Evaluating the roll-out of environmental control units in Veterans Affairs Spinal Cord Injury Centers: Workflow observations

Abstract

Objective: Evaluate the value of providing environmental control units (ECUs) to Veterans with spinal cord injuries and/or disorders (SCI/D) in Veterans Affairs Medical Centers (VAMCs).

Design: Industrial engineers observed SCI/D staff (support) and Veterans (use) with ECUs at four participating VAMC Spinal Cord Injury (SCI) Centers.

Measure(s)/Analysis: Standardized data collection efforts included: 1) time study (trend analysis) and 2) open-ended, semistructured interviews on Strengths-Weaknesses-Opportunities-Threats (SWOT) feedback (qualitative analysis).

Results: From 59 interactions, reasons for ECU downtime were troubleshooting (n = 30, 51%), repairs/replacements (n = 10, 17%), and 29% combined for patient education (n = 8), set-up (n = 5), and admission (n = 4). ECU strengths were functionality (n = 23, 70%) and 30% (n = 10) combined for patient independence and staff satisfaction. Functionality was both a weakness (n = 43, 78%) and opportunity (n = 29, 66%). Threats were functionality (n = 8, 50%), staff satisfaction (n = 3, 19%), and maintenance (n = 5, 31%). When ECUs were functioning properly, Veterans participated in leisurely activities (e.g., games, television), had increased control of their environment (e.g., bed, lights), and clinicians spent less time troubleshooting the ECU, hence, increasing clinical care availability.

Conclusions: ECUs minimized physical limitation challenges, and may improve safety, comfort level, and general satisfaction with care of Veterans with SCI/D who often spend much of their time in bed when hospitalized. Veterans and staff reported that the ECUs added value by increasing patient independence and social support including communication with loved ones. Functionality strengths and weaknesses influenced the Veterans’/staff’s perceptions of ECU value. Therefore, ECU training/maintenance education and dedicated non-clinical support staff are recommended prior to future ECU roll-out.