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First, they came for the TVs ....

Hats off to those helping the patient

In the early 2000s, clinical designers and treatment chair manufacturers starting rapidly adding features that aided patient comfort in a clinical setting. Engineers and designers as well as nurses could all feel for the patients as they sat through 5 hours of dialysis, 7 hours of chemo, 9 hours of stem cell harvesting. Making the time pass easier was the goal.

(My favorite features to include on a treatment chair are listed at the end of the post)

By far, the most popular feature added was the heating elements in the seat and back. Often, the early stage of electronic development meant that massage had to be coupled with heat even though in some departments - chemo for instance - massage was used less frequently. Less often requested was the TV and the TV mount, possibly because there were TVs mounted high on walls or attached to articulating arms at shoulder height on the wall.

What engineers (and patients) crave: System Reliability

The problem with some of the features was and still is the certainty that those features would consistently work when the patient pushed their On Buttons. Some features were better than others. The electronics for the heat and/or massage are usually located right under the seat, downstream from the patient and any cleaning liquid. Replacing the unit usually happens after patients complain, a part is ordered and shipped, and replacement is scheduled. With a chair turnover of at least 3 patients per day, a lot of disappointed patients have made it known to the Charge Nurse that they feel that the clinic isn't living up to its Patient-Centric Care pledge.

The TV feature seemed to drop in popularity within in 3 years of its widespread specification and use (though they haven't disappeared altogether). I think the accidental benefit of the failure was that the USB port on the TV was still usable and demanded by the patient. This led to the eventual inclusion of a free-standing USB port so patients could charge their mobile phones.

Removing the TV feature from the chair allowed the chair to do what it is go at: providing as much comfort for the patient as possible while positioning the patient for the nursing staff so that their job was performed as ergonomically as possible. This made the chair easier to maintain, less expensive, and, if you're like me, thinking it is more aesthetically pleasing. The monitor on an articulating mount returned.

Either make heat reliable or send to out the way TVs went

We've spent too many 3rd shifts replacing chair parts and often those parts are heating units. Replacing the heat controller as well as seat cushions with the heating elements embedded is an expensive operation, especially once labor is accounted for.

Providing comfort for each patient is an important goal. Providing comfort for that patient and next one requires system reliability and good maintenance. When the feature isn't designed for maintenance-free existence, patient experience suffers, chair performance is diminished, and lifecycle cost - cost of ownership - increases. We learn much of this while the chair is in use. What we need to demand from engineers, designers, and nurses is that we identify systemic issues, plan a new path, and iterate solutions and new features.

Higher amperage USB ports are coming soon from electronics engineers which may allow for new thinking on warming the patient in addition to fully utilizing the ubiquitous Blanket Warmers, particularly in chemo.

Any ideas from designers or nurses?

(as promised above)

My Favorite Features (patient comfort focused)

  • Cushion Design: Integrated bolsters for support

  • Power Recline/Infinite Positioning

  • Adjustable Pelvic Tilt (inching towards Zero Gravity)

  • USB Port

My Favorite Features (staff safety focused)

  • Height adjustment: Create an ergonomically safe workplace

  • Time saving positional presets (power chairs)

  • Power lift out of Trendelenburg: Eliminates nurse lifting endangering backs

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