Digitizing Patient Handoff for Nurses
Solving for Dangerous Process Gaps in Patient Hand-Off
I became involved in Caringly by referral, contacted by the founder to provide UX Research and Design to solve problem they had observed based on real customer insights and high quality design.
From their training and time in the medical profession in India and the United States, these doctors-turned-entrepreneurs identified a dangerous gap in nursing and patient care.
The handoff process between nurses at the time of shift change was stuck in the past, and worse was creating real risk and dangerous mistakes and omissions, jeopardizing patient care nationwide.
Nurses changing shifts at a typical hospital include visiting each patient and capturing key details for their colleagues taking over.
"Failed hand-offs are a longstanding, common problem in health care."
User Experience research, design and prototyping in collaboration with the founders to develop a SaaS product for nurses to digitize and manage patient hand-off efficiently and accurately for mobile and desktop.
UX Designer & Researcher
Founders, Trained Doctors
What is a hand-off?
A transfer and acceptance of patient care responsibility achieved through effective communication. It is a realtime process of passing patient specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.
Taryn (RN) talks about challenges and risks at shift change, and her experience using Caringly.
The paper-based Kardex Shift Report System is still in use today. Can you imagine having your care details shared in such a way?
Friction in Shift Report Systems
Electronic Medical Record Systems (EMRs) such as Epic are used by nearly all hospitals and medical facilities, and are vast, slow and information-dense.
They require focus and precision to enter and retrieve often critical details somewhere within a patient's records. Nurses reported that they use only a small fraction of available EMR features.
In fact, for hand-off the majority of nurses today still use a paper-based process such as Kardex, and have often even resort to creating their own informal systems to hand-off sometimes life-saving care details and daily events for each patient when they change shifts - including taking photos and texting information to their colleagues! Holy HIPAA!
Communication lapses were the No. 1 root cause of sentinel events reviewed by the Joint Commission on Accreditation of Healthcare Organizations from 1995 to 2004.
Queens Hospital Center, a facility I visited to observe and interview nurses in their work environment around shift change.
Nurses were eager to talk about their experiences
I participated in a series of phone interviews with registered nurses, attending nurses and doctors from all over the country to learn more about their process, pain points and to capture their latent and expressed needs.
I found the series extremely illuminating and resoundingly supportive of the risk created by nurses using ad hoc systems to manage patient details at shift change. Nurses need and are asking for an easier, faster way, intelligent way to capture and share patient details, improve care, reduce risk and get home faster.
I've included 3 samples in their entirety, each filled with insight into the process and the challenges of nursing in a hospital setting and patient handoff.
The session were led by Vivek, the cofounder with a medical background who was familiar with the vernacular of the nurses.
Phone interview with Nurse Reena G.
Phone interview with Clinical Charge Nurse Elissa V.
Phone interview with Nurse Roma M.
Distillation of learnings into features and wireframes
We initially targeted our MVP feature set and user experience design on a native mobile UI to enable the most portable and powerful one-hand operation while on the go throughout the hospital ward, visiting patients and capturing notes and alerts for the next shift. The following sketches are translated from numerous whiteboard exercises conducted in person and via video.
Dashboard & Task View
The core screen is essentially an easily toggled list of patients and tasks to provide easy access to drill in and capture data or consume alerts to manage patients better.
Unified, Scalable Patient Profile
The Patient Profile is designed for simplicity and at-a-glance verification of key details. as well as their story (history from admission through care events), things to watch out for and a Floating Action Button (FAB) to initiate data input.
Quick Add FAB: Patient, Task, and Note
Initiating task creation via the FAB with a clear data structure and follow-up prompts.
Patient Profile: Medical History Cards
A patient's medical history and counter indications can be complex and plentiful, so we designed a scalable system to review, manage and contribute to the data.
Patient Profile: Multimedia Notes with 'Watchout' Flag
A feature to compose notes and see a history of notes added by nurses from past shifts replaces the manual scribble on paper method we saw above.
Patient Profile: Medical Condition Toggle
Quick toggle medical conditions, events and other attributes to help communicate the full picture for a patient's care.
High-Fidelity UX/UI Design
Native & Responsive Mobile App UI
The resulting UI deliverables from our research and UX collaboration, with multiple rounds of refinement.
I also contributed the simple product name and branding.
Reminders accessible via quick right-swipe from the dashboard.
Report are the list of patients and the data about their care.
Time-sensitive reminders can be created and managed here, accessible via toggle from the top of the dashboard.
Patient Profile: Story
Presented in chronological order, a logical way to review the patient history from admission to hand-off. Key at-a-glance patient details presented in the header to make sure the nurse is with the correct patient.
Patient Profile: Background
Key information in simple yet scalable, informative card component.
Patient Profile: Assessment
May include test results, diagnostics and doctor or nurse impressions.
Patient Profile: Flags
Flags are accessible throughout the app, surfaced both at the patient level and dashboard level, so nothing gets missed.
Patient Profile: Reminders
Time-sensitive with notifications and a process for indicating that the task has been completed.
The application state in which an individual patient record is put into review mode and must be accepted by the next nurse on shift once they've reviewed specific screens and patient data.
Floating Action Button (FAB)
Putting easy-access to the most important tasks within reach through the entire experience.
Timely, OS-based reminders help a nurse keep up with patient care.
Tablet and Responsive Web App UI
I subsequently provided tablet and web breakpoints of a responsive app to provide more options for nurses on different devices including hospital-provided and personal devices.
For the MVP, and simple, flat and clean login screen to differentiate the product from the visual complexity of modern EMR systems like EPIC.
Shift Summary Report
A new view of the patient report list in a UI of cards that scroll horizontally and vertically.
Nurse Access List
A list of all nurses with access to the patient to provide a means of asking questions and verifying patient details.
Notes & Reminders
An easy way to annotate a patient record with the added ability to set it as recurring and as a time-sensitive reminder.
Entry Card Details: Assessments
Annotating characteristics and/or areas of note, concern or review for a patient profile so nurses at shift change are aware of key patient details and diagnostics to perform.
Exposure to the problem and participating in the user research - both on-site and remote - was highly illuminating. I am proud of the effort, the quality of the design deliverables and how they may help make patient hand-off easier for nurses.
Despite this being a side-project for me, I was enthusiastic about donating my time to the project and spend more time in the HealthTech space.
Now the project is back in the founder's hands as they recruit for pilots in hospitals across the country.