The Emergency Department Waiting Room
As a clinic dedicated to the timely resolution of urgent medical conditions, the Emergency Department has become an infamous feature of contemporary life.
In recent years, increased patient presentations to Emergency Departments (ED) in Australia have resulted in increased crowding in waiting rooms, and longer wait times for patients. Congestion in the Emergency Department waiting room is a major patient safety concern, and is associated with poor patient outcomes. To date, there is little consensus among government, hospitals or healthcare leadership as to how to best address these challenges.
This website presents a speculative concept, that explores a future vision of attending and waiting at an Emergency Department in a distant future.
In doing so, we ask you – dear viewer – how do you feel about the future of the Emergency Department? Would you feel cared for in this kind of future?
(Image: Royal Melbourne Hospital. Out-patient waiting area. Fowler 1945)
In this alternative future, ASKLEPIOS is an avatar for a digital artificial intelligence (AI) system that assists patients, carers and staff in the Emergency Department. ASKLEPIOS derives its name from Asclepios, the Greek god of medicine and healing.
ASKLEPIOS automates a series of processes in the Emergency Department – in particular the processes of triage and registration. ASKLEPIOS also assists staff in the prioritisation of tasks and workload, synthesis of medical data, monitoring of patients in the waiting room through embedded ambient sensors, and liaising with healthcare systems outside the Emergency Department. ASKLEPIOS assists patients and carers by providing information and feedback on their healthcare journey, answering questions, as well as providing real-time feedback about developments that may impact individual wait experiences.
We might think of the ED experience as comprised of a series of moments.
Keep scrolling to see how each part of this experience might be experienced.
Health Incident —
The human proclivity for injury, and thus urgent care, is almost as old as pain itself.
While advances in public health and primary care might make critical injury less likely – the human proclivity for injury means that there will always be a need for urgent medical care. As is the case today, this concept commences when a patient is so acutely unwell that they need urgent medical care that cannot be provided by another medical provider.
As is the case today, patients might be referred to the ED in a number of ways. The adjacent image maps how many different patients might arrive at the front door of the ED.
Arrival —
How a patient arrives at the Emergency Department — either by private car, taxi, public transport or ambulance – has a significant impact on their overall waiting and Emergency Department experience.
In helping patients connect with the Emergency Department before their physical arrival, ASKLEPIOS is accessible to members of the community via their smart devices. ASKLEPIOS helps patients navigate from their point of injury to the Emergency Department best equipped to deal with their illness - diverting patients away from busy Emergency Department’s to less busy ones. ASKLEPIOS assists with route planning - providing real-time traffic advice for patients travelling by taxi, private car, public transport or on foot. Wherever possible, ASKLEPIOS will connect with other AI systems to integrate user experiences across platforms.
This future also explores the possibilities of this AI system connecting with other AI systems, to better integrate user experiences across different services – such as the AI systems controlling autonomous Taxi and the AI ASKLEPIOS at the hospital.
Registration —
The front door of the Emergency Department
Registering a patient into the ED system is an important process that draws together relevant data required for care – addressing their medical history, contact details, social security details and more. In this speculation, clerks and nurses – who are today seated behind a desk – are now ‘floating’ within the ED environment, supporting patients and carers as they interact with the automated system.
Floating staff are available to help users approach and engage with Asklepios via registration kiosks. These kiosks then record, documents and synthesise relevant medical data. An array of sensors within the kiosk device record patient vital signs, which is then recorded for use as part of their medical care. This data is then available to ED staff via the electronic medical record and ED electronic “whiteboard”.
The front door of the Emergency Department
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Registration Kiosk
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Triage —
Determining the acuity and urgency of a medical condition.
Triage of patients is now managed by Asklepios, but supervised by a human triage-nurse. While Asklepios might synthesise medical data, data collected through patient observations with their chief complaint to make a judgement about the urgency and importance of their condition, a triage nurse remains ‘in-charge’ and approves the decisions made by the machine. Asklepios then priortises work for clinical staff, where individuals with the most urgent needs are seen first. Ultimately, Asklepios is subservient and supports the duties of the triage nurse in initiating care for patients.
Mixed-Reality interfaces and the Patient whiteboard
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This example demonstrates how a digital interface might integrate with the physical reality of devices and objects in the ED. In this example, a patient whiteboard for use by ED staff, we might observe how a virtual reality interface might fuse with the physical objects within a space.
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Waiting experience
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Defusing intense emotion
Even with AI-powered interventions such as Asklepios, when patient demand exceeds that of available supply in the ED, some patients will be required to wait in the ED waiting room. Asklepios measures vital signs and behaviour of patients through a raft of sensors embedded within the ED furniture. In the case of a deteriorating patient, Asklepios alerts ED staff who can then directly manage that case.
For patients awaiting care, Asklepios provides a range of entertainment and media directly to individuals. Unlike the magazines and single television screens present in the ED of today, this experience enables the waiting room to be more responsive to individual preferences and ideas. Beyond just this form of ‘distraction’, Asklepios also provides information and feedback to individuals about their waiting experience – their place in the queue, how long they can expect to wait and what is likely to happen on their health journey. Unlike the printed material that are often found in waiting rooms of today, patients can engage with all of this information via Asklepios through a mixed-reality interface.
The waiting room
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The waiting room
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Waiting room chair
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“We feel a slight disgust when sitting down in a chair warmed by a stranger, as well as a slight pleasure in sitting down in a chair that we ourselves have warmed.”
— Susan Stewart, Poetry and the Fate of the Senses (2002).
The waiting room chair is a central feature of the ED, and a central touchpoint in any kind of ED service journey. In this concept, the waiting room ‘chair’ is a central touchpoint and part of the narrative in this speculative service future.
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Disposition —
Following the waiting room experience, patients who leave the ED do so either as an admission to hospital, or are discharged from the ED with their own specific care plan. For reasons of scope, this is where this speculation ends, and leaves the door open for imagination as to how Asklepios might interface with other parts of the hospital, and how other AI systems might interact with one another.
Speculative Service Design: Towards a speculative service blueprint
The below images present the speculations described in this section as part of a speculative service blueprint. In these diagrams, Asklepios becomes an integral component of overall operations, and mediates interactions between human and non-human participants throughout the service journey, offering operational and experiential benefits to staff, patients and carers. The blueprint of what exists today (NOW) is contrasted against this alternative (NEXT), where the Asklepios AI is omnipresent, and made central to urgent care activity.
Rather than as a deterministic schematic or ‘plan’ for the future, this blueprint aims to summarise the provocation generated by this study, and invites discussion and debate about the attributes of preferable Emergency Department futures, to inform the conception of new healthcare facilities.
