© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 © The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011

Project Emerge: Systems Engineering the ICU

Adam Sapirstein

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

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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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