DOME - Designing Out Medical Error: Establishing Performance Requirements for Equipment Use on Hospital Wards

The challengeHuman error and systemic failure lead to unnecessary harm and suffering for patients, including permanent impairment and loss of life. Research indicates that in up to 10% of all hospitals admissions some kind of adverse incident occurs, more than half of which are believed to be avoidable. The effect on staff and the 2billion+ consequential costs further increase the need to improve all aspects of patient safety. A significant contributory factor is that healthcare processes have undergone many revisions in recent years, while the design of much non-surgical equipment remains largely unchanged. Modern healthcare involves a combination of processes and procedures supported by a broad range of equipment and products that have to co-exist within the 'patient cubicle' or ward treatment space. Few of these have been designed to ensure safe integration within the context of use, be it ward, theatre, or community, nor is this a purchasing requirement within NHS Trusts. In short, current treatments are not properly and effectively supported by available equipment. Research aimsThe outcomes of this research will be both patient and system aware. The aims are to enhance patient safety in hospital by designing out medical error, to ensure that medical products and equipment are fit for purpose, and to contain risks associated with the introduction of new designs into a system of great complexity. The Chief Medical Officer recognises the potential of a design-led approach to patient safety and wishes to see it adopted more widely across the NHS. To design out medical error it is necessary to: (i) understand healthcare process demands with regard to diagnostic, monitoring and treatment routines, in particular in terms of the consistency and usability of interfaces and other features, and in light of the progressive introduction of 'smart' products and equipment; (ii) translate that understanding into a knowledge base for the design of medical products and equipment that support safer and more effective healthcare processes; (iii) establish a best-practice, evidence-based approach to the design, equivalent to that underpinning the development of treatments, procedures and medication regimes in modern medicine. Research approachWe will use both global and candidate approaches in the project. The global approach will follow a systematic methodology to capture the broader system of healthcare process and ensure there are no gaps in our understanding of the patients/system interactions. In addition, we identified from our clinical observations and design perspective, three candidates that require detailed attention in the project: (i) the communication process in the ward; (ii) the patient local environment personal cubicle and (iii) the ward clinical activity.In order to address the broader challenge of equipment and products in use on the hospital ward, a Consultant Surgeon and Clinical Reader at Imperial, Mr George Hanna, who has research interest in ergonomics, instrument design and surgical safety will lead the clinical side of the programme. Professor Charles Vincent will lead on healthcare process and patient safety aspects, and PhDs will be attached to each of these strands to build up a cadre of young researchers in the field.DeliverablesThe project will have the following deliverables (i) a thorough map of healthcare processes both on a ward and within the broader context of the patient journey (ii) comprehensive knowledge of the design requirements for ward equipment; (iii) design proposals for a ward communication system, (iv) design proposals for a ward treatment space or 'patient cubicle' and (v) guidelines for safe ward activities and staffing levels.