Field Studies

Introduction

In relationship to the two projects “the interactive operating theatre” and “the AWARE project” several field studies have been conducted. Three different departments have been studied at two different hospitals. One of them had introduced the electronic patient record and the other one still used the paper record.

Århus University Hospital
The field study was conducted in Marts and April 2003 and the main focus of the study was how cooperation was established and how interruptions affected the everyday work of clinicians. The department chosen was the department for plastic and reconstruction surgery at the hospital. The first five days was used to follow the nurses in the department around and hereafter five days with the physicians and surgeons.

The department for plastic surgery (Department Z)

The department Z is specialized in plastic surgery. The main focus is to reconstruct the human body’s surface. Typical injuries is either congenital, is due to accidents or complications after other operations, but the main part of the patients is hospitalized with cancer especially skin cancer. A typical procedure is to remove the diseased area and depending on the size of the area transplant skin or muscles from other parts of the body. Some of the larger operation is for instance breast reconstruction after cancer diseases. The department has 36 medical employees and of these are 8 physicians. The department still used the paper patient record at the time.

Personas
The experienced doctor
The young doctor
The experienced nurse
The secretary

Central artefacts
The clipboard – A list of all hospitalized patients fastened on a wooden board
The operation list – A list of all the scheduled operation
The paper journal – The collection of all medical papers about a patient
The alarm – An alarm system the patient can activate if the need help from a nurse or when emergencies arises.

Cooperation
Three different kinds of cooperation types was observed: ‘craft’s apprenticeship’, ‘cooperation between professions’ and ’Coordination’

Craft’s Apprenticeship
Craft’s apprenticeship denounce the situation where a young and less experienced clinicians have to draw on the knowledge of a more experienced co-worker.

Episode 1:
”A young doctor is treating a patient and is checking up on an open wound to se if it is ready to put the transplanted skin on. The wound has been bleating a lot and is flawed close to the edges. It might on one hand be better to wait transplanting the new skin to the wounds looks better, but on the other hand the transplanted skin might protect the wound and make it heal faster. The young doctor starts looking around for a more experienced doctor at the ward. Finally he finds an experienced doctor in an office on floor up and together the move down to the ward to look at the wound” [Day 6].

Cooperation between professions
There are a lot of different tasks at a hospital and the doctors might be specialized in some tasks but might need the help of for instance nurses in solving other tasks. Cooperating between professions tries to categorized these situations where professions need to cooperate

Episode 3:
”A patient wants to be transferred to a hospital closer to his home. The patient asks the nurse when he is able to leave. The nurse calls the doctors pager and waits. Nothing happens. Se looks at a piece of paper called doctors calendar and the responsible doctor is apparently doing something called visions today. The nurse wonders want visions means and finds and tries to find another doctor to ask if this person knows what ‘visions’ is all about. This doctor has seen the other doctor this morning and tells the nurse he will be down any minute. The nurse moves on with some other activity and later she catches the doctor concerned and asks him to see the patient in question” [Day 3]

Coordination
The last example is called coordination and tries to address the temporal in cooperation. That is that many of the tasks at a hospital might have a sequential order. The patient has to arrive at a hospital before s/he can be treated; the patient has to be anaesthetized before s/he can be operated and so one. This last kind of cooperation tries to categorize these situations.

Horsens Hospital

The second field study was conducted in October and November 2003 at the Horsens Hospital. The main focus was to investigate the interaction with computers at a hospital. Two different departments were chosen, the department for Gynaecology and obstetrics and the department for Orthopaedic surgery. The focus was mainly to follow physician and surgery around and in total around 14 whole days was spend following doctors in there everyday work.

Pictures

Pictures from the Horsens Hospital. Click for large images.

1. Surgeons discussing X-Ray pictures		2. Communication table
3. Surgery		4. Interaction with computers
5. Operating table		6. Cooperation between surgeon and nurse
7. Non digitalized table		8. Computer station
9. X-Ray equipment in use		10. Anaesthetic equipment

Editor: Thomas Riisgaard Hansen (web, email) - last updated Feb. 2006.