Association of British Healthcare Industries (ABHI) Information poster

History of the electrocardiogram from 1600-2005

While the ecg machine has not technically been around since 1600 the theory behind it has.  This pdf notes key points in the progression of the ecg machine from theory to practice.  Apart from being a fantastic timeline going through the history of its development there are some incredible moments such as a professor using his own pet dog 'Jimmy' with paws in jars of saline to demonstrate new advancements, and the first oesophageal electrocardiogram was achieved with the aid of a professional sword swallower in 1906.  Fantastic advancements in medicine by fantastic means.

http://www.ecglibrary.com/ecghist.html

Being connected to an electro cardio-gram machine

I should state that I have no current heart conditions so the act of being connected to the electro cardio-gram (ecg) machine in this video is purely to gain a rough physical perspective of what a patient with an actual condition goes through.  Therefore I do not at this stage understand or could fathom the emotional feelings of a patient going through a similar process with a heart related condition.  This I can try to understand from current and ex-patients though interview techniques.

This video should also relay to the viewer the time and effort it requires to connect a patient to an ecg machine.

The machine presented in this video is not the usual standard to be used on a day to day basis as it is part of a study investigating the effects of reflexology, so it will be necessary to repeat this process.

Also you will notice 'chilled out' music in the background which was to provide ambience to the study I was a part of.

I aim to interview those who operate these machines on a daily business and patients who benefit from the results the machine produces.

Day Case Unit

When visiting the ecg department I also visited the day case unit, where patients are given a chance to recouperate after an operation.  Here they are given information on their operation in the form of handouts and booklets.  It is this method of providing information that concerned the day case unit manager when I asked about any other particular problems (apart from the ecg cables tangling during operations) that might affect patients.

She described that the majority of patients who are worried or concerned about their operation/condition are not going to sit and read through an intimidating number of booklets.  Which can then lead to that patient becoming more stressed because they do not fully understand what is happening or what has happened.

There is a card that patients are given in order to access information.  The idea behind the card which is postcard sized (roughly A5) is that the patient can find out information on their own terms, at their own pace, in the comfort of their own home.  The problem with this card, is it's physical size, it is perhaps too big.  After a small discussion it was determined that a credit card sized variation would make a good alternative.  The only trouble is fitting all the necessary information onto the smaller card, and designing the layout/information so it appears useful, helpful and informative to the patient.

On the card is a helpline in order to call for information if required.  Information is the keyword.  During my interview with and ex-patient she mentioned that a lot of the information she was provided with was through discussion with her doctors, surgeons and nurses.  Her exact words will be written up soon, but it was clear from my discussion with her that communication through good service enabled her to understand what was happening, and through that understanding she gained a strong confidence in her physicians.

This area of research is more suited to information, service and graphic design but it is still interesting to build a complete picture of the overall patient experience.   The main focus at the moment is still upon the issue of tangled ecg cables.

Below are pictures of the information available at the day case unit.

It's quite a lot to take in, and I imagine quite intimidating if the patient is stressed or worried.  On the back of the booklet is a helpline which could be useful if the patient is not already put off.  Below is an example of some of the other information handed to post-op patients in the form of A4 printouts.

Ninewells hospital ecg department

I have just arranged to visit Ninewells hospital ecg department in the new year.  This will provide a different perspective from the hospital I am currently looking at.  An interesting idea would be to visit a number of hospitals across the UK in order to gain a broad overview of the situation, ranging from public to private hospitals.

UPDATE:  I had an extra day or two free in the following weeks and phoned the Ninewells ecg department to see if I could arrange an earlier visit this month.  Unfortunately the department is a little understaffed right now but I am assured that there should be somebody available to guide me around in the new year.

Ninewells Library

Good news is that I am allowed access to the library at Ninewells hospital, however I will be unable to access computers or borrow books until I have re-matriculated.

Reflexology session and ex-patient interview

Just a quick note today.  This morning I had my first reflexology session whilst hooked up to a machine.  I was able to take a video of myself being hooked up to the ecg machine, so I will be posting this soon.  I also have the follow up session this friday.

