Applying Journey Mapping and Human-Centered Design to Improve Critical Care Delivery for Patients with Acute Respiratory Failure

Background Acute respiratory failure is a common cause for hospitalization and intensive care unit (ICU) admission. Prior literature has found that hospital factors unrelated to patients’ illness severity or clinical needs contribute to substantial variability in ICU admission rates across hospitals. Overuse of the ICU for patients unlikely to benefit from critical care is inefficient, contributes to rising costs, and may cause harm. As part of efforts to improve the value of critical care, we utilized human-centered design to create a prototype, system-level intervention designed to optimize ICU utilization for patients hospitalized with acute respiratory failure. Methods We created a multidisciplinary taskforce and conducted four meetings over a 5-month period in 2022 at a VA medical center. We used journey mapping to depict the care continuum of acute respiratory failure patients and identify facilitators/barriers to high-value care; next, we integrated qualitative methods using rapid team-based analysis with human-centered design to develop a system-level intervention to guide triage decisions and tailor care-delivery processes. Results Our taskforce was comprised of ten participants (including nurses/physicians/respiratory therapists) with clinical and leadership roles in the emergency department, medical/surgical wards, and ICU. We created a service blueprint map and leveraged it to identify themes influencing ICU utilization among patients with acute respiratory failure, including: 1) hospital organization and care processes (e.g., lack of established ICU admission criteria); 2) available resources outside the ICU (e.g., staffing/bed shortages); and 3) staff interactions (e.g., lack of communication/coordination between clinicians/departments). Informed by these results, the taskforce designed a prototype intervention with four components: a) create explicit ICU admission criteria; b) assign levels of care based on patients’ needs; c) geographically cohort patients with shared needs outside the ICU; and d) re-engineer rapid-response teams to proactively assess/follow patients outside the ICU. Conclusions We combined qualitative and human-centered design methodologies, in concert with creation of a service blueprint map, to develop a prototype intervention designed to improve the value of care for patients with acute respiratory failure. Our methods serve as a model to address complex problems within the inpatient healthcare delivery system. Future work includes pilot-testing the intervention for feasibility/acceptability.