
interaction efficiency with patient, electronic
records etc
Systems Integration
Synthesizes diagnostic (lab, radiology), with
state (intubated, sputum) data; Creates
diagnosis, predicts risk; Assess implementation.
Learning/
Accountability
Measures outcomes, identify defects, provide
feedback to all provider levels
VAP = Ventilator Acquired Pneumonia
DVT = Deep Vein Thrombosis

17. Notional System Architecture
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