Texas Children's Hospital 

A feeding dashboard to bring feeding transition back to the forefront of care in the Cardiac ICU through parent empowerment.

Background

Dr. Roddy sought student collaborators for a project focused on the Cardiac ICU at Texas Children's Hospital in Houston, Texas. 

Through his clinical research, he uncovered a problem: It is not uncommon for nutrition to take the proverbial "backseat: during rounds due to the fact that so many other complex medical decisions are being made by the medical team.

~50% 

of infants in the Cardiac ICU were malnourished at the time of surgery

Only 2/3 

of their recommended caloric and protein requirements were provided by week 1

Only 2/3 

of their recommended caloric and protein requirements were provided by week 1

How might we redesign the clinical approach to nutrition to incorporate parents and provide optimal nutritional support? 

How might we redesign the clinical approach to nutrition to incorporate parents and provide optimal nutritional support? 

User Research

A focus on including parents was important to our problem owner, so we identified them as an important aspect of our problem and a guiding consideration for our solution.

Throughout our evaluation of the problem situation, we were careful to let our assigned problem and the stakeholders involved define the solution, rather than entering the problem with a solution in mind.

Methods

  • NICU Rounds Observations
  • Stakeholder Interviews
  • Parent Interviews

Observation Findings

  • Parents wanted to be involved in their child’s care and were often willing to ask questions and offer insights
  • Parents knew their children on a more nuanced level than the hospital staff
  • Hospital rooms had brand new bedside portal screens, which would allow hospital staff to display medical information during rounds and use the touchscreen interface to navigate
  • Nutritionists often have to return to discuss nutrition decisions with parents after rounds

Interview Findings

  • Parents are focused on providing their "normal" parental roles as best as they can in the limited setting
  • Health literacy is a constant concern that impacts parent confidence
  • Nutritionists feel as if their duty is reserved to the last thought during rounds
  • Clinicians value medical measurements of baby's success, while parents focus on more personal goals such as achieving 100% breastfeeding 
  • Physician and nutritionist emphasized growth charts and nutritional goals as key requirements for the interface
17176226_1458228544195482_1806318994_o

This is the view of the touchscreen portal that clinicians interact with. The data presented here is very clinician-focused, and although the intention was for clinicians to be able to reference charts and numbers on this screen while updating parents, the layout wasn't congruous with parents' needs and concerns. 

Screen Shot 2019-01-22 at 7.46.04 PM

The touchscreen portal also allowed for alternative views to be added by the hospital team. This is where our design would live. 

Design, Test, Iterate

We prototyped a nutrition dashboard according to what nutrition information the doctors and dieticians identified as important. When asked about what information should be displayed on the nutrition dashboard home screen, both the doctor and the dietician emphasized growth charts and nutritional goals as key elements of their own clinical decision-making tools as well as resources for parent reflection. We designed the prototype with a familiar-looking layout, to minimize barriers to usability. We also incorporated things like an ICU glossary, which we felt would empower parents to understand their child’s care plan and have the vocabulary to ask valuable questions.

“I don’t think I’d want to show this to my wife... This growth chart here—this would hurt her. The doctors here know my wife and I pretty well. We know our child is not going to be the size of a healthy baby, but the doctors know that reminding my wife of that would make her upset. I don’t like to compare my baby to other babies. She’s my baby.” - Parent

“I don’t think I’d want to show this to my wife... This growth chart here—this would hurt her. The doctors here know my wife and I pretty well. We know our child is not going to be the size of a healthy baby, but the doctors know that reminding my wife of that would make her upset. I don’t like to compare my baby to other babies. She’s my baby.” - Parent


It was this quote during testing that led me to realize that creating something for an audience is an iterative process, and although we did not have the foresight to predict this parent’s critique, it was our duty as product designers to ensure that the needs of the user, not just the “client,” were met. I understood then that user experience designs, especially in the healthcare setting, deal with nuanced human factors. In order to build an interface for patient parents, we have to feel their experience, value their input, and adapt accordingly.

Screen Shot 2019-02-17 at 6.33.14 PM

Our first prototype included a baby growth chart — one that compared the patient to the average or expected weight and length.

Screen Shot 2019-02-17 at 6.33.27 PM

Our second iteration took into account both physician and parent feedback, including altering the growth chart to display the baby's progress over time, rather than the baby's size as compared to the "healthy" average.

Optimizing Clinical Engagement & Nutritional Strategies (OCEANS) is under development with Rice University and Texas Children's Hospital.