How can people-centred design improve the patient experience in Intensive Care Units (ICUs) whilst improving the setting for the clinical staff?
The intensive care unit (ICU) works with patients who are in a critical condition, so the care that is provided there is mainly focused on life support. Entry into the ICU usually happens through three distinct paths: planned operation, emergency operation or moving from a regular ward due to worsening physical conditions. The whole experience is medically driven, and from the patient’s point of view, this can be very traumatic. Not long ago, patients in the ICU were generally more heavily sedated; however thinking has changed and doctors believe it is better to sedate people less, so that they are more aware. However, they now experience confusing drugs and lying in an alien environment full of beeping machines that can be extremely upsetting. This situation can bring about delirium and hallucinations.
There are three ‘levels’ of consciousness that categorise different ICU patients. Level 3 is when the patient is highly sedated and not responsive. At level 2, they often have two to three organ supports, do not know where they are, but often remember their hallucinations and visions upon waking. At level 1, the patient is usually aware of their environment and fully responsive, getting bored because there is nothing, not even a television, to stimulate them.
Research Associate Gabriele Meldaikyte has been working with The London Clinic. Over the last year, she has engaged with ICUs in four UK hospitals, shadowing staff; talking to nurses and relatives; observing patients’ experiences and procedures of the different ICUs. She gathered insights from medical staff, conducted many interviews with ex-patients to find out about their experiences, and ran workshops with staff and patients.
Gabriele has identified a key area to create a better patient experience and improve their orientation. Often the patient will not know what time it is, as they won’t have a routine, and they are fed through a tube so they do not have set meal times. This disorientation, combined with interruptions every hour for more treatment, can cause sleep deprivation. The project aims to improve orientation and define routines in order to help normalise sleeping patterns, assist recovery, and reduce hallucinations, boredom and distress.
The final outcome of the project is an app that will provide a personalised sensory experience for the patient. In the case of a planned admission (the idea being that it will expand to emergency cases in the future), the patient would fill in a preoperative assessment, noting down sensory preferences from particular sounds and smells to relaxing videos and photos. This helps the medical team to personalise the experience to them, but also allows the patient to understand the ICU in advance of admission.
The app, called Senso, will generate a mood board of images and videos of their favourite things, helping the staff to engage with the patient and relatives and keep up-to-date on their progress. It also provides them with a daily routine, which supports the patient through all the stages of their ICU stay, from the operating theatre up to the point they are well enough to no longer need it.
See 2016 project