Designing Experience for Logistics Flow Overview

Northern lvsborgs County Hospital(NL)

Trollhttan, Gothenburg, Sweden

Sefat Chowdhury

Interaction Design Final Year Class project

Chalmers University of Technology
Gothenburg, Sweden

Home Screen
The most important information that the nurses always need to know is the patient's health condition. Hence I
decided to visualize patient priority information on the home screen. Below is how the home screen works:
1. Each bubble represents a patient.
2. The text on the bubble (B2, A7 etc.) tells where the patient is located (hospital section/ward).
3. The color of the bubble represents patient priorityOrange being the critical, Yellow of medium threat and
Green means the patient is safe. Red is only used in case of life threatening situation which is not very desirable
for any patient. The dot inside a bubble indicates awaiting actions(e.g. test results waiting, time for medication
etc.)
4. The bubble size increases as the gap between current time and the last check up time for a patient increases.
The nurse strives to keep the bubbles as smaller as possible.
5. The bubbles float around the screen. They can be moved around/tapped/clicked. Tapping or clicking a
bubble reveals the account details for that patient.

Patient Details
In this section, all the required information about a patient is recorded and displayed. Some notable features
are:
1. Nurses can check to-do list and add new entry by clicking the journal icon.
The timer can be used to set reminder if required. If set, the reminder is displayed as a dot inside
the bubbles in the home screen.
2. The patient data are shown as list of blocks. Nurses can add new data block or delete an existing one.
Current graphs are used as placeholders that are supposed to be replaced by actual graphs. The placeholder
view provide a sense of how certain variable has changed(e.g. Blood pressure) in last few days/hours without
the need of getting into the details. Of course it is also possible to know the details by clicking/tapping on the
small display icon at each corner of the block.
3. The patient location is shown at the right-top. The blue dot indicates the patient is at the blue section of the
hospital.

Patient Details (continued...)

4. Nurses can add new tasks and also check existing chores/tasks by clicking the journal icon that is only
applicable to that particular patient. The journal icon turns green if there is a task that requires attention within
short period of time. Besides, the timer can be used to set any special reminder. Whenever a reminder is about
to go off, it is shown as an awaiting dot in the home screen bubble.
5. A new variable about a patient can be added by clicking/tapping on the empty block. In that case, a new
modal window appears and the nurse can select the data (e.g. Heart rate) from the list.

Patient details (continued...)

1. The newly added block is shown by highlighting the area. The highlighting color disappears in few seconds.
2. If a variable is not normal (e.g. Body temp) the corresponding icon glows. The nurse can check the condition
and change the priority if required. For example, the priority is set to orange now. Moving one step to the left
gives yellow and to the tight gives red.
3. The basic information(age, allergy etc.) about a patient comes from the initial registration section.
4. The nurse can check on the other nurses and doctors by clicking/tapping on the icons at the top.
5. The nurse can call up or chat with other nurses as well which is placed at the right-bottom corner of the
screen. The nurse sees pending messages as notification that bubbles up where the red speech bubble is
shown.

Cause and Effect

1. In this section, any staff can check the cause (treatment/ actions taken by doctor/nurses) and effect (the
change in patient) flow for any given amount of time.
Use case scenario:
Pernilla Augustsson's blood pressure and heart rate seem to be at alarming condition. So, the doctor assigns a
blood test and x-ray test . The test report says x-ray report has a yellow level threat and blood result has it at
orange level. The doctor prescribes certain medication(green pill icon) which in turn proved to be effective and
the blood situation turns normal over time(green blood icon). The icons are tappable/clickable to reveal more
details test details and medication details to be precise.
2. The staff can set a range of time period to check the progress/ flow of any patient. The cause and effect flow
is swipe-able to the left and right.

Comparison (Correlation and Pattern recognition )

1. In this section, the staff can compare different patient data sets. The data visualization helps the doctors and
nurses to discover patterns that can help them discover and realize the source for many problems.
2. The staff can choose from a list and select to bring them on the stage for comparison. For example, the
figure shows the comparison between blood pressure and respiratory rate of Pernilla Augustsson for last 1
week. Depending on the time length the data visualization can expand further to the left ad right of the screen.
In that case, the user has to scroll to the right and left. The zoom feature can be enabled to adjust effective
viewport.

Task Prediction
1. In this section, the nurse choose from several task routes that are presented to her based on the current task
selection. For example, this nurse is dealing with 9 patients under her supervision. For her next task she chose
Pernilla Augustsson. The task prediction tool shows her 3 different routes to choose from so that she can
accomplish rest of the task the safest way possible(route 3 in this case).
2. The task combination is dynamic and highly prone to change anytime depending on the patients' physical
condition. The staff choose a task, completes it and update the routes before continuing with the next task. It is
also possible to play around with different selection to find the safest path. This task completion with constant
discovery is inspired from the popular game chess and the prediction mechanism is known as 'pruning'.
3. The blocks in the figure represents the patients. The colors stand for priority. Every block is movable and the
staff can play around with different settings to discover new combination. The blocks with a smaller block inside
means those patients' condition might degrade if it takes too long to check on them.
4. In reality, it is not possible to know when a patient's condition would change but if the system learns patient
profile, disease type and other determinants then it is possible to come up with more reliable task
predictions(machine learning) .

