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Emergency Medicine

 
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Neonatal Intensive Care Unit


Overview

There is arguably no place in the hospital with more long-reaching impact than the Neonatal Intensive
Care Unit (NICU). The NICU, by definition, treats the youngest and often most vulnerable patients
immediately after birth, literally changing health for a lifetime to follow. Innovation is one of the most
important aspects of neonatal care; when reduced to its core, the NICU functions as a recreation of the
womb through design. Technological innovation and creativity are paramount to the betterment of
NICU care.

Chief complaints in the NICU range from prematurity (and all the sequelae that accompany early birth)
to a wide variety of congenital and complicated disease processes. “Premies” range from those just
near full term to extremely preterm infants weighing only a few hundred grams at birth. While full term
infants weigh around 7 lbs, extremely preterm infants can easily fit in the palm of one hand.
What makes the NICU unique, especially from a design perspective, is both the unique size and
problems of the patients as well as the length of stay. Every scale of design, from devices and beds to
the very rooms and unit layout, can have a profound impact on both care of the infants and well being
of the families. While most NICUs have “bays” whereby all infants are placed next to each other in one
large room, Women & Infants is comprised of two beautiful and spacious floors where each baby has
their own private room—a design change meant to prioritize parental care and privacy within the
hospital.

Spending even a small amount of time in the NICU can demonstrate the impact of design in healthcare.
Without a doubt, design CAN save lives.


Care Team

Attending Neonatologist: a pediatrician with advanced training in the care of sick and/or premature
newborns. They typically lead the care teams and conduct research.

Neonatology Fellow: a graduate of pediatrics residency selected for a 3-year subspecialty training
program in the care of sick and/or premature newborns. They will become an attending after their
training and will coordinate care for the infants alongside the attending.

Pediatric Resident: medical doctor who is training to be a pediatrician. Under the guidance of the
attending and fellow, they will help with the management and care of infants.

Neonatal Nurse Practitioner: an advanced practice nurse with specialized training in the care of sick
and/or premature newborns. They are often the primary caretakers of the infants for their 24/7 needs.

Bedside Nurse: often with years of experience, these nurses provide the continuous care and monitoring
of infants necessary for any NICU to be successful.


Questions to keep in mind

1. How does the room environment create a good bonding atmosphere for mothers? Are their
ways through design to facilitate maternal/fetal bonding?

2. How does the layout of the NICU facilitate care?

3. What design devices are implemented to make a long term hospitalization more comfortable for
families while still providing the best medical care?

4. What specific devices and instruments are used to recreate the womb environment?

5. What technologies are most commonly utilized during procedures?


Pre-identified Needs

1. Neonatal incubator that provides tactile/sensory bond with mother

2. Devices for easier umbilical venous and arterial line placement

3. Privacy screens that provide feedback to mother on infant well being

4. Respiratory devices that allow for better and safer care

5. Comfort swaddling device to decrease overstimulation to preterm infants


Track Mentor

Ravi D’Cruz, MD
Teaching Fellow, Neonatal/Perinatal Medicine
Women & Infants Hospital
Email: rdcruz@wihri.org

 

Hospital Contact Information

Women & Infants Hospital Main Number: (401) 274-1100
NICU 2nd Floor: Ext. 3200
NICU 3rd Floor: Ext. 3300
NICU Main Number: (888) 717-2229

 
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Primary Care

 

Overview

Primary care is the front line of medical care. It is the foundation of a high functioning health system. Practitioners of primary care partner with their patients over the course of a lifetime of births, deaths, health and illness to ensure that they don’t fall through the cracks of our increasingly complex healthcare system. There is no equivalent to being cared for by someone who knows you well in the context of your community and understands both your health issues and personal values. 

The Family Care Center at Memorial Hospital is a “Patient Centered Medical Home”; this is a model of care that is patient-centered, comprehensive (covers physical and mental health needs, addresses acute and chronic illnesses), coordinated internally and externally with specialists, hospitals and the community, and accessible (available 24/7 through electronic and telephone access).

Providing high quality, accessible and efficient care to each and every individual is an ambitious but essential aim of primary care that can only be accomplished through a brilliantly designed medical home and system. From a design perspective, the challenge lies in acknowledging the breadth of primary care and creatively addressing specific needs that can have a wide reaching impact on patients and providers. Opportunities for smart design interventions are endless; right from the patient’s handheld device at home, to the physical space of the clinic and even to the everyday interactions among team members and with patients. The future of primary care lies in the hands of great design. 