In the afternoon I interviewed an ex-patient who recently underwent  a Minimally Invasive Mitravalve Repair Procedure.  She was originally diagnosed with her heart condition five years ago, so she has had a lot of experience over the past few years with tests involving ecg machines.  We talked about a variety of variables and drew some sketches to get an idea for improving the condition of the wires belonging to the ecg machine.  I will be posting the interview soon in video or transcript format, with highlights of the conversation, very soon.

Endoscopy department

I have been in contact with an endoscopy department and will be discussing with their endoscopy/day surgery manager how I can begin my research into this department, how much access I can achieve etc.

I will have an update for this on or after the 26th October as the day surgery manager is currently on holiday.

Participation in Reflexology Study

I have been asked to participate in a study into the possible effects of reflexology on a patient admitted to the cardio respiratory department of a hospital.  As a participant I will be hooked up to an ECG machine, giving me invaluable first hand experience of what it is like to be connected to one of these machines.

Reflexology is a complimentary treatment where a therapist will apply pressure to my feet.  The ECG machine will measure any and all physiological responses during the treatment.

This is phase one of a much larger investigation and it will be interesting to find out what these initial results yield.

I am told that a large number of doctors have dismissed reflexology with little to no scientific evidence.  Even if through this study reflexology is scientifically proven not to have any actual effect upon the condition of the patient, the possible placebo effect that could be derived from this study could prove invaluable to the condition of the patient.

A large number of people have described the reflexology treatment as a very relaxing experience.  That experience alone could prove very useful during the treatment of a patient.  It could among other things relax feelings of anxiety during what could be a particularly troubling time for a patient. 

This will be happening in the following week.

Cardio Respiratory Department visit

Yesterday was my first introduction to an ecg department.  Before the tour of the department I signed a disclosure agreement from the NHS Code of Practice on Protecting Patient Confidentiality.  Basically if I wish to involve patients with this research I have to gain their consent. On the tour I was introduced to a number of interesting areas from the waiting area to the preparation room and even the 'brew' room where members of staff (maybe even patients, I'll have to ask) can enjoy a cup of tea.

The waiting area was interesting from a patient point of view as I had to sit and wait to be seen.  As with most waiting areas that I have visited from dentists to doctors, the atmosphere was very quiet.  There was a number of basic chairs in an L shape around the room.  The ecg department recently moved to a newly furnished part of the building, so the chairs and carpets appeared to be in good condition.  As mentioned before the atmosphere appeared to be a little stifled, with whispered conversations.  For children there was only a couple of toys to play with and for adults there was information on procedures and pace makers. The information I collected was presented in what appeared to be a white grill.  I will be reading what I collected in order to gain an insight into how information is presented to the patient, both adults and children.

I was then invited into the office of one of the senior members of staff which is shared between two.  Although not the focus of this project, it may be interesting to investigate how they feel about sharing an office what are it's pros and cons?

We then moved onto one of the preparation rooms where the problem of tangled cables I had previously discussed with my guide was brought up.

When my guide detangled the cables it was clear how frustrating and time consuming the process of detangling these cables can be.  In the top image you can see there is a small space where cables should be ideally stored, however it is a very cramped space.  I can imagine, as you do with anything new and electrical that you buy for your house that the cables were neatly packed when it first arrived from the factory, but unfortunately you are left with no real practical storing options.  I was told that these machines sometimes don't even come with a storage compartment, and they are unfortunately left to dangle.  They are cleansed before and after each use.

This is one of the main complaints from the majority of the Cardio Respiratory department, where to and how to store the ecg cables.

More information from this tour will be added in the following days.

Hospital standards in relation to colonoscopy throughout Scotland

http://living.scotsman.com/health/Poor-hospital-standards-39putting-thousands.6550821.jp?articlepage=2

Discovered this recent article in the Scotsman online which mentions the level of dignity the patient maintains waiting for and during the colonoscopy procedure.  I am currently organising a research trip to a day case unit (as well as the ECG department) and will hopefully receive word from them at the beginning of next week.

