Medical Equipment Library Design: Revealing Issues and Best Practice

Using DiCoT

Julia Werth & Dominic Furniss

Clinical practice often evolves in response to local issues and opportunities, hence it is diverse.

Can we recognise, describe and compare this diversity to reveal issues and best practice across

similar clinical settings?

• What is DiCoT?

• What is a Medical Equipment Library?

• What design opportunities did we recognise?

Content

DiCoT: Distributed Cognition for Teamwork

• Where did DiCoT come from?

Open Clip Art from papapishu 2007

• Distributed Cognition • Focuses on socio-technical systems• Focuses on the propagation and

transformation of information• Uses information processing concepts

• E.g. How a cockpit remembers is speed

• Contextual Design • Advice on doing observational

studies• Focuses on developing models and

representations of work practice• Models used for reflection,

assessment and design

DiCoT’s Five Models

• Information Flow Model• Physical Model• Artefact Model• Social Model• Evolutionary Model

Open Clip Art from Geralg_G 2010

DiCoT Principles (an example)Information Flow Model’s Principles• Information movement• Information transformation• Information hubs• Information buffers• Communication bandwidth• Informal and formal communication• Behavioural trigger factors

Medical Equipment Libraries

MEL Information Flow

MEL1 Physical

MEL2 Artefact

MEL Social

MEL Evolutionary

Design Opportunities and Requirements

Process• Focus (on Medical Equipment Libraries)• Data gathering *• Develop 5 models• Comparisons between contexts• Issues & Best practice• Design opportunities & Requirements *

Data Gathering

• 6 visits in total (4xMEL1, 1xMEL2 & 1xMEL3)Visits lasted between 1-4hrs

• 3 interviews with management at MELs• 5 interviews with experts across UK

• Feedback and validation on results

Design Opportunity 1Identification and Tracking of Equipment• Medical devices go missing – £££• T-card system was good [Situation Awareness]• Out-of-hours is a particular problem• RFID?

Design Opportunity 2Better Administrative Systems• MEL2 uses codes for devices e.g. D01, D04• MEL2 and MEL3 use T-card system• MEL1 non-streamlined (notes-forms-database)• Usage reports were recognised as good

practice but MEL1, 2 and 3 did not do them• Barcodes? QRcodes?

Design Opportunity 3Solutions for Out-of-hours Working• MEL1 has a skeleton service at weekends• MEL1 has a smaller room for devices that are

frequently used• ID card entry to gather ‘who’ and ‘when’• CCTV for tracking people• Regular libraries have self checkout?

Design Opportunity 4Better Knowledge Sharing and Support Between Practitioners• Currently some meetings and word-of-mouth• EBME discussion forum• NAMDET• Developed online community support tools?• Our small scale study reveals best practice

Design Opportunity 5Usage of Physical Space and Dedicated Areas• Space is often limited (MEL1 is bigger)• Need separation between dirty and clean areas• Clear barriers? Disinfectant sprayed?• Equipment that knows it is dirty? Violation

alerts?

• What is DiCoT?

• What is a Medical Equipment Library?

• What design opportunities did we recognise?

Content

Full Thesis Available from: http://www.sighit.org/thesis.php

Thank you!

Questions

Julia Werth & Dominic Furnissjuliacwerth@gmail.com d.furniss@ucl.ac.uk