79 Exploring Wayfinding Challenges in the Paediatric Emergency Department Using a Human-centred Design Approach

Abstract Background Wayfinding is defined as the way people orient themselves in and navigate a physical space. Wayfinding systems may include cues in the built environment, printed information and signage, and human interactions (1). The unfamiliar environment and processes of the paediatric emergency department (ED) can cause increased patient and caregiver stress, anxiety, and dissatisfaction with the healthcare system (2). Even though improved wayfinding can improve trust, communication, and patient safety (3,4), it has been a longstanding challenge in the ED. This challenge was magnified during the COVID-19 pandemic, as the ED had to create temporary rooms and waiting areas to accommodate higher patient volumes and social distancing. Objectives The aim of this project was to explore wayfinding challenges in the paediatric ED and use a human-centred design approach to create an improved wayfinding system. Design/Methods We followed a human-centred design methodology (5,6). Three site visits were conducted to observe the workflow of the paediatric ED. Semi-structured and unstructured interviews were conducted in-person with key stakeholders and subject matter experts, including flow support staff, information and registration clerks, physicians, triage and bedside nurses, and security staff. We synthesized the data using content analysis. The objective of the analysis was to transform themes into actionable design opportunities (7). Themes were used to guide ideation sessions with the research team. Results There were specific gaps in wayfinding and common points of confusion for caregivers, including the lack of any map, lack of standardized naming and colour-coding for certain ED locations, unintuitive naming for key locations, cluttered and contradictory or absent signage, and a lack of accessible information for patients who may have visual impairments or reduced English language proficiency. Specific areas of challenge included the triage and line up process, the location of bathrooms, and understanding the process of the ED visit. To address these challenges, our team followed an iterative approach of ideation and creating a low-fidelity prototype of a wayfinding system using visual mock-ups. We also created a map of the ED, signage for the entrance, a journey map (see Figure 1, below) and an informational pamphlet for families. Conclusion Wayfinding is an important part of the care experience for children and their families. Many stakeholders validated that patient flow in the ED needed improvement and that the pandemic had further exacerbated existing challenges. Next steps include implementing our wayfinding solution and evaluating its impact. Figure 1. Journey Map REFERENCES 1. Madson M, Goodwin K. Color Coding the "Labyrinth": How Staff Perceived a Two-Part Intervention to Improve Wayfinding in an Adult Emergency Department. HERD. 2021 Oct;14(4):429-441. 2. Maqbool T, Raju S, In E. Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic. BMJ Qual Improv Rep. 2016 Jan 14;5(1):u209473.w3887. 3. Zamani Z. Effects of Emergency Department Physical Design Elements on Security, Wayfinding, Visibility, Privacy, and Efficiency and Its Implications on Staff Satisfaction and Performance. HERD. 2019 Jul;12(3):72-88. 4. Naccarella L, Raggatt M, Redley B. The Influence of Spatial Design on Team Communication in Hospital Emergency Departments. HERD. 2019 Apr;12(2):100-115. 5. Bubric K, Harvey G, Pitamber T. A User-Centered Approach to Evaluating Wayfinding 00Systems in Healthcare. HERD. 2021 Jan;14(1):19-30. Journal Of Library User Experience 6. Lorusso L, Lee JH, Worden EA. Design Thinking for Healthcare: Transliterating the Creative Problem-Solving Method into Architectural Practice. HERD. 2021;14(2):16-29. 7. Thomas DR.. A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation 2006;27(2):237-246.