Applying journey mapping and human-centered design to improve critical care delivery for patients with acute respiratory failure

Acute respiratory failure is a common cause for hospitalization and intensive care unit (ICU) admission. Prior literature has found that 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 reduces access to critical care for those who most need it. As part of efforts to improve the efficiency and 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. 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. Our taskforce was composed 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. We combined qualitative and human-centered design methodologies to develop a prototype intervention designed to improve the value of care for patients with acute respiratory failure. Future studies will pilot test the feasibility and outcomes of the intervention we have developed in this study.