PDC_2008_Headwall Boom Study

Medical Gas Booms vs. Traditional Headwalls

James A.Thomas, M.D., Associate Professor, UT Southwestern Medical CenterDebayjoti Pati, PhD, AIIA, Director of Research, HKS Architects

Jennie Evans, RN, BS, Director of Clinical Operations, HKS Architects

2008 International Conference and Exhibition on Planning, Design and Construction™

• What is optimal for patient care?• What are the differences between caregivers’ needs g

and wants?• Is there a safety component in the choice of medical

gas delivery systems?


Learning Objectives• Identify what clinicians prefer between medical gas

booms and headwalls.A hi h f id h d idi• Assess which factors to consider when deciding between the medical gas options.

• Discuss the family considerations as it relates to the• Discuss the family considerations as it relates to the provision of the medical gas booms vs headwalls while in the ICU.


Acknowledgments• Study participants, Children’s Medical Center of Dallas

• Getinge USA Inc for partial funding support• Getinge USA, Inc. for partial funding support


Agenda• Why the question• Study methodology• Assessment framework• Definitions• Caregivers preferences• Family considerations

h i i b• When to invest in booms• Future directions


Why the Question• Current drivers of

decision-making• Problem definition

– Arbitrary decision-ki– Early technology

adoption– Peer competition

making– Absence of empirical

data to support or Peer competition– Perceived efficiency– Perceived safety

data to suppo t orefute contentions

y


Study Methodology• Objectives

– Assess the relative impacts of headwalls

• Simulation scenarios– Admission

I t b tiimpacts of headwalls and ceiling booms

• Study Design

– Intubation– Surgery– Code

– Simulation runs of real life situations

– ECMO


Methodology Cont.• Hospital:

– Children’s Medical Center of DallasCenter of Dallas

– 66-bed ICU has both headwalls and ceiling bbooms

• Setting1 ICU room with ceiling– 1 ICU room with ceiling boom

– Headwall mock-up


Methodology Cont.• Participants:

– 2 physicians2 titi– 2 nurse practitioners

– 2 respiratory therapists– 4 ICU nurses

• Patient:– 1 pediatric manikin

• Data:– Video recording; Notes


Assessment Framework• Physical Elements

– Intravenous tubingEl t i l d

• Performance Dimensions

Fl ibilit– Electrical cord– Medical gas tubing– Equipment

– Flexibility– Ergonomics– Teamworkq p


Flexibility• Definition

– Conceptual definitioni h

• Measure– Bed positioning

• Distance the bed could be moved • Responsive to change;

adaptable

– Operational definition

from the wall• Maximum turn angle achievable

in relation to original position

– Equipment• The ability to offer

optimum layout of bed, caregivers and equipment for various levels of

Equipment• # of equipment pieces affecting

circulation in a particular scenario

– Caregiverfor various levels of acuity and procedures

Caregiver• # of caregivers accommodated in

a scenario, without affecting circulation + patient access by caregivers and mobile equipment


g q p

Ergonomics• Definition

– ConceptualM i i d ti it b

• Measure– In a particular scenario, count measure

of the number of times the following are obser ed in iolation of the criteria• Maximize productivity by

reducing operator fatigue and discomfort

– Operational

are observed in violation of the criteria outlined in the operational definition: bending, stretching, reaching

• The ability of caregiver to move about the space and attend to all tasks void of reaching greater than 70” AFF, reaching lower than 24” AFF reaching greaterthan 24 AFF, reaching greater than 30” from center of gravity and twisting of the spine.


Teamwork• Definition

– Conceptual definition:• Cooperation between those

• Measure– In a particular scenario, count

measure of the number of time th f ll i h h tp

who are working together on a task

– Operational definition:

the following happens when at least 2 clinicians are working together:

• Losing timeI i t f t l t f• Ability to work together, by

virtue of the layout vis-à-vis patient bed, in an orderly, comfortable and safe

• Inappropriate space for at least one of the clinicians

• Inappropriate adjacency for at least one pair of the clinicians

• Unsafe body mechanics for at least f th li i imanner, void of any time

delays in accessing crucial services within the patient room.

one of the clinicians


Clinician’s Preference


What Booms Change• Booms reduce the area of restricted access• Booms reduce the area of restricted access

to the patient (Concept #1)Headwall Boom

Boom or headwall

Patient access area

Bed


Area of restricted access

Wh t B ChWhat Booms Change• Booms mobilize area of access restriction

(Concept #2)Restricted Head/Neck

AUnrestricted Head/Neck

AAccess Access

Boom or headwall

Patient access area

Bed


Area of restricted access

Physician

Flexibility Ergonomics Teamwork CommentsIV TubingEl t i l Boom (+) in Boom (+) in Boom (+) in Majority of powerElectricalCords