Poor hospital standards 'putting thousands at risk

Published Date: 26 September 2010

By Kate Foster

THOUSANDS of patients undergoing hospital tests are at risk from poor hygiene and understaffed wards, a damning investigation has revealed.

A report by Scotland's hospital watchdog has found "breaches" in the adequate decontamination of equipment and patients being treated on understaffed, overcrowded units.

The inspection examined hospital units across the country carrying out endoscopies, diagnostic tests which tens of thousands of Scots undergo every year.

The tests help diagnose conditions including cancer, stomach ulcers and bowel disease. But services at a number of hospitals in Aberdeen, Inverness, Glasgow and Kirkcaldy have been heavily criticised by NHS Quality Improvement Scotland. In categories including clinical safety and patient dignity, some of the hospitals were found to be operating "minimum acceptable standards."

Inspectors found a catalogue of problems, including staff failing to sterilise equipment properly and follow infection control standards. Patients were being treated on understaffed and "cluttered" mixed-sex units, with some forced to wait in corridors.

Patients' groups condemned the findings and warned that pressure on officials to meet government waiting time targets meant patients were being treated "like cattle."

Doctors carry out endoscopies using a flexible tube with a camera which is passed into the gut or bowel to help diagnose or even treat a number of health problems. Patients are either sedated or given a local anaesthetic for the procedure, which is usually treated as a day case in hospital.

Health boards must now ensure patients wait no longer than six weeks for the tests. But at Aberdeen Royal Infirmary, inspectors found "inadequate staffing" with patients who had been sedated left without supervision. Staff were so scarce, their report said, it "raised concerns for patient safety."

They also found "multiple deficiencies" in the way staff at Aberdeen were decontaminating equipment, raising safety concerns about infection risk.

Patients who had been undressed for the procedure were kept in mixed sex areas, which was also criticised.

The unit at Ninewells, Dundee had "excellent" decontamination facilities, a report said, but staff failed to follow basic procedures such as handwashing. Patients were put into mixed-sex recovery areas and the unit was understaffed.

Inspectors said the endoscopy unit at Raigmore Hospital in Inverness was meeting waiting time targets but warned that staff "posed an infection control risk" by failing to wear scrubs (sterilised clothing) during procedures. Their report also found a lack of trained staff and sedatives being prepared by junior staff.

Victoria Hospital, Kirkcaldy, was described by inspectors as "well performing" but noted "significant breaches" in decontamination practice.

It warned that some of the facilities were not up to scratch, "posing an infection control risk."

Stobhill Hospital in Glasgow was praised for its "superb" new facility and decontamination procedures but said the dignity and privacy of patients c

ADVERTISEMENT

ould be improved to make it a better experience for patients.

Although the endoscopy service at the Western Isles Hospital, Stornoway, was of a "high quality, " patient dignity and privacy was being compromised by long journeys through the hospital and by patients having to wait in main corridors.

Jan Warner, director of patient safety and performance assessment for NHS Quality Improvement Scotland, said: "We found staff to be hard-working and motivated to provide a good quality of endoscopy service within the hospitals we reviewed.

"We also found areas of concern, largely surrounding decontamination, training and the use of equipment. We have highlighted what we believe the NHS boards concerned need to do to improve their services, and we are satisfied that the hospitals are taking appropriate steps to make the necessary improvements."

But Dr Jean Turner, executive director of the Scotland Patients' Association said last night: "This is dreadful. People are being treated like cattle. This points to people being processed and that's what happens when you have waiting time targets."

Dr Alan Robertson, Scottish council member of the British Medical Association said: "Decontamination standards are set for a reason. Waiting targets will put pressure on hospitals because there is a limited number of staff and rooms but you have to get the balance right."

Health boards said that following the inspections action plans were in place to improve areas which had come in for criticism.

