A Roundtable Discussion: Home Healthcare—Not A Hospital in the Home

Abstract

Home healthcare is vital for a large percentage of the population. According to data from the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control (CDC), 7 million people in the United States receive home healthcare annually. The use of medical devices in the home and other nonclinical environments is increasing dramatically. By the year 2050, an estimated 27 million people will need continuing care in the home or in the community and not in a controlled clinical environment. 1 The FDA recently announced its Home Use Devices Initiative and issued the document, "Draft Guidance for Industry and FDA Staff-Design Considerations for Devices Intended for Home Use" on Dec. 12, 2012. 2 The Center for Devices and Radiological Health (CDRH) regulates medical devices, but that regulatory authority alone is not enough to ensure safe and effective use of devices in the home. To address these and other issues, AAMI and FDA will co-host a summit on healthcare technology in nonclinical settings Oct. 9-10, 2013.

The patient work system: An analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers

“…The PWS approach broaches the question, what kind of new design will be necessary, provided that patients and caregivers perform work ? The approach also suggests consideration of the design implications of differences between professional work, including dissimilarity in supervision, accountability and legal responsibility, familial role distribution, reward and incentive structures, who suffers from performance breakdowns, control over design of the physical environment, the length of work “shifts” (e.g., 24 hours for patients), and more (Logan et al, 2013). For further discussion of the research and design implications of adopting a patient work lens, see Valdez et al (in press) and Schubert et al (in press).…”

Living and Working in a Multisensory World: From Basic Neuroscience to the Hospital

“…Given this, we could imagine the development of an alarm where the effective volume could be lowered if the audible signal was efficiently coupled with a (weak) visual stimulus. This adjustment would lower the relative amplitude of the auditory alarm relative to the background noise, referred to as the signal-to-noise ratio (SNR) [18]. While in most circumstances a positive SNR (where the level of the signal is higher than the competing noise) is considered favorable, in naturalistic and multisensory settings there can be greater gains in signal detection under conditions of low or even negative SNR (in which the signal lies embedded within the noise).…”

“…In addition to addressing the sensory features by which alarms alert clinicians about various aspects of a patient's condition, another issue that alarm design needs to address is the impact of continuously streaming that sensory information. Alarms in the ICU sound frequently, and yet 85% to 99% of cases do not require clinical intervention [18]. Furthermore, as alarm frequency increases, clinicians experience habituation, which later results in missed alarms and delayed responses [17].…”

“…TJC declared alarm management as a 2014 National Patient Safety Goal [16], and alarm improvement has also been a priority for the Association for the Advancement of Medical Instrumentation (AAMI). An outcome of the 2011 AAMI-FDA summit on alarms was the vision that "by 2017, no patient will be harmed by adverse alarm events" [18]. It is clear from these statements that further research on alarms is desperately needed in order to inform and guide individual and institutional alarm management.…”