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Armstrong Institute for Patient Safety and Quality 1
A Collaboration of The Armstrong Institute – Applied Physics Lab of The Johns Hopkins University & The Gordon & Betty Moore Foundation
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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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..?”
3 The Upside of Irrationality – Dan Ariely
Emerge 7 Harms and Problem Statement
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Is this the “As Is” of the ICU?
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Systems Approaches Align People, Processes, and Technology
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Emerge: Engineering Solutions from Need to Deployment
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Emerge: Care Team Portal
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Emerge: Condition Specific Display- VAE
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Emerge: The Patient Family Portal
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Engineered Systems: From Awareness to Control
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Concept of Operations Operational View
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Model System
Armstrong Institute for Patient Safety and Quality
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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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
Notional System Architecture
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