 

Care Team

Faculty Attending: a family medicine doctor who is licensed to practice independently and is teaching faculty at Alpert Medical School. They typically precept patients with residents, have their own patient panel and may have other research/administrative/teaching responsibilities.

Family Medicine Resident: a family medicine doctor who is doing a 3-year specialty training program in the care of children, adults, pregnant women and newborns. They will become an attending after their training.

Team Nurses: a registered nurse who may have wide ranging responsibilities including triaging phone calls from patients, refilling prescriptions, administering immunizations, assisting with procedures and doing initial prenatal intake visits.

Medical Assistants: a health professional cross-trained in administrative and clinical duties including scheduling appointments, handling correspondence, taking medical histories and vital signs, assisting with procedures.

 

Questions to keep in mind

1.     How can we transform time spent in the waiting room by patients?

2.     How do we improve communication between the care team while patients are being seen?

3.     How do we make patient rooms patient and provider friendly?

4.     How can we improve the workflow from waiting room to check out?

5.     How can we empower patients to take charge of their own preventive care?

 

Pre-identified Needs

1.     Redesigning workspaces to encourage real time collaboration

2.     Reliable way to monitor chronic illnesses between visits (eg. blood sugar, blood pressure)

3.     Tracking medication adherence

4.     Patient-driven preventive screening

 

Track Mentor

Minoo D’Cruz
PGY-2, Family Medicine
Family Care Center/Memorial Hospital of RI
Email: minoo.b.dcruz@gmail.com

 

Hospital Contact Information

Family Care Center/Memorial Hospital of RI
Team A: (401) 729-2304
Team B: (401) 729-2206
Team C: (401) 729-2769

 
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Surgery

 

Overview

Surgeons employ operations in the treatment of disease or injury. Surgery can involve cutting, abrading, suturing, or otherwise physically changing body tissues and organs. Most surgeons enjoy a range of perspectives in their practice, from seeing patients for consultations or check-ups to performing these various procedures in the operating room (OR) setting. Beyond general surgery, fields of specialty surgery include cardiothoracic surgery, colon and rectal surgery,, gynecology and obstetrics, gynecologic oncology, neurological surgery, ophthalmic surgery, oral and maxillofacial surgery, orthopedic surgery, otorhinolaryngology, pediatric surgery, plastic and maxillofacial surgery, urology, and vascular surgery. 

Surgery is a special field, notably from a design point of view, due to the need for solutions within both the office and surgical suite settings. One can also look at solutions on both a micro and macro level—from specific instruments to the way those interact with the OR or surrounding hospital space. Due to the demands placed on surgeons themselves, solutions can reach beyond those that just improve the patient outcomes but those that also make the surgeon’s job more feasible or enjoyable as well. Though often, improvements for the surgeon’s job are realized in the form of better patient care.

 

Care Team

Attending Surgeon: a surgeon with advanced training who completed surgical residency and often a fellowship. They lead the care teams and conduct research.

Surgical Fellow: a surgeon in training who completed residency and is training in one of the various specialties listed above.

Surgical Resident: a surgeon in training who is completing a minimum of 5 years of residency after medical school.

Anesthesiologist: a medical practitioner trained in anesthesia and perioperative medicine, who reduces patient pain before, during, and after surgery.

 

Questions to keep in mind

1.     How are patient vital signs taken during surgery?

2.     Which are routine tests performed during surgery?

3.     What types of checklists are the surgeons using?

4.     How is the OR different from other spaces in the hospital?

5.     How difficult is it to keep the procedure sterile?

 

Pre-identified Needs

1.     Surgeon discomfort during surgery

2.     Making sure patient is receiving the best possible sterile care at all times

3.     Patient post-operative care instructions

4.     Patient intake design

5.     Clearer instructions for surgeons in training to follow

 

Track Mentor

Dr. Jan Groblewski
ENT-otolaryngologist
Rhode Island Hospital
Email: jgroblewski@lifespan.org

 

Contact Emails

jgroblewski@Lifespan.org (overall surgical lead and Team 1 lead)
Albert.Woo@Lifespan.org (Team 2 lead)
lizaaguiar@gmail.com (Team 3 lead)
hale_wills@brown.edu (Team 4 lead)