DOME (Designing Out Medical Errors)
Aims
The Designing Out Medical Error (DOME) project aims to better understand and map healthcare processes on surgical wards, establishing an evidence base to design equipment and products which better supports these processes and therefore reduce instances of medical error.
Background
Primum non nocere (‘above all, do no harm’) is considered a fundamental of medical practice. This is in stark contrast to the Institute of Medicine landmark report of 2000, To Err is Human, which revealed that up to 98,000 hospital deaths occur in the United States as a result of medical error each year. A number of studies from around the world suggest that approximately 10% of patients admitted to hospital suffer some kind of harm. A significant percentage of adverse events are associated with a surgical procedure, with as many as 50% deemed avoidable. It has been stated that technique-related complications, wound infections, and postoperative bleeding produce nearly half of all surgical adverse events.
A significant contributory factor is that healthcare processes have undergone many revisions in recent years, while the design of much non-surgical equipment remains largely unchanged. Modern healthcare involves a combination of processes and procedures supported by a broad range of equipment and products that have to co-exist within the 'patient cubicle' or ward treatment space. Few of these have been designed to ensure safe integration within the context of use, be it ward, theatre, or community, nor is this a purchasing requirement within NHS Trusts. In short, current treatments are not properly and effectively supported by available equipment.
Multidisciplinary Approach
Design skills are often engaged late in the stage of development of hospital equipment, and as a consequence the designs can show little regard for the systems in which they work. A multidisciplinary approach is necessary to gain a more thorough understanding of these systems and healthcare processes in order to develop more appropriate products and devices. This collaborative methodology allows systems and products to be considered concurrently, paving the way for process reforms as well as new designs.
The research team consists of staff from the Royal College of Art Helen Hamlyn Centre, Imperial College London and St. Mary’s Hospital, Paddington. It brings together designers, clinicians, ergonomists, psychologists and academics in the fields of design, business and patient safety.
Project Plan
The project has a 36-month duration, and is divided into seven work packages, running sequentially, but overlapping at points.
The first work package is a ‘broad brush strokes’ outline of the patient journey for elective surgery from a clinical, psychological and design point of view. The purpose of this is to highlight points in the broader system prone to error, and to set the context for work package two.
The second work package concentrates on the hospital ward, the main location for subsequent design work. More detailed healthcare processes will be outlined, along with associated errors, and this will be linked in to the patient journey outlined in work package one to establish a firm grasp of ward-based processes, their errors and context.
Work package three uses this as a basis for research into analogous industries, learning from other sectors where risk is tightly managed. Imperial College Business School leads on this research. Lessons learned from these industries add an extra dimension to our understanding of healthcare processes and associated risks and risk management.
Work package four focuses on translating the accumulated knowledge of processes into developing demands on equipment, resulting in a series of briefs for design work. Performance requirements for these are generated and assessed against the knowledge of systems gained previously.
Work packages five and six involve the specific research, co-design, development and testing of a series of exemplar products to illustrate the validity of the performance requirements outlined above. This is carried out iteratively to refine the exemplar designs.
Deliverables
The extensive clinical research will feed into a series of maps defining healthcare processes and associated errors. A series of design briefs will result from these maps. This, in turn, will lead to new designs of equipment for hospital wards.
This work will be disseminated through the academic channels of publications, conferences and presentations, through exhibitions of design work, and through the commercialisation of designs, exploitation of intellectual property and engagement with the wider healthcare and design communities.
Partners
Engineering and Physical Sciences Research Council (EPSRC)
The EPSRC are the main UK government agency for funding research and training in engineering and the physical sciences, investing more than £800 million a year in a broad range of subjects – from mathematics to materials science, and from information technology to structural engineering.
Royal College of Art Helen Hamlyn Centre
The RCA has a long-standing interest in healthcare design dating back to the 1960s and the development of the standard or Kings Fund hospital bed. This work is now based in the Helen Hamlyn Centre where the focus is on Design for Patient Safety, with current and recent projects impacting on the design of packaging for oral and injectable medications, surgical instruments, ambulance design, infusion pumps and the preparation of drugs for anaesthesia.
Imperial College Business School
Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research.
