Vital Signs Trolley, Designing Out Medical Error (DOME) - Prototype design (2008-2011)

West was the lead researcher (PI, Myerson) on a multidisciplinary project with partners from Imperial College London to improve patient safety in the hospital bed space. West conducted and coordinated research between RCA designers (West and Davey) and clinicians, psychologists, patient safety experts and process management academics in Imperial College London. West led on drawing evidence from how analogous industries manage risky processes such as mining, chemical, oil exploration, shipping and construction, to find new ways of reducing systemic error on surgical hospital wards. This research developed a number of design interventions in the hospital bed space. West developed the Vital Signs Trolley as a direct result of the analogous industries study and collaboration with clinical partners. He found that the main problem with the trolley, which measures vital signs such as blood pressure and temperature, is that data is not captured accurately, the unit is hard to clean and its trailing wires spread infection. West’s new trolley has an easy-clean design, an improved cable management system and a digital transcription system to avoid errors. The design was refined for manufacture in collaboration with an industrial partner, Humanscale. The thinking behind the Vital Signs Trolley built on West’s previous work on the award winning Resus-Station (2006-2008), a resuscitation trolley that is now in clinical trials. West presented the DOME interventions, including the Vital Signs Trolley, at the ‘World Congress on Design and Health’ (USA, 2011) and published ‘Taking ergonomics to the bedside – A multi-disciplinary approach to designing safer healthcare’ in Applied Ergonomics, October 2013 (West REF Output 1)

Neck Brace (Cervical Collar redesign project)

Matthews, an industrial designer and medical engineer, led the RCA’s workpackage in a multidisciplinary research project to develop a new neck brace to improve safety and comfort for people with spinal injuries. He worked in partnership with clinicians from the University of the West of England, the Royal National Hospital for Rheumatic Diseases, the Great Western Ambulance Service, and the Bath Institute for Medical Engineering, under the National Institute for Health Research’s i4i programme. If it is suspected that an individual has fractured a neck vertebra in a fall or accident, ambulance staff fit a cervical collar to immobilise the neck in order to avoid further injury. Current solutions can be ineffective at limiting head movement; they may also increase blood pressure in the head by restricting the return of blood to the body. Matthews studied the complete patient journey, analysing the anatomy of the upper chest, neck and head, and the way that existing collars are used. The evidence collected formed the basis of a brief for the design and development of a better neck brace. Based on the principle of creating a band around the crown of the patient’s head and supporting it through rigid struts bearing on the chest and shoulders, a number of basic prototype structures were made and tested. The resulting patented low-cost ‘Kensington Collar’ has a front frame, adjustable for height and width, that attaches to a rear support, providing better neck immobilisation, unimpeded return blood flow, greater patient comfort, easy fitting for the clinician and clear access for examinations and x-ray imaging. Matthews presented the design at the AHRC Skills Development in Design Practice Workshop, Kingston University (July 2013), the Flexibility in Enterprises Conference (Tallinn October 2013) and the Student Paramedics Conference, University of Hatfield (2013)

UV laser photoactivation of hexachloroplatinate bound to individual nucleobases : In vacuo as molecular level probes of a model photopharmaceutical

Isolated molecular clusters of adenine, cytosine, thymine and uracil bound to hexachloroplatinate, PtCl6 2-, have been studied using laser electronic photodissociation spectroscopy to investigate photoactivation of a platinum complex in the vicinity of a nucleobase. These metal complex-nucleobase clusters represent model systems for identifying the fundamental photochemical processes occurring in photodynamic platinum drug therapies that target DNA. This is the first study to explore the specific role of a strongly photoactive platinum compound in the aggregate complex. Each of the clusters studied displays a broadly similar absorption spectra, with a strong λmax ∼ 4.6 eV absorption band and a subsequent increase in the absorption intensity towards higher spectral-energy. The absorption bands are traced to ligand-to-metal-charge-transfer excitations on the PtCl6 2- moiety within the cluster, and result in Cl-·nucleobase and PtCl5 - as primary photofragments. These results demonstrate how selective photoexcitation can drive distinctive photodecay channels for a model photo-pharmaceutical. In addition, cluster absorption due to excitation of nucleobase-centred chromophores is observed in the region around 5 eV. For the uracil cluster, photofragments consistent with ultrafast decay of the excited state and vibrational predissociation on the ground-state surface are observed. However, this decay channel becomes successively weaker on going from thymine to cytosine to adenine, due to differential coupling of the excited states to the electron detachment continuum. These effects demonstrate the distinctive photophysical characteristics of the different nucleobases, and are discussed in the context of the recently recorded photoelectron spectra of theses clusters

Not seeing the carbon for the trees? Why area-based targets for establishing new woodlands can limit or underplay their climate change mitigation benefits

Acknowledgements: The James Hutton Institute is supported by the Scottish Government’s Rural and Environment Science and Analytical Services Division (RESAS). This research was funded through both ClimatexChange and two strategic Research Programs (2011-16 and 2016-21). The authors acknowledge the assistance provided by other staff – Marie Castellazzi, Nikki Baggaley, Allan Lilly (The James Hutton Institute); Jo Smith (University of Aberdeen); Philip Taylor, Duncan Ray (Forest Research).Peer reviewedPublisher PD

