MedStar Emergency Department Internal Innovation Challenge

Challenge judge Jonathan Davis announcing the winners.

Background

When an emergency happens, MedStar Health Emergency Departments (EDs) are equipped with cutting-edge technology and an experienced staff to care for patients and their families. In fact, MedStar receives more than 500,000 ED visits each year across the system.

Two questions were at the heart of the MedStar Health Emergency Department Internal Innovation Challenge:

  • How might we catalyze innovation energy within and among a diverse group of MedStar Health ED associates?

  • What ideas might those associates have to (innovatively) improve the ED experience across our system—regardless of their job in the department?

MedStar Emergency Physicians co-sponsored the Challenge with the MedStar Institute for Innovation (MI2), MedStar Risk Management, and MedStar Nursing, awarding two winning teams with two great prizes: further exploration of the top ideas and tickets to a sporting event.

 

 

Summary

MedStar Health Emergency Department associates shared ideas to improve the MedStar ED experience for all.


Team

MedStar Institute for Innovation’s Innovation Challenges team
(in partnership with MedStar Emergency Physicians, MedStar Risk Management, and MedStar Nursing)



Idea

In March 2019, the Challenge invited MedStar associates whose main job responsibilities focus on the ED—including nurses, physicians, advanced practice clinicians, techs, security, social workers, and any others—to submit ideas individually or in teams of up to five people that could change their ED shift.

More than 50 ideas were submitted online summarizing the problem, solution, value proposition, metrics, and barriers. The Challenge Steering Committee then identified 25 semifinalists for inclusion in a process that crowdsourced finalist selection: ED colleagues could each cast up to 10 votes for ideas with the greatest potential via an online survey. Nearly 1,500 votes identified the eight finalists.

In April 2019, seven finalists each presented a 4-minute pitch, either in-person or via recorded video, followed by a 4-minute Q&A, to a panel of judges and other attendees at the MedStar Innovation and Design (MIND) Lab located off the main lobby of MedStar’s corporate headquarters in Columbia, MD. The judges selected two winners after a closed-door discussion.

Impact

The MI2 team and its partners are further exploring the following winning ideas, among other submissions.

  • Pictured from left to right: Challenge Steering Committee member Kevin Maloy with finalists Carolyn Phillips and Michael Yacovelli

    It’s 2019, and we read a medical record number (MRN) on the phone to admit a patient? A hospitalist communication system for admissions
    Carolyn Phillips and Michael Yacovelli; MedStar Washington Hospital Center and MedStar Georgetown University Hospital; Emergency medicine resident and attending physician team

    When ED providers seek to admit their patients into the hospital, they communicate with the hospitalist team: a group of internal medicine providers who care for patients solely while they’re in the hospital. Despite electronic health record (EHR) and text messaging technology, however, the current process requires ED providers to page hospitalists without any information about why they’re paging, and to read basic patient information that’s already available in the EHR over the phone when they do receive a call back, such as the patient name, MRN, medical history, presenting chief complaint, pertinent labs, and imaging data. This winning team envisions leveraging technology that facilitates communication between hospitalists and the ED providers—so hospitalists can better review cases before responding to ED providers. This allows for a more informed, purposeful conversation. By doing this, the team sees a potential to improve the handoff process with respect to patient safety and outcomes. The team is exploring the short- and long-term technology and workflow solutions, including use of pre-existing EHR orders for hospitalist consults, automatic messages to hospitalists to flag these consults, and an integrated mobile secure messaging app.

     

  • Pictured from left to right: Challenge finalists Munish Goyal, John Brickley, and Lindsay Batson

    Less PercoceT and more PT: The MedStar Health Urgent Physical Therapy Program
    Munish Goyal, John Brickley, Lindsay Batson, and Liz Delasobera; MedStar National Rehabilitation Hospital, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, and MedStar PromptCare; Physician and physical therapist team

    Patients commonly turn to EDs and urgent cares for management of their soft tissue injuries (e.g., ankle sprains). In turn, they are often prescribed pain medications and advised to follow up with their primary care doctor, orthopedist, or podiatrist for an appointment that may happen one to two weeks later. Alternatively, this winning team proposes that emergency providers prescribe early physical therapy, which optimally includes an appointment within a day, to strive for benefits such as reduced inflammation, targeted strengthening, neuromuscular re-education, reduced pain, less medication (including opiate) use, and faster and safer return to function. However, it’s difficult for many emergency providers to make a warm handoff to a physical therapist due to access issues and uncertainty with insurance requirements and if prior authorization is needed. The team proposes building a seamless, comprehensive system to ensure quick patient access to physical therapy. The solution includes providers placing an order for physical therapy in the EHR and the ability to send one email to MedStar central scheduling to manage the one-day referral and insurance needs. The team also envisions working with MI2’s MedStar Telehealth Innovation Center to ensure a telehealth physiatry visit, with the physical therapist mediating that telehealth appointment between the patient and physiatrist.

