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Transformation of Pediatric Care Spaces --- Pediatric Design of the Future TRANSFORMERS: Marianna Jewell, Jamie Beyer, Dr. Jiten Chhabra, Hui Cai Problem 1 Patients with chronic diseases have to make unnecessary hospital visits, about matters which can be addressed by remote bio monitoring techniques The ability of tele medicine to help children suffering from Asthma is not being utilized to its maximum capacity ? ? What is Asthma Increased responsiveness of lower airways to multiple stimuli; episodic, and with reversible obstruction Air flow obstruction Airway hyper responsiveness Airway inflammation Etiology: Allergic Idiosyncratic Numbers (2002) 8.9 million children 10.4 million outpatient visits 1.8 million ER visits ½ million hospitalizations 14.7 million school days were missed $ 2 billion direct and Indirect costs Facts (2002) Asthma is the 3rd ranking cause of hospitalization for children under 15 yrs. Low-income populations, minorities & children living in the inner city are more likely to have ER visits, hospitalization and death due to asthma then the general population. Young children (<4yrs) had the highest rate of hospitalizations; ( twice the rate than children of the same age w/o asthma Asthma Signs and Symptoms History: Wheezing, Coughing, Frequents RTI’S, Exercise intolerance Nighttime worsening, Chest tightness, Shortness of breath, Examination: Tachypnea, Tachycardia, Use of accessory respiratory muscles, Cyanosis, Pulsus paradoxus, Symmetry of breath sounds, Wheezing, Prolongation of expiratory phase, Hyperinflation Investigations: CBC, IGE, Curschmann’s spirals, Charcot-Leyden crystals, PFT Classification Mild intermittent Mild persistent Moderate persistent Severe persistent Treatment: - Acute vs Chronic Adrenergic agonists, Methylxanthines Anticholinergics Glucocorticoids, Cromolyn sodium and nedocromil sodium, Leukotriene modifiers Spirometry Peak Expiratory Flow Rates Evidence Based Medicine 1) The monitoring of peak expiratory flow (PEF) and maintenance of a symptom diary have been proposed as means to monitor asthma severity. Daily PEF variability in combination with the daily frequency of beta-agonist inhalation is very useful in the management and early detection of acute asthma 2) A program run by the San Mateo Medical Center in San Mateo County, California helps children manage their asthma through the use of cell phones. Over a one-year period, these children experienced no emergency room visits or hospital stays due to asthma and they rarely came into the clinic for asthma-related medical treatment. 3) After six months of participation in the program, the number of emergency room visits decreased significantly and the activities of daily living were improved in the telemedicine group. Most of the patients in the tele-medicine group were able to continue measuring and transmitting peak expiratory flow (PEF) value successfully, and at six months had noticed an improvement in PEF. Our Proposal 1) Develop and implement a flexible and open ended interface to receive, analyze and transmit pediatric asthma specific information. 2) Research a new parameter, sub-auditory wheeze frequencies as a remote monitoring tool for asthma Problems addressed 1) Better care delivery 2) Reduce number of complications 3) Patient empowerment and involvement 4) Conserve national resources 5) Implementation in the hospital Problem 2 Lack of accessible interactive educational materials at the child's level in pediatric hospitals. Evidence: •Patients who had their medications electronically reconciled reported a greater understanding of the medications they were to take after discharge from the hospital, including medication administration instructions and potential adverse effects. •Misunderstanding prescriptions and dosages leads to adverse drug effects. •Patients are encouraged to become "part of the health care team" along with their physicians, nurses, and pharmacists, to prevent medication mistakes. ? ? Microsoft Surface COW for Medication Education Interactive surface easy to use and easy to clean using disposable plastic skins Place the medication on the surface and it will be recognized. Tutorial of instructions, side effects, interactions, alternatives will be given. Videos and pictures for clear understanding Information will be presented at age specific levels. Choice of language offered. Print out, email, or video to cell phone for home use Technology will be more widely used and cost effective in 3-5 years Flexibility for other applications proves a valuable investment. Additional Problems Addressed • Lack of complete knowledge of medications at the care giver level. • Lack of understanding on how to self medicate, especially at the pediatric level. • Errors due to allergies, interactions, incorrect prescribing. • Infections transmitted on highly used surfaces. • Time of nurses and doctors better spent in other place Problem 3 Is waiting room simply for waiting? Waiting room design does not address various needs of users. Comfort Flexibility Information Interaction Disaster support ? ? Registration / Play area Resource center Business center Learning center Physical therapy space ? ? Proposal:---“Transformable space" Provide adjustable furniture, can provide different size of chairs and even unfolded to universal bed that fits different age groups; Proposal: ---“Transformable space" Provide various options of separation that can transform the waiting room into ED in case of disaster; possibility to re-organize the zone of play area, family-caregiver interaction area, resource center and parents’ business area. Problems addressed & Evidence Flexibility and Disaster Preparedness. Different consideration for different user groups Children’s hospitals in urban settings or large, academic referral centers must invest heavily in creating a culture of readiness and a response plan for any disaster, natural or otherwise, that they may encounter (Karlsberger 2005). Proposal---“Magic touch" Proposal---“Magic touch" Expedite the registration process for repeated chronic patients. The fingerprint identification allows the kids' self-registration Incorporated with CPOE (Computerized Physician Order Entry) systems and EMRs (Electronic Medical Records) to retrieve patient history All ages of kids can enjoy creating their own art pieces. Easily cleaned and sanitized. Problems Addressed & Evidence Efficiency and fun EMR /CPOE can improve clinician workflow, reduce errors, and increase revenues through reduction in billing delays. (Greiger G. et.al. 2003) Patients’ perceived quality of care and opportunity of interaction was significantly higher in the more attractive waiting room settings. (Becker & Parsons, 2007)