A digital decision support for Swedish emergency care

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Project: Further development of the interface and functions of ERICA, a decision support system developed for the emergency department at the hospital in Trollhättan (NÄL).
Course: Bachelor thesis, Department of Signals and Systems, Chalmers University of Technology (2017).
Project team: Daniel Hallberg, Arto Kemppainen, Anna Kollberg, Ellen Korsberg, Sara Lindgren and Oscar Nilsagård.
Project supervisor: Kristofer Bengtsson, Department of Signals and Systems, Chalmers University of Technology.

Read the full thesis in Swedish here: ERICA – A digital decision support for Swedish emergency care

As my role in this project was that of a product/interaction designer the focus of this summary will mainly be the areas I contributed the most in which were user research, interface design and usability testing. If you’re interested in how the system was implemented you can read all about that in the thesis linked above.

Background

High work-load and long waiting times are common in Swedish emergency departments. At the same time the staff is spending a big part of their working day exchanging information between each other and other various information systems. A contributing factor to the amount of information exchange is a loss of overview with respect to patients and available resources. To increase the overview and thereby making it easier to communicate – the digital decision support ERICA (Emergency Room Information and Coordination Assistant) was developed during the spring of 2016. ERICA has since then been in use at the emergency department at Norra Älvsborgs Länssjukhus (NÄL) where it has been well received and is used in the daily work. The aim of this project was to further develop ERICA with respect to its functions and interface.

Observational studies and the user groups

To get a clear picture of which groups of personnel at the emergency department that handles the most information and their needs a observation study was conducted at NÄL. During this study two critical user groups were identified as major handlers of information – the coordinators and the team nurses.

The team nurses work among the patients and medicates, monitors, examines and run tests on the patients. The team nurses have a lot of patients to monitor and have a hard time getting a good overview of them and which activities the patients have and have not gone through.

The coordinators are responsible for the distribution of the medical personnel and patients on the right teams, coordinates emergency alarms and answer a lot of questions from both patients and staff. These tasks lead to a large amount of searches in IT-systems, as a lot of the coordinator’s decisions are based on information found in these.

The data collected during the observations was subsequently analyzed and formulated into functional requirements which the system ERICA later was formed after. The users were also represented in the form of personas as a way of testing the systems functions against them continuously during the development.

ERICA´s user interface

With the aim of creating a system that can be continuously expanded for new user group and new medical departments ERICA is made up by a collection of modules. Each module fulfill a function that one or more user group have the need for. These modules can then be arranged together to create different user specific views.

As team nurses and coordinators were identified as critical users for this project function modules and views were designed to satisfy the needs of these user groups primarily.

The view designed for the team nurses – Prototype made in Adobe XD

View for team nurses

The view for the team nurses is designed with the aim to help them get a good overview of the their team’s patients.

The main part of this view is made up by patient cards. These contain information of the patient’s medical severity grade (triage color code), room number, latest medical event and the patient’s status by showing if the patient have been seen by a physician, have gotten a plan for the emergency room visit or is ready leave.

In addition to these cards the view contain three diagrams that show the patient distribution depending on the medical severity grade, status and current patient location, as well as a queue list where all patients that have waited to long since their last event is collected.

When discussed with personnel at the emergency room this view has been described as informative and as a good tool when you need to see the team’s patients and how they are distributed really fast.

The view designed for the coordinators – Print screen from ERICA

View for coordinators

The view for the coordinator has been designed with the aim to give a good overview of the current patient status at the emergency department as a whole.

This view is made up by three modules. One module presents the patient distribution of the different teams sorted on the patients’ medical severity grade and status. This helps the coordinator to easily understand the current workload in each team.

The view also contain a large map of department’s rooms. The coordinator can use this map to see if the rooms are free or occupied but also as a regular map to show patients and other visitors the way.

At the bottom of the view a table is presented that show how many patients that are placed in the waiting rooms and their status, that is if they have met a physician, have a treatment/diagnostic plan or are ready to leave.

This view is a based on a view that was designed in 2016 by a different project group and that has been used since then with great satisfaction by the coordinators. In this further developed version redundant and cluttering information was removed and the interface redesigned to make it more visually clear.

Further possibilities with ERICA

Mobile version of ERICA – Prototype made in Adobe XD

A mobile version of ERICA

During the project a mock-up of a mobile version of ERICA was developed and tested by nurses at NÄL. The test users were very positive to the mobile version of ERICA as it’s a way for mainly the coordinator that moves a lot around the department to access the information whenever needed.

The interactive prototype of mobile version of ERICA can be viewed below!

Presenting and predicting the flow of patients

One problem at emergency departments is how hard it is to understand and predict the flow of patients as the flow depends on the time, the weather, the traffic, the personnel team… and the list goes on. Fortunately there are mathematical methods that can be used for this but it’s a challenge to visualizing patient flow in a way that facilitates decisions without stressing the user out at the same time. Therefor the best combination of a mathematical method and a visual presentation for this needs to be tested out continuously with the users to ensure the the flow value and the presentation of it helps with decisions in a non-stressful way.

User evaluation of ERICA

The interface was first developed in the form of static prototypes sketched out in Adobe XD. These were later evaluated during a concept presentation/focus group with users from the critical user groups and iterated according to the feedback.

As a final step the interface was evaluated both in a group interview and in a real time test. The main focus of the group interview was to see if the interface presented relevant information in a visually clear and pleasing way. The interviewed users liked the new interface and the information presented was relevant to them. They also expressed a lot of entusiasm for a possible mobile version of the system as it would make it easier to get information on the go and minimize the time used on moving around the department.

The real time test was carried out to find bugs in the system but also to understand if and when the users used the system. During the real time test a lot of problems occurred with the data handling and therefor the user motivations could not be examined within the time frame of this project.