The Integrated Design Innovation Consortium Tackles Postoperative Cognitive Dysfunction
By Melissa Parrillo, MITidm Program Administrator
The surgery was successful, according to the doctor. I thought: The cancer is gone and Mom is finally safe.
But a few hours later, Mom asked, “Is this one of the new chemo rooms?” And she wasn’t in a chemo room. She had undergone surgery to remove her lung. We started to worry: What if she is having a stroke? What if there is some kind of brain damage? What if she isn’t safe?
Ultimately, my mother doesn’t remember much of her six-day stay at the hospital. She suffered from a condition known as Postoperative Cognitive Dysfunction (POCD), a disorder that occurs in up to 10% of elderly surgery (and anesthesia) patients. I didn’t learn about it at the hospital though. The nurses and doctors never mentioned it to my family. Yet, the issue is growing in importance in the medical community.
In fact, POCD was addressed at the recent Brain Health Summit in Washington, D.C. Additionally, the American Society of Anesthesiologists is leading the charge to increase awareness of the risks of surgery and anesthesia on postoperative cognition in the vulnerable brain and to implement strategies to reduce postoperative delirium and cognitive dysfunction. But, I learned about these conditions one year later at the Integrated Design Innovation Consortium (IDI) 24 Hour Design Challenge, on October 28, 2016.
The IDI 24hr Design Challenge, the fourth led by Penn’s Sarah Rottenberg and Northwestern’s Amy O’Keefe, brought together partners from Penn Medicine, along with students from University of Pennsylvania’s Integrated Product Design (IPD), Northwestern’s Engineering Design Innovation (EDI) program, Carnegie Mellon’s Integrated Innovation Institute (MII-PS), and MIT’s Integrated Design & Management (IDM) program in Philadelphia. The goal was to solve three complex problems associated with POCD and postoperative delirium:
- How can we preoperatively screen for behaviors and risk factors associated with onset of Postoperative Cognitive Decline (POCD) or Delirium post surgery?
- How can we enlist caregivers to mitigate delirium/POCD or expedite recovery when the patient demonstrates symptoms of Delirium/POCD post surgery while they are still in the hospital?
- How can we improve life and prevent death at home after surgery for patients who show symptoms of POCD?
At 5pm, on Friday, 10/28, 76 students gathered in Penn’s Towne Building to learn about the challenge, break into teams, hear an introduction from Shushila Murthy, and begin secondary research. By 9pm, the 15 teams were able to state research questions and initial hypotheses.
On Saturday morning, the students reunited in their inter-school, cross-disciplinary teams to continue to apply the human-centered design process to the problems of post-surgical delirium and POCD. They started by exploring the problem firsthand, by interviewing caregivers, design researchers, medical researchers, physicians, professors, surgeons, an anthropologist, and an anesthesiologist to understand the stakeholders’ perspectives. They also visited an intensive care unit to get a sense of the surgical environment. In this manner, the challenge participants were able to develop empathy, user journeys, and stakeholder needs.
Full of understanding, they got to work on concept generation. The white boards were covered in marker and sticky notes. Words like “solutions,” “nurse action lists,” “data analytics,” “screening,” “games,” and “virtual reality,” appeared from wall to wall and the volume in the room went from a low hum to a noisy buzz. Teams generated multiple ideas and talked about the pros and cons of each. Then, they broke down the ideas and built them back up again hypothetically until they were confident in their direction.
Then, students built actual prototypes—early representations of their concepts. Groups constructed a sleeve for wireless bio-monitoring, a photo booth, and an app for assessment and anxiety reduction. While working on their ideas and prototypes, the IDI students received feedback from physicians and design researchers from Penn Medicine. The practitioners provided input that allowed the students to make meaningful changes to their concepts.
After 24 hours, the students were ready to reveal their ideas. Each team had 3 minutes and a 2-slide maximum to present. There were options that addressed all three periods from the challenge—before surgery, during the hospital stay, and following discharge. There were also innovations designed to aid the various stakeholders, including: patients, caregivers/family, doctors/nurses, and the funders (insurance/Medicare/Medicaid).
Teams invented products that were at the leading edge of technology and that were low tech and accessible for all audiences. In fact, one team created a virtual reality solution to simulate the sundown effect and the difficulty focusing attention that are often experienced as patients emerge from anesthesia; while another group created a 12 inch cubic block of games that resembled a popular toddler toy. There were apps, a chatbot, a digital-to-physical calendar, physical and interactive care kits, an interactive storytelling platform, flash cards, physical space designs, and games. Mark Neuman commented on the nature of the IDI students’ ideas, “Many things in medicine just aren’t designed. Bringing in the design context adds a lot!”
Even the “clients” from Penn Medicine appreciated the way that teams capitalized on their human focused insights. For example, the Lee Fleisher remarked upon groups’ utilization of family members’ time in the waiting room, calling it an “intervenable moment that we should be using.” He also showed interest in a tool that collects data from patients and provides a feedback loop for medical personnel to learn about which of their own practices are most successful. Overall, Fleisher was impressed by the manner in which the students attacked a “20-year-old problem in 24 hours” producing a diversity of thought, which he attributed to the diversity in the room.
The Integrated Design Innovation Consortium
The Integrated Design Innovation Consortium is a collaboration of graduate programs (Carnegie Mellon’s Integrated Innovation Institute (MII-PS), MIT’s Integrated Design & Management (IDM), Northwestern’s Engineering Design Innovation (EDI), and University of Pennsylvania’s Integrated Product Design (IPD) programs) that bring together design, engineering, and business. The programs provide students with the tools to make the world a better place and graduates understand their responsibility to approach complex problems with empathy, integrity, and optimism.