woe scenarios in ER

[davidppp]

Hi all

I will introduce myself first; I am a PhD student in UCLA Electrical Engineering department. This post is regarding some questions I have in order to justify my researches. Also, just so you know, I have zero-knowledge in the nursing field. Thus, I would like to have your feedbacks. Thanks in advance.

In a general sense, the research I am doing is the binding between a medical device and a patient. I am looking at a healthcare environment where devices are miniaturized and wireless connected. Scenarios where you can continuously remote monitor the blood pressure, heartbeat rate, ECG signals, etc. with these type devices. We then divide the process into three steps: first, you associate a device with a patient; second, you can now receive the physiological data; third, you disconnect (disassociate) the device with the patient.

The focal questions we aim are (1) the association/disassociation process mentioned above. (2) Which patient is physically using which device? To further motivate my researches, I would like to know your opinions and real-life experiences on how things can go wrong in the current setup of emergency care unit.

Some questions I have are followings, and please feel free to answer any/all of them. Any other feedbacks/stories/suggestions are very welcome.

(1) Is it common in a crowded emergency room that a madness of connecting different instruments to different patients? What are things that can go wrong?

(2) During the process of disconnecting one device from a patient and putting it onto the other patient, have you ever encountered the problem that the device suddenly just doesn't work anymore? Are the protocols smooth and intuitive, or confusing?

(3) Is it easy to tell that one device is physically using by which patient (especially when there are many patients)? Does it ever happen to you (or your colleague) that you thought device A is connected to patient A, but in fact it is connected to patient B?

(4) What are the common human factor errors in emergency room?

(5) Are you a US nurse who works in the emergency care unit?

At last, it will also be very helpful if you could point me some references or articles regarding the issue.

I appreciate your valuable time,

David Jea

NESL, UCLA EE

Email: dcjea @ ee.ucla.edu (remove spaces)

[Crocuta, RN]

I've lost track of the number of times I've checked on my ER patients and found them totally disconnected from their monitoring devices. Usually it's because they were taken out of the department for tests and when they were returned, they were just put in the room without being reattached.

Patients also have a habit of removing their own SaO2 sensors, BP cuffs and even tele because they "got tired of it."

Have you ever seen the rat's nest of tangled wires that can result in a pt who has been lying in an ER bed for a few hours? Monitoring options that required fewer wires would increase monitoring compliance and patient safety, as well as create a greater volume of trending data by allowing continuous data collection on all patients, rather than going in every hour and reattaching everything for a set of vitals.

I picture small wireless leads placed on the chest, each with a wireless connection to the monitoring station to provide the EKG monitoring. SaO2 should be able to be collected in the same way. BP would be more tricky since it requires air for pressure. The self contained cuffs are way too inaccurate although the model might be adaptable.

I would suggest that you contact a local hospital ER and ask for permission to job shadow a nurse for a day to gather first hand data on how medical monitoring devices are used on a practical basis.

Good luck, and send me your prototypes.

[Altra, BSN, RN]

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[davidppp]

Hi, Crocuta, MLOS,

Thank you very much for valuable input! I will need to rethink something. And job shadow a nurse is a great idea, I will try to get a permission on that.

Does anyone has more comments that can share with me? Thanks in advance!

David Jea

NESL, UCLA EE

[SuesquatchRN, BSN, RN]

Something that the demented can't play with/remove would be wonderful.

[PICC ACE]

An ICU visit will also give you the chance to see even more monitors and their attendant tubes,hoses and wires in action.

[canoehead, BSN, RN]

How about something like an abdominal binder that tracks all vitals?

[ecat81]

Unfortunately making wireless monitors would be great except we had to quit buying remotes and phones (we now have the old huge phones in the rooms that have buttons but used to have the round dials) because the pts walk off with them and there is a huge market on ebay for this type stuff. Also never lay down your stethoscope or it will go too. We have all brand new monitors in our er dragers that monitor everything you could imagine. The only problem is that we have some nurses that lose the leads and o2 cables.