UX RESEARCH
Contextual Enquiry
Notes from the observation are listed below:
The ED environment is highly stressful. There are interfering noise beeps, blinking lights and different displays being constantly updated
and being monitored. At the same time nurses and doctors are dependent on various means of short verbal communication.
There is constant flow of information through multiple channels. Everyone shares information, sometimes without it being shareable, for
example the journals. Sometimes the doctors and the nurses disappear with journals and thereby make them unavailable for others.
The system that is being used does not scale well with the demand. The patient locations are marked on the placement card holder that
only has slots for 10 patients even though there are as many as 45 patients sometimes. In that case, the staffs roughly estimate how many
cards are piled up, allocates their time accordingly for each patient and even multitask by running here and there. This whole process is
extremely stressful and hard to transfer as every staff has their own cognitive process to organize information and treat each patient with
equal care and attention.
The hospital staffs interchange their responsibilities depending on the various emergency demand or patients severity level. They
communicate through wireless radio within the ED premises. However, this changes do not get updated in the software system. That
means, resource management and planning staffs allocation are big issues and the existing system does not by syncing or updating.

Artifact analysis
The 11 different types of tools that are used to handle various data are listed in this page. The data types variate inway of communication
(one-way, multiple way), technical in and output (digital, analog), registration of information (hearing, vision, sensory) and resources using
the different types.
Tool

Data type
Extensive patient
information
Room of patient, short
patient information

Users
Doctors, Nurses,
Administrators

Why?
See previous history, full
Journal
medical records
Fast overview of patient
Placement cards
Nurses
placements
Overview of the basic
Elvis
Patient order and priority
Nurses
patient facts
Referrals, tasks to be done
See other wards, send
Melior
Doctors
by other wards
referrals
Get information down fast,
Dictation
Verbal monologue
Doctors, secretaries
later to be transcribed by
secretaries
Doctors, Nurses,
Immediate update on
Heart Monitor
Graph on screen
Administrators
patients heart condition
Fast handover, cross
Patient updates,
Mostly nurses but also
Verbal communication
checking that information
handovers
doctors
has been perceived
Adding additional data
Post its on journals
Patient updates
Nurses
and updates
Making sure specific
reorganization of patient,
Doctors, Nurses,
information is perceived by
Phone
moving patients
Administrators
specific resources. Check
situation in other wards.
As a template to make
Comparing values to
Doctors, Nurses,
sure the same prioritization
Retts A
prioritizing patients
Administrators
is made by different
resources.
Sending test documents
A fast way of sending
Doctors, Nurses,
Tube messaging
and pictures between
specific documents to
Administrators
wards
specific wards.
Fig: Tools used at NL by the hospital staff *The highlighted tools are the ones mostly used.

Interview
We interviewed the nurses, doctors and Kristofer Bengtsson. Some answers were repeated several times and patterns in communication:
Nurses and doctors had very different working routines and programs. Nurses mostly relies on direct verbal communication, Placement
card holders and Elvis. On the other hand, doctors uses Melior and dictation(reference: tools chart). By having different routines and
priorities, the understanding for overall discipline was lacking and never in sync.
Nurses handled patients as an ongoing flow while doctors saw them more as specific tasks. While the nurses focused on the patients
entire flow and taking care of a person, the doctors rather focused on fixing specific problems to most effectively solve a problem. In
general, the nurses seemed to be empathic in terms of ensuring patients care where as the doctors had a more engineering way of
thinking.
The mental workload was immense for both the doctors and nurses. Usually in pressed situation, high stress level and demands it was
difficult to effectively handle everything while being the link between hospital and patient at the same time. This could easily be perceived
as a feeling of chaos.

User Scenarios
Scenario#1
Pernilla Augustsson
Woman, 27 years old, comes into the emergency. Her condition starts as hangover but develops into heart palpitation, anxiety and
dizziness. At the reception P1 get registered. Her name and person number as well as a brief explanation of her medical emergency is
written down. A triage is then performed where the basic parameters are filled into a journal. By filling in different parameters for blood
pressure, pulse
rate, temperature and more the patients priority is filtered with RettsA, which helps the staff determine which prioritygroup the patient
belongs to. The system suggests a priority which the staff can choose to ignore or to accept. Between the actions the patient sits in the
waiting room waiting for her next task to be prepared.By logging in with her person number she can see what her priority is, depending on
different values just input by the nurse during triage.
The nurse chooses the next person to tend to depending on two aspects: first and foremost priority, Red, orange, yellow/green but also
size of the patients bubble which indicates the time since the patient last got updated/ had an exam. When it is time for P1s exam the
nurse and doctor examines the past data and adds to or changes to match the current state of the patient. By changing the perimeters of
the data the RettsA the system suggests a change of priority grading if specific thresholds are reached. When changing priority the patients
get assigned a new colour of their bubble and the size is minimized due to recent exam.
Scenario#2
Aban Hammond
Man, 81 years old, gets signed in to the emergency because of respiration problems and pressure on chest. He soon becomes unconscious
and immediately treated as a red priority. Patient is tended to instantly and when the situation is stable enough the information is
changed in his chart. Since the priority was orange before the unconsciousness and is orange after the treatment the priority is not
changed. What is being filled in though is how the situation changed at that time and how it is currently. Since the blood pressure is one of
the most important aspects for this patient the nurse chooses to keep the view open. This is partially done to see an immediate update of
the situation but also to see how potential treatments might affect other parameters.
When changing the patients data an update is done and a log post is created when the nurse presses save. The log post can be used
later when analyzing behaviour and decision made by hospital staff.The doctor deems that a blood test and a heart xray has to be taken
and therefore puts it on the tasklist. She sees that the blood test can be done right away from the startbuttonbeing pressable. The blood
test is started while the xray is put on cue, meaning it will be sent to the xray ward and done when no higher priorities is on cue before.
When the blood test is done the coordinator sees that another test has to be done instantly, since it might be a risk for a bad reaction to
the medicine prescribed. She walks over to the ward and talks to the nurses. Together they open up the journal and agrees on
measurements to be taken.

Dark background absorbs lights which makes the app more effective and unobtrusive
for the doctors and the nurses while working in low-light, calm environment.

UX Research, UI Concept & Visual Design:

Sefat Chowdhury
User Experience Designer