Design Challenge and Design Ideas

Each of the 680,000 patients that are admitted to Irish public hospitals annually will undergo a procedure involving the insertion of a cannula or “line” into one of their blood vessels. Usually completed by nurses or junior doctors, this procedure is more difficult in up to 20% of these patients. The inability to obtain intravascular access can be a barrier to administering medications, result in multiple failed attempts, and cause unnecessary trauma.
Ultrasound-guidance is used in these cases but, the skill is often reserved to specialist anaesthetic doctors. Trying to coordinate access to this expertise when specialists are dealing with emergencies and critically ill patients proves difficult, causing shared frustration between patient, practitioner, specialist, and hospital management.
In the context of a busy public hospital, can we use this shared frustration and deficiency in patient care to produce a shared solution that benefits all stakeholders and improves care?

How the brief was fulfilled

Ethnography, autoethnography, and user interviews were undertaken as part of the research approach among junior doctors and anaesthetic trainees. A literature review consisting of 3 databases (PubMed, Academic Search Complete, and EBSCOHost) provided evidence supporting our findings and informing best practice for patients. A survey created using Braun & Clarke best practice in medical education guidelines was delivered to the cohort of intern doctors in the hospital site. Research was conducted in the field during each team members work day.
Inductive thematic analysis was undertaken. Affinity diagrams, journey maps, and a service blueprint were presented to senior doctors/nurse managers. Points of frustration and time-inefficiency were identified using a systems-thinking approach. Best practice was illustrated based on primary research findings among intern doctors and supported by evidence obtained through peer-reviewed literature.
With the aforementioned analysis undertaken, potential solutions were explored by the multidisciplinary team with reiterative feedback obtained from a representative sample of junior doctors and anaesthetic trainees in a dynamic design process.

Our design needed to be:
1. low-cost for all involved
2. time-efficient in the context of a busy public hospital environment
3. high-fidelity to ensure competence/confidence
4. produce a research output for further development among other hospital departments and sites.

Our design comprises 3 elements:
1. Low-cost, high-fidelity simulation model prototype – Given the expense associated with “phantom limbs” for the practice of inserting intravenous cannulas, a homemade model was created using gelatin, food-colouring, and penne pasta ensuring the intervention was free at the point of access.
2. Near-peer led workshop pilot – Anaesthetic trainees led a workshop teaching junior doctors the skill of ultrasound guided intravenous cannulation refocusing frustration into constructive action.
3. Capacity building pathway – Junior doctors that request the assistance of specialist anaesthetic doctors undergo additional training at their earliest convenience at no additional cost to ensure dissemination of learning at the pain point experienced by all parties.

Based on this simulation model prototype and workshop pilot, the educational department within the hospital adopted the design and expanded its reach to more doctors improving patient care, cost-saving, and learning throughout the hospital.