Many people become frustrated with the A&E service because of a lack of clear, effective information and guidance.
Patients and other service users arriving at A&E by means other than an ambulance may have significant difficulties in navigating the physical space, and can become lost even before arriving in the A&E department. Once there, they are exposed to a complex system that they may not understand and is frequently not explained to them. This lack of knowledge, guidance and information increases their anxiety, and this in turn has the potential to develop into aggressive or violent episodes.
To define and develop the most relevant, useful and implementable design solutions, the Reducing violence and aggression in A&E design team explored each stage of the journey made by patients and other service users through A&E. What were their physical and emotional needs at each stage of the process, and what could be done to provide for these?
This project looked primarily at the question of how to convey basic information in a busy A&E department, where staff are often too busy to offer information or guidance on an individual basis.
Their primary design output focused on a guidance package that communicates essential information to the patients and other service users arriving at A&E. This contains both generic information relating to the process for receiving treatment, as well as live information relating to the status of the department and waiting times. The solution had to be retrofittable and easily implemented in any hospital, as well as addressing the issue of violence and aggression.
The goal of this guidance package was to give patients and other service users in A&E a better understanding of how the department works, and a sense that their human, as well as clinical, needs are being attended to. As a result, this would make them less likely to become confused, frustrated and potentially aggressive as they progress through the system.
The design team felt that this would be best achieved by retrofittable environmental graphics, complemented by a live digital system and welcoming arrival process.The first step was to establish exactly what kind of information was required, where and why. A matrix was developed, which categorised information into the three levels of static, live (dynamic) and personal, and whether this information was mobile or fixed to a location.
Different delivery formats and technologies could deliver the various levels of information. For example, the more generic static information, such as the general process for treatment, can be delivered in a fixed print/graphic format. Personal information can only be delivered digitally with a password and identity number for access, due to confidentiality reasons.
Given the emphasis on the solutions being retrofittable and easily implemented, the decision was taken to focus on the static and live information for this project, with the potential for personal information being scoped out as a future development.
The design team’s primary solution for providing essential guidance to patients and service users was to develop a series of static, fixed format signs. Digital formats could also provide the opportunity to display dynamic and personalised information.
The recognition that static, fixed information presented the best opportunity for conveying basic information to patients and other service users in A&E led to the design team developing the concept of the ‘slice’.
A narrow vertical slice in each space would be modified to contain all the information relevant to the user at that stage in the treatment process, and become the recognised communication point for patients throughout the department. This meant that rather than redesigning the whole department, or refitting each and every room, a ‘slice’ could be inserted, which would gently guide the patient or other service user along their journey through A&E.
The flexibility of the ‘slice’ system means it can be inserted into any room, space, or corridor, creating an instantly recognisable point for information and communication throughout the department. The ideal case scenario would be to have a four-sided slice, but when retrofitting space constraints might mean it would have to be scaled down into one full-height panel.
The patient survey confirmed that there was a need for even the most basic of information, so the first necessity was to make sure that this information was conveyed in the panels. This meant explaining what the process for treatment was, and addressing the gap between the patient’s or other service user’s expectations and the actual process.
Print information is ideal for communicating the basic static information about the department, but a digital information stream is necessary to communicate live information. The digital content builds on the visual language established in the print information.
The design team’s patient survey was instrumental in establishing what type of live information was useful. Displaying department waiting times would enable people to
relax while waiting, rather than having the anxiety of constantly wondering when their names will be called. It would also enable people to decide whether to come back to A&E
at a less busy time for faster treatment.
Departments working with electronic patient records now have all the data needed to output the information on waiting times and busyness. Although this is reliant on the data being inputted into the software system in real-time, many A&E departments now appear to be moving towards achieving this goal for their own self-monitoring purposes.
The question then simply becomes what information to extract, and how to display it. Different levels of technology allows different amounts of information to be presented,
but these are not all able to be implemented immediately. Live information screens are currently being used in some A&E departments. Many of those seen by the design team, however, were being changed manually. Typically, they were not being updated consistently, especially when the department was busy, or they were broken and showed blank screens.
Using the existing data stored in software systems already used by A&E departments enables the updating to be done automatically and regularly. It can also provide more
accurate and relevant information. For example, it can inform the waiting room when urgently ill patients arrive by ambulance. As a solution which could be immediately implemented (subject to the A&E department having the right software), this solution was developed for this project. Contact has been made with the largest provider of A&E
software to form a collaboration to develop the software.
The ‘slices’ themselves were envisaged as starting outside the building in the car park, and then continuing inside throughout the department. A handful of standard-sized wall panels were designed which could be used anywhere within A&E. A ceiling panel was also incorporated for patients arriving on stretchers. These were intended for the ambulance entrance, as well as being above the bed for resuscitation and major wards.
In deciding the content of each panel, it was crucial to understand that there was no linear order to the panels. Patients and other service users can enter the A&E system from a number of routes, and so each panel must make sense in isolation. The visual language was deliberately developed to reference a journey map, with each step represented as a ‘stop’. The stop names can be read from a distance, and the overall process can be quickly understood. If the reader moves closer, they can read the explanatory text and learn more about each step.
The panels are designed to hold the key information at a height of 1–2m. They place the location at the top, followed by the key message for that space, then information about
what happens in that space, and then what the patient/visitor should expect to happen next.
The realities of retrofitting these panels into existing departments with very little spare wall space meant that the width had to be quite constrained, and that crash bumpers would run through the middle of each panel. It is important to ensure that the information can be read by everyone coming through the door, so the graphics took into account the need to use a clear font and font size, colour contrast, readability and pictograms.
When creating the colour scheme for the Guidance solution, the design team recognised that each A&E department is different and that it was necessary to provide more than one colour option for the slices and slice variations. As a result, the design team created a palette of three different colours, allowing each NHS Trust to choose the most suitable option for its respective A&E environment(s).
In addition to the live information screen highlighted in ‘Solution 1: Guidance’, the design team also identified the potential benefits of installing a touchscreen facility within A&E departments. In particular, a barcode-enabled touchscreen can enable patients to access their own records and view the waiting times particular to their own personal treatment. The touchscreens could also display information in multiple languages, and provide an audio channel for those with impaired vision.
Smartphones are becoming ever more prevalent, with one in three people now owning a smartphone in the UK. This medium provides the greatest scope for information personalisation and breadth of information.
It is anticipated that in future, phone apps would enable users to self triage, find their least busy local urgent care centres, and check-in before arriving at the centre. This has benefits both for users, who are able to maximise the use of healthcare provision in their local area, and also for the centres, who are able to anticipate patient numbers better, and prepare accordingly.
A phone app is fully anticipated to be the next stage in development for this project, but was beyond the scope of this project’s objectives and timelines.