How can people-centred design improve the patient experience in Intensive Care Units (ICUs) whilst improving the setting for the clinical staff?
This two year-long research and develop-ment project was carried out in partnership with The London Clinic. The output is ‘Senso’, an app that provides sensory stimulation for patients who are admitted to Intensive Care Units (ICUs) post-operation, with the overall aim of offering relief and improving mental wellbeing to the patient during their recovery in the ICU.
Care Unit (ICU)
A hospital ICU treats patients who are in a critical condition and in need of life support. This usually includes organ support and/or heavy medication, both of which can present further problems such as severe discomfort or delirium – these can exacerbate symptoms of stress in patients. Research has shown that patients often experience severe difficulty in sleeping, their day-to-day routines disrupted by their physical condition, medical treatments during hours of sleep, and other external factors related to the ICU environment. This affects the patient’s sense of orientation, which in turn has an impact on their physical and psychological wellbeing.
In the past, it was thought that ICU patients should be heavily sedated during their recovery time. However, now that it is generally understood that it is better for patients to be conscious during recovery, this can often result in a more distressing experience due to their raised awareness of the ICU environment – often described by patients as alien, overly clinical and full of alarm noises. Depending on their condition or stage of recovery, the patient will move through different levels of consciousness, from being fully sedated to fully responsive to their surroundings. At these different stages, the patient will need different kinds of mental support and relief. Likewise, it is now widely recognised that ‘humanising’ the patient experience can contribute to the overall wellbeing of the patient, and so it is important that staff know how to engage with each individual. This is where the Senso app helps.
The work leading up to the development of the app involved Research Associate Gabriele Meldaikyte’s in-depth engagement with ICUs in four hospitals – three in London and one in Reading – shadowing staff, talking to nurses and relatives, observing patients’ experiences and the procedures of the different ICUs. As part of the 24-month research and development process, Gabriele conducted 17 interviews with former ICU patients, eight co-development workshops with both patients and healthcare professionals, and took part in several conferences.
Senso is an app that is personalised to each individual patient. Situated within easy reach of the patient (i.e. attached to their bedside table) and tailored to suit their interests and individual tastes, Senso aims to improve the sensory experience and navigation of the ICU environment. The first version of the app has been designed for patients going through a planned surgical procedure that may require a short ICU stay.
To initiate Senso, patients go through an onboarding process before being admitted for surgery. The process includes the selection of images, sounds and smells that will be made available to the patient once they are in the ICU ward. Additionally, the onboarding process helps patients gain an understanding of the ICU environment prior to admission with the aim of easing anxiety and fear. After onboarding, Senso generates a mood board from the selected images and videos. This not only provides a familiar view for the patient but can also help staff to engage personally with them.
A daily schedule helps relatives understand the patient’s day-to-day activities and progress. Furthermore, Senso provides patients with a daily routine, supporting them through their journey from leaving the operating theatre through to the point of discharge from ICU. Our hypothesis is that by providing structure to the patient’s day we will help in orientation and engagement.
See 2016 project