Endoscopy journal

https://www.thieme-connect.de/ejournals/toc/endoscopy

This is a journal for endoscopists and it is clear that there is a lot more to endoscopy than I at first thought.  If I am looking at providing a design intervention to the colonoscopy procedure I should look at how the endoscopist operates throughout their workday, look at their routine as well as looking at the steps the patient has to go through.

Maybe several staff members have to use the same workplace, examination room throughout the day for differing types of procedure.  What would be ideal, is to arrange a day where I can perhaps shadow a member of staff for a number of hours, in order to gain insight into how their daily game plan operates.

Colonoscopy brief outline

bmi healthcare colonoscopy, brief overview

This is a very brief outline of what a colonoscopy is by bmi healthcare, the private division of GHG General Healthcare Group.

A colonoscopy is a method whereby a physician known as an endoscopist will examine the inside of the large bowel of a patient for any problems using a long flexible telescope with an illuminating light.  Generally the colonoscopy is a safe invasive procedure with little to no side effects, in fact the patient should be able to return to his/her work or general routine with a number of hours, usually two or more. 

If required the patient will be given a sedative in order to relax them.  The only noticeable complication that can occur throughput the procedure is an allergic breathing reaction or heart irregularities causing trouble.

What is interesting, is the need for the sedative.  Is this because a particular patient physically needs the sedative in order for the procedure to go smoothly?  Is it because their not comfortable during the procedure, how is their body positioned in order for the endoscopist to complete his, her work.  What is the general environment, atmosphere in which the procedure takes place like, is t welcoming, comforting, clinical or sterile.

These are a number of factors that could begin to makeup an interesting investigation into the methods and environment of the colonoscopy procedure.

I have contacted the BMI Fernbrae Hospital in Dundee and will approach my local hospital for information and hopefully arrange an interview with some members of staff.

The Healing Environment Without and Within

The healing environment: without and within By Deborah Kirklin, Ruth Richardson

This book provides a broad over view of topics dealing with medical humanities without and within medical environments.  It mainly covers the physical areas that patients may have to inhabit during illness or recovery.

The book discusses bringing outside arts within, performance and music and other forms of art, not what would appear to be permanent cures but positive none the less.  When I began reading this information I considered the word permanent and thought that it was an interesting word or sentence to use, because what is a permanent solution?  Personal identity and taste is constantly in flux.  The world of fashion for example rapidly changes from week to week.  A persons’ choice of furniture and fixture, perhaps even the entire layout of their home will evolve over the years.  In the world of medicine, doctors and scientists are constantly researching, developing and refining how to treat illness and disease.

So should the NHS adopt a similar semi-permanent, low cost, environmentally and patient conscious approach to their interiors.

“Physical appearance, geometrical forms, colours, fixtures and furniture affect the atmosphere of the ward.”

The importance of architecture and the built environment of the hospital covered in a chapter, serves as an introduction to further investigation.  The built environment can be measured and its impact is either positive or negative, very seldom is it neutral.

New hospital buildings are described in contrast against old hospital buildings within the book.  It is observed that the quality of treatment and staff is greatly improved within a modern, well-lit and designed hospital. Studies have shown that improving the built environment can achieve the positive of reducing the average amount of time a patient stays in hospital.  This benefits the patient and has obvious beneficial cost implications for the NHS.

When considering environment for hospital patients it is perhaps necessary to recognise that a future patient has a pre-existing social environment shaped by friends, family, personal interests and a variety of external variables including hobbies and activities.  Hospitalising a person, it appears is essentially removing them from their comfort zone.  Patients do not give up their hobbies simply because they are being hospitalised, albeit sometimes for a temporary amount of time.

The ability to have personal control over the environment is as important to patients as aesthetic and functional design throughout the hospital is important to staff, even if that control is limited.  Patients like the idea that they could participate in a social context but also retain autonomy and have their own personal space.  The ability to decide how much privacy or community they require is very important.

