Innovative research in the Health Services Administration program at Auburn University is paving the way for more streamlined and efficient healthcare facilities. When Dr. Haneen Ali began looking into the inefficiencies of hospital call lights she knew there must be a better, more accessible and more efficient solution. Following a hotel stay, she began developing a solution that could revolutionize the inpatient healthcare experience.
- Imagine you're in the hospital. I know not ideal, but say with me, you've just come out of a pretty rough surgery and you need to use the restroom. What do you do? You press the button to call a nurse and wait for them to arrive. There's only one problem, another patient around the corner hit their call button first, they just need an aspirin for a headache. With the current hospital technology time, not need, may be the determining factor as to who gets the nurse's attention first, but it doesn't have to be that way. Thanks to innovative research being done at Auburn university, the future of patient care could be right on your wrist. Wanna welcome you to the third episode of the "Things You Didn't Know You Didn't Know" podcasts. And joining me today is the very impressive and very busy Dr. Haneen Ali. She is an assistant professor in the health services administration program at Auburn. And because that's not enough, she's also an assistant professor in the industrial and systems engineering program. Dr. Ali, thank you for joining us. - Thank you for having me. - When I first heard of your work, I knew I had to get you on the podcast because what you're doing is really, really impressive and could really change how patient care works in hospitals and long-term care facilities. And I wanna dig into that, but let's set the scene first. You notice a problem with the current call light system in inpatient healthcare settings. Explain a little bit more about that. - Also, let's first define what as the call light system. The call light system is a bedside button that patients use to notify nurses about their needs or perceived needs whenever they need the nurse attention. So they press a button next to their beds and a notification will be sent to the nurses station notifying them that are this patient and this room needs attention or has a need. However, the call light system was described in literature as patients lifeline, because it is the major communication device or the major communication way that patients use to notify the medical staff or their care team about their needs. However, with how much important is the call light, is to communicate patients need. It was found that call lights are associated with many economic issues and usability challenges, like a lack of prioritization, lack of directional information. And some settings in health care such as nursing homes, call light are associated with like more major usability issues, such as noise, systems are kind of old because of lack of resources in those settings. So the system can handle only one alarm. So if there is another alarm, or if there is a new alarm, this can override the old alarm, there's no feedback information or feedback about a previous alarm. - So there's clearly a problem with the current system. Tell me about the solution that you've come up with to tackle this. - So, many technologies became available not only in healthcare, but in all the other industries. And the main goal of introducing technologies is to reduce costs and also improve the quality. For call light system, we did a previous work with nursing home settings where we designed a system, a smart communication system for residents of nursing homes and nursing staff in order to replace the traditional call light system. And hospital settings was always a future work to me until I was in one of the conferences. I was attending a conference and I was in like a hotel room where Alexa was employed in the room. So whenever, for example, the guest needs a towel, he'll say, "Alexa, can I have a towel?" Five minutes later, someone will be knocking on the door and bringing the towel. That was an easy process. So I was, "Why this is not implemented in healthcare", because this can overcome like many of the physical challenges and language barriers and communication between patients and nurses. I came back from the conference, I sent an email to my team. We had the meeting, we invited some of the undergraduate students in my classes. They were participating in some of the research activities and I always liked to have them because they always bring these fresh eyes and fresh ideas of things. We started the brainstorming the... To recreate and redesign the call light system in hospital settings. And to create a system that is not only used for communicating patients need, but also use the system to increase the patient satisfaction in the hospital. So, we implemented the user-centered design technique and we had several visits to the nursing school simulation lab where we looked at the room... The rooms, we looked at the call light system implemented there. We mimicked our patients and patient's bed, like how easy is to access devices on the bedside. And we had a lot of iteration, I think we had four major iterations on our design. We met with nurses. We met with our patients. We listened to their feedback and we improve the design in four major steps. So the major design consists of two major groups of light technology. One is implemented in patient's room, and one is implemented for the nurses, for the use of nurses. So what we proposed in our design is to implement the technology that we use in daily basis with our children, with ourselves, Alexa, iPod, smart TV, smart light, and the patient can communicate their needs using Alexa. This way the patient can communicate the exact need. So I need my pain medication, or I need to go to the bathroom, or I need a cup of water. The iPad also can be used to access the medical record. If they requested a medication, they can track where their medication is or where the nurse in process of getting them the pain medication, they can have access to the patient portal. The hospital can provide information about their medical condition, like educational videos. They can read the news, they can control the TV, they can control the lightening by technologies that are installed around them. The device that we