Improving the patient experience for children at the paediatric acute medical unit

Abstract

An acute admission is a disruption from daily life and affects the child patient and his or her family. To reduce this disruption of daily life, the VKC is planning to build a Paediatric Acute Medical Unit (P-AMU) in the coming years. The VKC (Vrouw-Kind Centrum; Woman-Child Center) is the center of excellence in the field of all woman and child healthcare inside of the AMC and VUmc alliance. Their mission puts a strong focus on patients that participate and have control. The key values of the VKC are to be ‘Open’, ‘Sensitive’, and ‘Innovative’.
The P-AMU will provide 24/7 care, and focuses on rapid and effective diagnostics, formulating treatment plans, and starting the execution of said plans within a maximum of 72 hours. The current plans for the P-AMU are made from an organizational or management perspective. The patient perspective is not yet included in this stage of development. Literature research showed many benefits of an AMU from the organizational perspective with the main benefit being; containing chaos in one place makes the other regular nursing departments more plannable and will improve the quality of care. The main goal is for children to go back home as quickly as possible. Medical professionals consider this to be in the child patients best interest.
To include the patient perspective in the plans, design research was conducted to fully understand the patient experience during the paediatric acute admission process. The result identified two main themes; unsure: not knowing when, where, and what to expect; and bored: which occurs during the many moments of waiting. This uncertainty consists of two kinds; the medical uncertainty and the uncertainty about the process, where the medical uncertainty is a stable factor and the uncertainty about the process is a variable. The patient journey clearly showed more fluctuation in patient’s emotions and more innovation opportunities at the ED in comparison to the paediatric nursing department. Therefore, improving the patient experience at the P-AMU already starts at the ED.
The design goal was formulated as followed:
‘‘Design a tool that improves the communication of child patients and parents with the healthcare system about the acute admission process, and that puts the children in control in a playful and understandable way, in order to make the feel less unsure and bored during the acute admission.”
An iterative design process was performed where child patients, medical professionals, and technical and design experts provided feedback from their perspective on the intermediate designs. This eventually led to the development the final concept design ‘Mijn Buddy’. ‘Mijn Buddy’ is a digital application designed for children, aged 8-13 years old, that provides insights in order to reduce the uncertainty about the acute admission process, which will eventually lead to a better patient experience. The connection of ‘Mijn Buddy’ with EPIC, the digital patient record, makes sure the journey is personalized and adjusted to a patient’s individual situation, so the right information is provided at the right moment. It helps child patients and parents to manage their expectation by providing information about what, who, where, and when things will happen.
An interactive prototype was developed to evaluate ‘Mijn Buddy’ with both a number of child patients and (non-patient) children in their home environment, as well as pediatricians and ED-doctors. The feedback and outcomes of this evaluation study were very positive. ‘Mijn Buddy’ increased the knowledge about an acute admission for appendicitis, so it can be assumed it will reduce the uncertainty about the process. Children perceived it as fun and easy to use. Not only did child patients that were unfamiliar with the hospital and their journey see a clear added value, familiar patients also perceived the information provided by ‘Mijn Buddy’, like who to expect and when, as useful. Recommendations to further improve the design were also identified from this evaluation study, such as showing the possibility of a transfer to another hospital in the patient journey.
However, more research is needed since ‘Mijn Buddy’ was only tested with one kind of acute admission (appendicitis), whereas there are a variety of reasons for an acute admission. Further research and pilot tests are needed to implement the application in the current healthcare system. ‘Mijn Buddy’ has the potential for many future extensions and build-ins like feedback surveys and pain measurements. Furthermore, with small adjustments ‘Mijn Buddy’ can also be valuable for a larger age-range. It is recommended to bring ‘Mijn Buddy’ into the market in various phases with continuous testing, adjusting, and developing.