MakerHealth caught up Rose Hedges RN, DNP a MakerNurse champion at St. Luke’s hospital about her team’s response to the COVID-19 outbreak to create hardware with frontline staff.
How did the culture of St. Luke’s Hospital prepare you and your team to respond to COVID-19?
At St. Luke’s Hospital, we have embraced the spirit of making from our leadership team to the frontline staff. We’ve invested in the tools to let staff bring their ideas to life. We have a medical makerspace, called generate, which opened in November 2019 as an open-access resource for any employee or patient from across the hospital to create a solution to impact patient care. Staff have learned that no idea is too small. Our mandate is to create prototypes of ideas within 15-minutes. Often, that’s all the time a nurse will have to spend in the lab. The hospital has a culture of experimentation to try new ideas in our space and quickly redesign them with clinicians a few steps away on the hospital units.
We could never have anticipated that 6-months later this culture of experimentation would have prepared us to respond to the COVID-19 pandemic. In the last 6 weeks, doctors, nurses, and other clinicians from across St. Luke’s hospital have designed and prototyped 20+ solutions to challenges brought on by COVID-19 resulting in nearly 2,000 device units in use across our health system. With the tools of making here at the frontlines with us, we have gone through more than 50 iterations and testing with 150 St. Luke’s staff. Nine of these projects went from sketch to bedside in under 4 hours.
The open-access culture of accepting all ideas helps our entire hospital team make an impact in our response to the pandemic.
What are some of these COVID-19 projects made at the hospital?
Everyday we have 3-4 clinicians coming into the lab to bring new ideas or iterate on their prototype. Some of my favorite ones:
The small pieces to help patients breathe
Like Legos, the tubing circuits we use in patient care daily are interchangeable–you have tubing, valves, masks, filters, adapters, and specialized connectors. Often, the parts you need for a given procedure will come from a couple different kits.
For instance, when ventilating a COVID-positive patient, the exhaled air from the patient needs to be filtered, otherwise it will spread aerosolized viral particles throughout the room. Devices called viral filters, a plastic piece with an internal filter, trap these particles. We had a hunch that these are types of parts that would start to run low as the system came under pressure, so we explored how to make our own. I took a hacksaw to cut in half one of the parts and found a casing holding a filter material, similar to what you see in a furnace filter. So we took that casing, modeled it in CAD, and 3-D printed a couple variations. We slotted a Halyard paper barrier in the filter slot. We then connected it to a ventilator with an artificial lung to check the air flow for things like high pressure alarms. It’s still a work in progress, but we learned that these components are not hard to recreate once you understand what’s inside. Taking it apart was straightforward and we are lucky to work alongside respiratory therapists who are showing us how to best evaluate it.
Many COVID-19 patients require intubation, which again, is another source of aerosolized viral
infection to the care team. Inspired by an intubation box design from Dr. Lai Hsien-yung in Taiwan, our team wanted to make the Iowa version. Nurses, respiratory therapists, doctors, and the EMT flight crew at the hospital came to our makerspace to design and prototype features of the intubation box. After a week of laser cutting and hacking the final design includes a larger entry window at the front of the box, overlapping clear vinyl flaps covering the window to provide an improved seal, and a quick release sheet to cover the patient’s body. We tested the performance of the intubation box by popping balloons full of fluorescent liquid to simulate viral particle spread during a patient cough and visualize the droplets with black lights to measure the ability of the box to shield the care team from those viral particles. Our experiments showed that the intubation box can help to keep our team safe at the frontlines of care.
We have made 7 boxes that are in use with patients everyday across 6 different departments in the hospital, and we’ve begun to share the how-to across our network.
Protecting the care team across the continuum of care for the patient has been a source of many challenges during the pandemic. Whether it is outside the hospital, from the helipad to the ED, or inside from ED to the ICU, transportation of patients has proven to be the most dynamic context in which the virus spreads. Inspired by the intubation box, our air ambulance and ED teams designed and built various versions of a lightweight space frame to provide a comfortable, but contained, airspace for the patient that can be used on an ambulance cot or hospital bed. We made a template with overlapped slits for easy access to patient airways if needed by the transport team in case of an emergency. It’s a lightweight system that collapses, and anyone can easily make it in less than 30 minutes.
You’re not the first nurse who’s making at the frontlines, but there are many more who want to jump into this style of care and help. What can you tell them?
Nurses make things every day and on every shift. Now, more than ever, it is critical to turn your ideas into actual things—prototypes. We’re at the frontlines of the pandemic and we have the best information about how to heal our patients. So use that information, to create something we can hold in our hand and get some feedback. Maybe it’s a cardboard model, maybe it’s foam, maybe you cobble it together from things in the supply closet. It doesn’t matter, by having people engage around the physical object, you’re going get better outcomes. You need to see your ideas made real. If anyone is looking for feedback on their idea you can reach out to me at @RHedgesRN or anyone on the MakerHealth team (@makerhealthco). We would love to hear from you. It doesn’t matter where in the world we are, we are all seeing similar challenges that have never been experienced before in healthcare. As a community of health makers, we’re going to help our patients get to the other side of this pandemic.