Boom (+) in situations needing access to head of bedHeadwall (-)



Majority of poweroutlets are on the boom

Medical Boom (+) in situations needing

Boom (+) in situations needing

Boom (+) in situations needing

Could be addressed with gases on one

Gasessituations needing access to head of bedHeadwall (-)

situations needing access to head of bedHeadwall (-)

situations needing access to head of bedHeadwall (-)

with gases on one side of bed in headwalls

Equipment


Nurse Practitioner

Flexibility Ergonomics Teamwork CommentsbiIV Tubing

ElectricalCords




Majority of poweroutlets are on the boom

Headwall ( ) Headwall ( ) Headwall ( )

Medical Gases




Could be addressed with gases on one side of bed in headwalls

Equipment


ICU NurseFlexibility Ergonomics Teamwork Commentsy g

IV Tubing Headwall & Boom: Separate work spaces for RN and RTs possible *

*Boom design dependent

ElectricalCords

Headwall: adequateBoom: Less bending (+)

Caveat: power outlets need to be ergonomically located at multiple locations

Medical Gases

Boom: conflict in some situations (-)Headwall: design dependent

Boom: Less reaching (+)Headwall: Ergonomically challenging

Boom: conflict in some situations(-)Headwall: design dependent

Equipment Boom: allows more options in locating equipment permittingbetter circulation (+)

Boom: allows more options in locating equipment permittingbetter circulation (+)


Respiratory TherapistFlexibility Ergonomics Teamwork Commentsy g

IV Tubing Headwall & Boom: Separate work spaces for RN and RTs possible *

*Boom design dependent

ElectricalCords

Headwall: adequateBoom: Less bending (+)

Caveat: power outlets need to be ergonomically located at multiple locations

Medical Gases

Boom: conflict in situations needing suction (-)Headwall: design dependent

Boom: Less reaching (+)Headwall: Ergonomically challenging

Boom: conflict in situations needing suction (-)Headwall: design dependent

Equipment Boom: allows more options in locating equipment permittingbetter circulation (+)

Boom: allows more options in locating equipment permittingbetter circulation (+)


Med Gas Tubing andMed Gas Tubing and Electrical Cords Management


TeamworkTeamwork


Flexibility: BedFlexibility: Bed placement; Equipment


Ergonomics


Clinician’s Comments• Physicians:

– prefer the boom

• Nurse Practitioners:P f h d ll d t i t d di t bilit– Prefer headwall due to consistency and predictability of equipment location across all patient rooms

– Perceive the benefit of boom over headwall as ‘low impact’ in high acuity scenarios

ICU N• ICU Nurses:– Prefer booms, because it is movable and all the gases

come off from one central place. Reduces figuring out which gas is plugged in where and less tripping over cables and connectionsover cables and connections.

• Respiratory Therapists:– Prefer booms owing to ergonomic advantages and

flexibility in equipment location


Family Considerations• Patient visibility

– In life threatening situations it is secondary to clinicians’

• Access to patient– In life threatening situations it

is secondary to clinicians’ needs.

– In lesser acuity situations no difference in visibility

Ci l i i / f

needs.– In lesser acuity situations no

difference in visibilityWh th hild i t bili d• Circulation in/out of room

– Patient population and acuity affects family circulation in and out of the room

– When the child is stabilized a pathway could be made in either scenario for parents to access their childrenand out of the room

– Not significantly affected by headwall vs boom


Parent CirculationSightline to PatientSightline to PatientAccess to Patient


When to invest in Booms• Anticipated level of acuity

– Frequency of ECMO, High Frequency Ventilator, Nitric

• Anticipated head access frequency– Frequency of 1) Intubation, 2)

Oxide ventilator, and Intracranial Pressure Monitoring

A ti i t d i l

q y ) )Cervical spine precautions and care, and 3) EEG monitoring

i i d b d• Anticipated surgical procedures

– Planned surgical procedures in the patient room

• Anticipated budget– budget limited, but encounter

some or all of the critical scenarios listed in this slidein the patient room scenarios listed in this slide


Some considerations

• Progressing reduction in invasiveness -means more surgery in patient rooms.

• How important is caregivers’ perception of flexibility?y


Shortcomings• Small sample

– One simulation of each scenario, with– Same subjects

• Day-to-day care delivery not includedy y y• Generalizability:

– Decision matrix could be generalized– Decision matrix could be generalized– Adult bed used to expand inferences to adult

ICUs2008 International Conference and Exhibition on

Planning, Design and Construction™

ICUs

Further Studies

• Multiple sites and larger sample to enhance generalizability

• Inclusion of medical gas columns• Examine headwalls with sufficient number• Examine headwalls with sufficient number

of duplicate medical gases


Further Studies

• Association between ceiling booms and adverse events (patient safety)

• Day-to-day care; bed repositioning; impact of view


Questions
