EMergency departMent (ED) Dashboards Jefferson
Defining the purpose and design of ED Dashboards to best serve floor staff in the Emergency Department.
Role Lead Design Researcher, UX Designer, Manager
Project Goal Understand why the ED Dashboard wasn’t being used, what would make it valuable to floor staff, and redesign accordingly.
Project Considerations Needs of leadership vs. floor staff, the role of a dashboard, staff needs and behavior
Skills Highlighted Contextual inquiry, shadowing and interviewing, analysis, synthesis, wireframing, A/B testing
ABOUT THE PROJECT
DICE created dashboards for the Emergency Department in 2017, following instruction from ED Administrators. The dashboard worked perfectly for the administrators, who proudly displayed it on large monitors in the ED.
Floor staff was frustrated by the dashboards which displayed data that meant nothing to them. Hearing about their dissatisfaction, our team decided to re-investigate in 2018 to determine what, if any, value a dashboard may be to the nurses, physicians, techs, EVS, and transport staff working in the ED.
At the same time, Emergency Departments from Jefferson’s hospitals in New Jersey were interested in getting dashboards for their departments. While we investigated the potential of a dashboard to support floor staff in the ED in Center City, we also looked into how our hospitals in South Philly, Stratford, NJ, and Washington Township, NJ might benefit from an ED dashboard. The goal was to create one dashboard design that worked for all Jefferson Emergency Departments.
I was responsible for all of the initial research, analysis, synthesis, and wireframe creation. There was a pause after that, and when the project resumed, I oversaw A/B Testing, wireframe refinement, and visual design by two of my team members as their manager.
Emergency Department nurses station in Center City Philadelphia.
The original Emergency Department dashboard.
Research + Analysis
Site Analysis + Contextual Inquiry
The Emergency Department is a unique environment, and every ED is different. It was important for us to understand the software used, workstations, floor plan layouts, and movement within the various EDs we were designing for to understand how and where a dashboard would make sense in each department.
The environments would likely dictate where the dashboard lived, and therefore, what information would be useful in that area.
Understanding the software and placement of workstations helped me understand what information team members already had frequent access to, how they used the information presented, and what effort it took to access that information.
Interviews + Shadowing
Interviews with physicians, nurses, techs, and support teams as well as administrative employees like the nurse manager provided valuable information about the current use of the dashboard, patient flow, how they think of their time at work, and common workflows and processes in the ED.
Shadowing nurses and techs, and speaking with physicians on staff provided eye-opening insight into just how much these team members are moving around and working in Emergmency Health Records (EHRs) at the workstation computers strategically placed around the ED.
Journey Mapping
Journey mapping helped visualize how floor staff move around the ED. This gave insight into where dashboards may make the most sense, or, if there aren’t options for placement, what information would make the most sense based on where the dashboards would be and how that physical location fits in their workflow.
Affinity Diagramming
After many interviews, shadowing visits, and contextual inquiries of software and physical space, there was a broad range and depth of raw data. Affinity diagramming was a helpful tool for sorting through that data and finding connections that may not have surfaced otherwise.
User Roles
Understanding the roles of the care team members in the Emergency Department and how they coordinate and work together helped to inform what kind of information would best support the care teams.
Findings
APPROPRIATENESS OF A DASHBOARD
This research found that, while the original dashboard did not support care teams, there is a valuable opportunity to better support care teams in the Emergency Department with a dashboard.
The Electronic Health Record systems provide all the information needed for patient care and most ED staff have sufficient access to workstations to access that platform, however, the constant movement of floor staff and the support that basic data offers for immediate decision making, like which direction to go in next, saves time and energy for many team members, while empowering others to make decisions independently.
The best way to support floor staff efficiency through a dashboard was found to be:
Enable care teams to see high-level information about their patients at a glance and while moving across the room both to help them make decisions about where they need to go next and to inform others about next steps for patients.
Empower techs to know where to go and who to support without needing to check in with a nurse or get permission to act.
UNIQUE USERS
Every person in the Emergency Department has responsibilities that impact other team member’s work, and some have overlapping responsibilities which may roll onto other team members if someone fails to complete a task in time.
Coming and Going
Support Staff
EVS and transport operate within their own system; they come into the ED as needed but are not stationed there, meaning they can be anywhere at anytime and the person who shows up to complete a task isn’t plugged into whatever else is going on in the ED. However, their actions directly influence the workings of the ED.
Admin
Emergency Room Administrators, like nurse managers and their leadership teams, benefit from the type of data we were originally aggregating, like patient wait times, patient time in their rooms, and left without being seen rates. While they spend some of their time on the floor, they benefit from having access to this information in their office area, where they are likely to be communicating with other leaders.
On the Floor
Physicians
Moving around less than nurses and techs. Need to spend more time at the computer to review patient data, write notes, create and check orders, and watch for new patients.
Nurses
Moving around constantly to check on and tend to patients, run to workstations to check and input data, and to confer with techs and physicians.
Techs
Main responsiblity is to support the nurses and physicians by completing tasks to reduce their workload. Techs are very important and incredibly helpful, but their knowledge and independence varies by individual, and some techs may slow down nurses’ workflows by constantly checking what is needed and where they should go.
Requirements + Wireframing
Design Criteria
These criteria were extracted through analysis and synthesis and confirmed by floor staff.
Must be easy to read from a distance and while moving.
Colors and images must coincide with those in the EHR.
Information displayed must support immediate decision-making and independence.
Information must help staff manage their time and patients.
Information must support team coordination.
Make data points clear by providing time references and locations.
Support care team-patient communication.
Wireframe with blueprint layout.
First wireframe- thinking through how to display information about both A side and B side of the ED on one screen.
Required Data Points
I determined the following data points would best support floor staff’s workflows and coordination, and confirmed the list with care teams.
Next room to be filled.
Wait time for a bed.
Number of patients waiting for triage.
Number of patients waiting for a room.
Total number of patients.
Total number of patients seen.
Number of readmits.
ED status.
Next side for Trauma Patients
Patient information: HIPAA compliant identifier and room, acuity, orders, how long waiting for orders to be filled.
A/B Testing and Refinements
During conversations with care teams, I floated the idea of a blueprint layout instead of the numerical layout they were used to seeing in the tables of data in their Electronic Health Record systems.
Care teams loved the idea and it seemed that the concept may be helpful in knowing exactly where to go rather than having to think about the layout.
As I reviewed the wireframes with teams, however, I noticed confusions around orientation and was concerned about implementing the blueprint for the layout. When the project resumed, the first request I had for my team members was to A/B test the dramatically different layout with a more traditional numeric organization.
The outcome of this test showed that while teams were excited about the concept of the blueprint layout, the numeric organization was more practically efficient.
Visual Design
The visual design of this dashboard carefully considered color, graphics, text styles, and data visualization techniques such that the information would be easily understood and digested by floor staff at a glance and while in motion.
