Authors (including presenting author) :
TAM YK, TANG TK, ANN F, WONG OC, CHAN YFo, FOK KM
Affiliation :
Department of Neurosurgery, Queen Elizabeth Hospital
Introduction :
Neurological emergencies are associated with airway compromise and respiratory failure. Patients with catastrophic neurological injury may require immediate airway management and prolonged mechanical ventilation; therefore, tracheostomy procedures are commonly performed on neurological patients. However, tracheostomy emergencies and complications are associated with significant morbidity and even mortality. Blockage and displacement of tracheostomy tube are classified as a life threating condition and account for the vast majority of the tracheostomy related incidents. In order to enhance patient safety and improve quality of care, it is important to identify the obstacles encountered by the clinical staff when caring tracheostomized patients and to assist them in overcoming those difficulties.
Objectives :
To assist the frontline staff in tackling the obstacles hindering the tracheostomy care through design thinking process.
Methodology :
Design thinking is a methodology to develop solution with the sensibility and creativity of the human being. It consists of five phases namely, empathy, define, ideate, prototype and test. Total 25 frontline staff including 7 doctors and 18 nurses were participated in the semi structured interviews to investigate for the difficulties they encountered when caring tracheostomized patients. Apart from the interviews, site visit and photo safari were conducted to investigate the obstacles in ward hindering the tracheostomy care. With the methodology of design thinking, it was found that the accessibility and availability of the tracheostomy equipment were the biggest concerns for the frontline staff. A mnemonic care practice: TRACHE and a tracheostomy emergencies kit were developed through design thinking process and piloted in the Department of Neurosurgery . The effectiveness of the product was evaluated with the philosophy of lean management and the satisfactory survey was performed. (Abbreviation: TRACHE: T-Tape securement, R-Resuscitation procedure, A-Airway clearance, C-Care of the site, H-Humidity, E- Emergencies kit)
Result & Outcome :
From lean management’s perspective, tracheostomy emergencies kit eliminated 8 wasteful processes in current state value stream mapping. It showed significant reduction on the total value added and non-value added time. It decreased the total lead time for the preparation of resuscitation equipment by 76%, compared with the conventional method. Design thinking explores the frontline staff’s unmet desires and places their demands front and center in the problem-solving process, hence, creating the solution in a human center way to achieve the success.