The views, opinions and experiences of patients and staff should factor into the future design of hospital environments.  It might be an idea to start interview sessions or begin an online submission of ideas, sketches and photographs in order to formulate a collaborative process of design with staff, former and current patients.  The idea is to look at each individual hospital environment as its own ecosystem but still part of a larger environment, and in nature an ecosystem is constantly adapting.

“Architectural styles, like medical certainties, change over time.”

This book was written in 2003 so it is interesting to investigate further and discover what advances have or have not been made.

Minimalist Intervention

I read this article in the recent issue of Wired Magazine and found it relevant to the current research.  The article is about philosopher James Wilk who utilises 'minimalist interventions' to change work environments including medical environments.  It is an experimental process.

Electrocardiogram

In the next couple of weeks I should have finalised a tour of a cardio-respiratory department.

When discussing the nature of the study, the subject of an ECG recording was brought up.  And althought this is off topic, it is interesting to investigate a wide view of problems.  An Electro cardiogram is a test that measures the hearts electrical activity.

The issue that arose during the discussion was that ecg cables often become tangled.  This means that hospital staff have to spend time detangling what has been described as a 'birds nest' of cabling, thus distracting them from the important job of monitoring readouts and attending the patient.

There does appear to have been some break throughs in this area, as evidenced by a company in the USA, their website has testimony from a number of staff.

http://www.ekgcable.com/testimonials/

Aside from preventing the cables from becoming tangled and damaged (they are expensive to replace), the equipment offered here helps interpret where each cable/electrode should be attached to the body.  This ability to read quickly where each electrode should be placed greatly improves the patients level of stress as they become more comfortable in the hands of the hospital staff.

The tour should prove interesting because if this product is a design or cost issue for hospitals then there could be room for an improved cost effective design.

First hand experience of this department will also prove useful in experiencing the environment for both the patient and the staff members.  To see the route the patient/staff member takes from the entrance of the building to the waiting room, toilets, consultation, operating room etc will prove invaluable in this current study of de-threatening, de-intimidating of hospital equipment and situations.

It should also be interesting to hopefully gain an insight into how a hospital appropriates and breaks down its budget, regarding equipment, patient comfort and many other factors.

Expect and update on the cardio-repiratory department in the coming weeks and more literature on the subject shortly.

David McCandless: The beauty of data visualization | Video on TED.com

David McCandless: The beauty of data visualization | Video on TED.com

A student studying bio-medical science suggested an idea for providing basic medical information for the general public. The general public without proper guidance can be misguided as to which medicine to take for which ailment, leading to prolonged illness or other problems.

I recently saw a talk on Ted.com by David McCandless which proved very interesting in relation to how important information can be. Because we are bombarded by a variety of visual information on a multitude of different mediums on a daily basis, it is harder to present facts and data in a way that can encourage the viewer to stop and take in the information. Presenting this information in a visually dynamic and understandable way is an important task.

Having watched this talk I immediately bought David McCandless book 'Information is Beautiful' which as so far proved both interesting and entertaining, the best of both worlds. So perhaps a dynamic information chart or map could be created representing symptoms and medicines or even an app for the iphone to guide a person to the correct choice of medicine.

Where this chart, poster or pamphlet would be placed could be very interesting especially for those people who don't have access to internet or iphones.

About this blog

This blog is designed to act as a catchment area and a springboard of ideas, a blank slate to post problems and potential solutions to issues that pertain to a medical or surgical situation.

The initial start of this investigation is to begin looking at how to make surgical equipment within medical situations less intimidating.  This can also be applied to the environment of the procedure, the waiting rooms or even how information is presented to people, be they patients, members of medical staff, trainees, or the general public.

At the foundation stage of this research, a wide net is cast in order to gather as much information as possible, ideas and designs that work for something completely different outside the world of medicine may prove useful in providing alternative routes of design and solutions to particular problems.  Inspiring talks and papers from professionals within their field will be posted and I invite people who read this blog to comment, critisize and suggest alternative ideas.