proposed for the nurse use is a smartwatch where the nurse is receiving directly the communication or the notification to the smartwatch they are wearing. So all the notification will be sent to your system and that system will prioritize all the notification based on the severity of the patient or the severity of the need, how fast the nurse is supposed to respond to that need. And the nurse will see like a list of requests that she needs to respond to. - So the podcast is called "Things You Didn't Know You Didn't Know", and so I've gotten pretty comfortable with knowing when I don't know something and I actually called a family member, that's a nurse and I discussed your research with her. And she was really impressed with the concept and really thought it was a great idea, but she asked a question and then I wanna pose it to you. You know, for some patients needing to go to the bathroom is not a big deal at all. It's no bigger issue for them than it is for you or me, but for other patients that maybe have just come out of a surgery or a fall risk that can be a much more urgent need. How does the system understand the complex medical histories of each patient that's being taken care of and understand how to prioritize their needs for the nurse? - So I will try to explain this with the simplest way I know. So each patient will be given a score, will be given a weight, basically that weight represent how severe the patient condition is, or how severe or how important the need is. So for example, a patient that has or had a major surgery, that patient will be given a higher weight indicating that nurses should respond to this patient quickly. An elderly patient with a high risk of fall, for example, will be given also high score, a high weight indicating the need. A patient who is asking for a pain medication, that is... The score will be different than a patient asking for a cup of water, for example, right? So all those variables, in addition to the location of the nurse that we will know base... Because of the smartwatch they are wearing. All those variables, in addition to the location of the nurse, the expected number of steps the nurse has to do will be entered into the algorithm. And using a simulation model, the nurse will receive a list of requests like a queue, you have to respond to this patient first, and then you have to respond to this patient first, including the severity of patient's condition. - And so, what I think is needed is this really innovative approach to patient care that we're talking about is not just an idea. You've actually developed a prototype and tested it here at Auburn, in a simulated environment. Tell me about that. - So we designed a system. We designed and we built, and we tested a similar system to our nursing home settings. That system was intended to replace the traditional call light system. We simulated a setting in the university where we use different rooms and we mimicked kind of a nursing home unit. We invited undergraduate student, we train them on how to be nursing home residents. We assigned each one of them a specific medical condition, and we train them how to mimic that medical condition. We invited real CNAs and real LPNs from local nursing homes to try the traditional system that is being used in their nursing homes and the smart system that we built. Also, we had a high fidelity prototype for our system and they just did both. We collected information related to like number of steps nurses had to do, response time, overall satisfaction, how easy it was for them to finish the task, how easy it was for them or the perception of easiness of using that system. - Obviously you collected a ton of data during those trials. What did it show you? Did it kind of articulate that need for something like this to really change that entire system in healthcare settings? - So the data showed that there was a 40% reduction in response time for call light from bedrooms and around 55% reduction in response time to call light from bathrooms because in nursing homes and in hospital settings too, the call light system is also installed in bathroom, just in case if the patient or the residents needs help while they are using the bathroom. We also found that our 29% of a bed exit alarm were improved through communicating those alarms directly to the nurse using smartwatches. - So when you ran that trial with nurses and CNAs, you were actually able to pick up a couple of ideas to be able to incorporate that back into your study, tell me a little bit more about that. - So, in general, when engineers or designers design a new system, they always have their thoughts, right? Or how they see the system, the... Like the final result of that system or how the system will operate, but it is... There is one major rule when you design a new system is to get feedback and input from the end users. It's like at the end of the day, it's not going to me... It's not going to be me who's gonna use that system in order to do my job. It's going to be nurses or CNAs or LPNs or patients, so it is important always to get feedback from the end users. And in order to be able to identify all the challenges they are facing and to propose features and functions to overcome those challenges, and to provide them with a quality product that satisfy their needs at the end of the day. - This is also incredibly interesting, but I wanna know from you now, what's next? You've done all of these prototypes and trials and done this iterative process working on this project. So help us understand what comes next in your research. - So the next step, we are currently building a high fidelity prototype, and we have support from the nursing school to use the nursing school simulation lab to test that system. And we are going to follow the same steps we did with the previous design. We are going to recruit students, train the students how to mimic patients. And then we are going to recruit nurses or maybe nursing students and ask them to try their traditional system and the smart system, and collect different measures in order to evaluate the smart system. - Well, Dr. Ali, I wanna thank you so much for joining us. I think this was a really interesting conversation for our listeners to get to join us on. And I really look forward to seeing where your research goes from here. 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