The magic desk project: Redesigning the desk in the clinic exam room

STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): In the presence of the electronic medical record [EMR], do desk shape and computer/printer position influence clinician-patient interactions and clinic visit satisfaction? OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1) reduce the temptation to stare at the EMR while talking and listening to the patient; 2) collaborate with architects, furniture designers, and craftsmen to redesign the clinic desk, improve access to the computer screen, and reorganize the space around the desk; 3) to determine if these changes affected the patient-clinician interaction during a regular office visit . DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): With a health and design grant from the School of Architecture and an internal grant from the Division of General Medicine, we conceived, designed, built, and installed the “magic desk” in an exam room at an internal medicine clinic. This desk is a curved wooden platform that is anchored to the wall, appears to float in place, and makes it easier for the patient to share the computer screen with the doctor or nurse. It has a built in swivel for moving the screen in or out of view, per HIPPA restrictions. For images see: http:// uvadesignhealh.org/docs/news/fellow-project-eye-contact-in-exam-rooms. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/ INTERVENTION): In order to determine the effect of the desk on the clinical encounter we designed a survey for patients and one for doctors. Patients were randomly assigned to be seen by their regular physician or nurse practitioner in either the redesigned room or in the standard room. The standard desk was a sheet metal desk with square corners and stationary computer screen. After the visit the research assistant asked patients if they felt the EMR was good for their health care, whether their doctors looked at them more than the computer, seemed interested in listening to them, shared EMR information with them, and spent enough time with them. Doctors were surveyed at the end of each session and asked if being in the redesigned room made it easier to listen to patients, maintain eye contact, and finish the note during the visit. We also asked if the doctors preferred one room to the other. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE eFINDINGS WILL BE DISCUSSED): The study was conducted in the summer of 2013. There were 43 study room patients, 36 standard room patients, 11 attending physicians, 1 nurse practitioner. One patient refused to complete the after visit survey. All patients were at clinic for routine follow-up visits. There were no significant differences in the demographics of the two groups of patients: each group had slightly more women than men, slightly more white than non-white patients, and approximately half the patients were older than 50 years. The length of the doctor patient relationship was also similar in the groups: approximately 25 % knew the doctor longer than 5 years. Comparison of the patient survey results from the patients seen in the redesigned room versus those seen in the standard room showed no significant differences. Almost without exception patients felt the EMR was good for their health care. Regardless of the room, almost all patients felt their doctors looked at them more than the computer, spent enough time with them, and were interested in their stories. In general, these patients were highly satisfied with their doctors and their care. Results of the doctor survey showed that in 75 % of the sessions, the doctors preferred the redesigned room to the standard room. Eighty percent of the time they felt that the redesigned room made eye contact easier. The redesigned room did not make it easier to listen; nor did it improve efficiency. As pretty as the desk is, moving the printer out of the way also made a lasting positive impression on the doctors working in that room. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): This collaboration helped us rethink and reimagine the space and information we share with our patients. Although the magic desk and the design changes that came with it did not make a measurable difference in doctor-patient interactions or patient satisfaction, the doctors preferred it and noted that it reminded them to share the EMR and then made it easier to do so. Perhaps the patients were already so pleased with their doctor that re-designing access to health information did not have an easily measurable impact.