Ambulance Treatment Space Ergonomic Layout

This is the first time a multidisciplinary team has employed an iterative co-design method to determine the ergonomic layout of an emergency ambulance treatment space. This process allowed the research team to understand how treatment protocols were performed and developed analytical tools to reach an optimum configuration towards ambulance design standardisation. Fusari conducted participatory observations during 12-hour shifts with front-line ambulance clinicians, hospital staff and patients to understand the details of their working environments whilst on response to urgent and emergency calls. A simple yet accurate 1:1 mock-up of the existing ambulance was built for detailed analysis of these procedures through simulations. Paramedics were called in to participate in interviews and role-playing inside the model to recreate tasks, how they are performed, the equipment used and to understand the limitations of the current ambulance. The use of Link Analysis distilled 5 modes of use. In parallel, an exhaustive audit of all equipment and consumables used in ambulances was performed (logging and photography) to define space use. These developed 12 layout options for refinement and CAD modelling and presented back to paramedics. The preferred options and features were then developed into a full size test rig and appearance model. Two key studies informed the process. The 2005 National Patient Safety Agency funded study “Future Ambulances” outlined 9 design challenges for future standardisation of emergency vehicles and equipment. Secondly, the 2007 EPSRC funded “Smart Pods” project investigated a new system of mobile urgent and emergency medicine to treat patients in the community. A full-size mobile demonstrator unit featuring the evidence-based ergonomic layout was built for clinical tests through simulated emergency scenarios. Results from clinical trials clearly show that the new layout improves infection control, speeds up treatment, and makes it easier for ambulance crews to follow correct clinical protocols

Designing Out Medical Error, WCDH Boston 2011

This talk is about using research and design to reduce medical errors. It doesn’t matter whether you deliver healthcare in the old-fashioned pathogenic way, or salutogenically, it all falls apart if systems and protocols let the patient down, and harm them

SlowMo / Mo - digital technology to provide support in coping with daily life.

This project builds on previous work bringing inclusive design methodologies and expertise to therapy for paranoid and suspicious thoughts in people with severe mental health problems. Culminating in an interactive digital platform to support service users both in and outside of therapy sessions, this prior work established core design principles, with the platform currently going through a multi-centre randomised controlled trial. This project seeks to extend the benefits of the digital platform beyond diagnosed mental health difficulties to include a standalone app for anyone seeking to better regulate emotions and cope with daily life. The fundamental therapeutic principles underpinning SlowMo include (among others) the ability to recognise unhelpful thoughts, to slow down ‘fast’ thinking (jumping to conclusions), and the identification of alternative explanations for the observed situation or upsetting thought. The design principles of SlowMo include (among others) representing thoughts as bubbles, resizing them, and slowing down ‘spinning’ bubbles to encourage the user to engage in slower thinking. A larger scale clinical trial will establish its clinical efficacy compared to treatment as usual. The project aim is to adapt and expand both the therapeutic and design principles to target a broader audience with common emotion difficulties experienced by the majority of the population. The team combined the ‘Double Diamond’ methodology with agile working with developers. Insights were gained through extensive interviews and workshops with a variety of potential users. Personas were built up from these insights, informing subsequent co-creation sessions. A number of extra functions and concepts were created, and refined using critical feedback. The additional app framework and functionality were refined, along with the visual language and branding. Rapid iterative design and coding work packages allowed for the collaborative development and testing of sections of the app

ICU Journey: Humanising the patient experience of Intensive Care

Intensive Care Units (ICU) are spaces designed to look after patients with life threatening conditions; they provide life-support, extensive therapies and continuous monitoring aiming to preserve life and return patients to good health. The clinical intensity and invasiveness of this highly medicalised and technology-dependent environment can be intimidating and threatening for patients. This paper details the development of a technology to mitigate against this. Working in partnership with four hospitals in England, the multidisciplinary design team co-developed a tablet-based application - called Senso - aiming to reduce the psychological effects of Intensive Care by enabling clinicians, carers and patients to personalise some aspects of their environment. During the first phase, the team performed primary research in four hospitals in England, developing an understanding of the problem from the point of view of different stakeholders including patients, relatives and clinicians. Further analysis through co-design workshops distilled three design issues: positive sensory disruption, orientation, and information and space utilisation. Through co-design workshops involving a ICU Patient Support Network Group, the team prototyped and tested ideas. After two cycles of iteration, requirements for a minimum viable product were outlined. The outcome is a digital application that provides a personalised sensory experience for the patient named Senso. After onboarding, Senso generates a moodboard from the selected images and videos. This not only provides a familiar view for the patient but can also help staff to engage personally with the patient. A daily schedule helps relatives understand the patient’s day-to-day activities and progress. Senso provides patients with a daily routine, supporting them through their journey from leaving the operating theatre through to the point of discharge from ICU. The hypothesis is that by providing structure to the patient’s day help in orientation and engagement. Initial testing indicates that Senso has potential to improve outcomes

Exile Vol. X No. 1

FICTION The Contest by Jon Reynolds 7-19 Engagement by John Hunting 23-34 Sea Scape by Ellen Heath 35-37 The Gift of the Pelican Keeper by Bart Estes 38-43 Trillium of Guilt by David Kay 46-50 The Enormous Snowfall by Ed Brunner 52-65 Story by Jane Cogie 66-67 POETRY Karen\u27s Elegy by Al Werder 20-21 Chicken Little by Curt Matthews 34 Autumn by Judy Pister 37 Poem by Curt Matthews 44 Madame Bovary by Al Werder 65 GRAPHICS Monoprint by Kathy Knapp 5 Pen and Ink by Bob Tauber 6 Linocut by Parker Waite III 22 Linocut by Jeff Barnes 38 Linocut by Jack Reilly 43 Water color by Kathy Knapp 45 Linocut by Bob Tauber 51 Awarded the semi-annual EXILE-Denison Bookstore Writing Prize: The Gift of the Pelican Keeper by Bart Estes 38-4