Resources

News

Think Differently

  • MedStar Innovation and Design (MIND) Lab
  • MI2 Forum
  • Concepts That Count
  • Good Reads

Our Work

  • MedStar Health Simulation Training & Education Lab (SiTEL)
  • MedStar Health National Center for Human Factors in Healthcare
  • MedStar Inventor Services
  • MedStar Telehealth Innovation Center
  • MI2 Influence Center

What is Human Factors Engineering?

Human factors engineering (HFE) is the science of understanding the properties of human capabilities and limitations and applying that understanding to the design, development, and deployment of systems. It is a multidisciplinary field incorporating contributions from industrial engineering, cognitive psychology, industrial design, statistics, operations research and anthropometry. Human factors involves the study of all aspects of the way humans perform and they way in which they interact with the world around them, with the aim of improving operational performance and safety.

How Does HFE Apply to Healthcare?

HFE is applied to healthcare to design processes, devices, and systems that support the work of care givers. Specific benefits of HFE applied to healthcare include:

• Efficient care processes;
• Effective communication between care providers;
• Better understanding of a patient’s current medical condition;
• Reduced risk of device use error;
• Easier to use (or more intuitive) devices;
• Reduced need for training;
• Easier repair and maintenance;
• Cost savings through mitigation of adverse events;
• Safer healthcare working conditions; and
• Improved patient outcomes

HFE should take place early in the system development process. It should include tools such as work domain analysis, function allocation, probabilistic risk assessment, usability testing, among others.

MedStar Institute for Innovation Intake Form

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National Center for Human Factors in Healthcare Team

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Raj Ratwani, PhD
Acting Director and Scientific Director, National Center for Human Factors in Healthcare
[email protected]

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Rollin (Terry) Fairbanks, MD, MS, FACEP 
Founding Director, National Center for Human Factors in Healthcare
Associate Director, MI2 
[email protected]

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A. Zach Hettinger MD, MS
Medical Director and Director of Cognitive Informatics, National Center for Human Factors in Healthcare
[email protected]

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Grace Tran, MS
Director, Human Factors Safety Integration
[email protected]

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Lawrence Wolpert, PhD
Director, Usability Services
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Angela Thomas, MPH, MBA
Executive Director, Health Services Research Administration, MHRI
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Allan Fong, MS
Research Specialist
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Natalie Abts, MS
Senior Program Manager, Usability Services
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Katie Adams
Research Assistant
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Erica Savage, MHA
Project Manager
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Kathryn (Kate) Kellogg, MD, MPH
Associate Medical Director
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Amy Will
Research Coordinator
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Daniel Hoffman
Research Assistant
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Jessica Howe, MA
Research Specialist
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Natalie (Nat) Benda, MS, PhD
Senior Research Fellow
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Nicoleta Parau
Business Manager
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Josh Puthumana
 Research Assistant


AnnKatherine Hoobler
Administrative Coordinator
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Rebecca Butler
Usability Specialist
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Lucy Stein, MS, OTR/L, CAPS
Clinical Human Factors Specialist
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Bidisha Roy
Research Assistant
Usability Services
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Tracy Kim
Tracy Kim
Research Assistant
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Ross Filice, MD
Ross Filice, MD
Clinical Informatics Scientist
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Joseph Blumenthal, BA
MI2 Clinical Informatics Developer
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Lisa Calkins, MS
Usability Specialist
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Thomas Scheurich, MS
Usability Specialist
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Rachel Wynn
Rachel Wynn, PhD
Post Doctoral Fellow
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Deliya Wesley
Deliya Wesley, PhD
Health Equity Scientist
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Kristen Miller
Kristen Miller, DrPH, CPPS
Senior Research Scientist
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Danielle Mosby
Paula Royster
Project Coordinator
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