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February 19, 2014

Improving Patient Safety with New Technologies

Alan Ravitz with nurse Rhonda Wyskiel
APL researcher Alan Ravitz and Johns Hopkins Medicine ICU nurse Rhonda Wyskiel, showing a clock she drew to illustrate her idea for a timer that would indicate when a patient should receive a particular therapy. Her design was incorporated into the tablet-based Project Emerge system.
Credit: Johns Hopkins Medicine

Two prototype technologies—designed by Johns Hopkins Medicine clinicians, patient and family advocates, and APL engineers—are being tested at Johns Hopkins University medical facilities, both aimed at improving patient safety and the standard of care.

In November 2013, Johns Hopkins researchers tested a new interface designed to improve the usability of large-volume medication infusion pumps. These devices are among the most widely used technologies in health care today, but infusion errors and pump failures have harmed or even killed patients. In 2011, APL and Johns Hopkins Medicine received a $1 million grant from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality to improve the safety of the devices.

“After consulting with pharmacists, nurses, physicians, anesthesiologists, engineers, patient-safety analysts, and human-factors experts, we zeroed in on the human–machine interface,” explains Alan Ravitz, of the Research and Exploratory Development Department. “Health care workers were often adapting their workflow to the designs of the infusion pump, as opposed to having the machines designed to their needs.”

This, he says, was largely due to the limited human systems factors engineering in the design of infusion pumps, as well as limited preproduction usability testing.

Ravitz and his team, including health care workers at Johns Hopkins Hospital and the Hopkins Armstrong Institute for Patient Safety and Quality, developed a tablet computer interface. The simulation testing took place at the Mount Washington Pediatric Hospital in Baltimore—an annex of Hopkins Medicine—and involved 40 intensive care unit nurses. “We are still analyzing the results, but the early reviews from the nurses were positive,” Ravitz says. “We think we are on the right track.”

The initial grant wraps up in April, but Ravitz says the team’s next steps are to publish its findings and transition its work into software that others can use.

A custom-made tablet computer is at the heart of another prototype designed as part of a larger effort to improve patient care. In 2012, APL and the Armstrong Institute teamed up on Project Emerge, an $8.9-million effort—funded by the Palo Alto, Calif.-based Gordon and Betty Moore Foundation—to design and deploy integrated tools and techniques to reduce medical errors in intensive care units.

Studies show that at least one in every five of the estimated four million patients treated in intensive care units each year is harmed during their hospital stay, largely because the medical devices commonly used in ICUs—infusion pumps, ventilator systems, defibrillators, electrocardiogram analyzers—are not integrated or interoperable. “The result,” says Ravitz, “is a set of life-critical systems that do not share data or functionality across the health care enterprise.”

The team developed software that coordinates and integrates the data and information about each ICU patient. Using a tablet to access this information, health care workers can determine a patient’s risk for preventable harms—such as delirium, ventilator-associated infections like pneumonia, bloodstream infections, or deep vein thrombosis—and receive recommendations on how to reduce the risk of a particular harm. Embedded alarms alert staff members to danger and remind them to perform certain tasks.

Patients, as well as their family members, would receive the tablet, which also provides information on how to be involved in the patient’s care.

“Clinicians at the Surgical Intensive Care Unit at Johns Hopkins are kicking the tires, taking it through the paces,” Ravitz says. “After fine-tuning the system, we plan to test it on a wider scale at Johns Hopkins Bayview Medical Center’s intensive care unit, and it will be ported to University of California, San Francisco Medical Center,” which is partnering with Hopkins on the project.