conclusion of hospital visit report

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How to Write a Visit Report

Last Updated: March 30, 2024 References

This article was co-authored by Madison Boehm . Madison Boehm is a Business Advisor and the Co-Founder of Jaxson Maximus, a men’s salon and custom clothiers based in southern Florida. She specializes in business development, operations, and finance. Additionally, she has experience in the salon, clothing, and retail sectors. Madison holds a BBA in Entrepreneurship and Marketing from The University of Houston. This article has been viewed 668,139 times.

Whether you’re a student or a professional, a visit report helps you document the procedures and processes at an industrial or corporate location. These reports are fairly straightforward. Describe the site first and explain what you did while you were there. If required, reflect on what you learned during your visit. No additional research or information is needed.

Writing a Visit Report

Explain the site's purpose, operations, and what happened during the visit. Identify the site's strengths and weaknesses, along with your recommendations for improvement. Include relevant photos or diagrams to supplement your report.

Describing the Site

• Reports are usually only 2-3 pages long, but in some cases, these reports may be much longer.
• In some cases, you may be asked to give recommendations or opinions about the site. In other cases, you will be asked only to describe the site.
• Ask your boss or instructor for models of other visit reports. If you can't get a model, look up samples online.

• If you visited a factory, explain what it is producing and what equipment it uses.
• If you visited a construction site, describe what is being constructed and how far along the construction is. You should also describe the terrain of the site and the layout.
• If you’re visiting a business, describe what the business does. State which department or part of the business you visited.
• If you’re visiting a school, identify which grades they teach. Note how many students attend the school. Name the teachers whose classes you observed.

• Who did you talk to? What did they tell you?
• What did you see at the site?
• What events took place? Did you attend a seminar, Q&A session, or interview?
• Did you see any demonstrations of equipment or techniques?

• For example, at a car factory, describe whether the cars are made by robots or humans. Describe each step of the assembly line.
• If you're visiting a business, talk about different departments within the business. Describe their corporate structure and identify what programs they use to conduct their business.

Reflecting on Your Visit

• Is there something you didn’t realize before that you learned while at the site?
• Who at the site provided helpful information?
• What was your favorite part of the visit and why?

• For example, you might state that the factory uses the latest technology but point out that employees need more training to work with the new equipment.
• If there was anything important left out of the visit, state what it was. For example, maybe you were hoping to see the main factory floor or to talk to the manager.

• Tailor your recommendations to the organization or institution that owns the site. What is practical and reasonable for them to do to improve their site?
• Be specific. Don’t just say they need to improve infrastructure. State what type of equipment they need or give advice on how to improve employee morale.

Formatting Your Report

• If you are following a certain style guideline, like APA or Chicago style, make sure to format the title page according to the rules of the handbook.

• Don’t just say “the visit was interesting” or “I was bored.” Be specific when describing what you learned or saw.

Sample Visit Report

Community Q&A

You Might Also Like

• ↑ http://services.unimelb.edu.au/__data/assets/pdf_file/0010/471286/Site_Reports_for_Engineers_Update_051112.pdf
• ↑ https://www.examples.com/business/visit-report.html
• ↑ https://www.thepensters.com/blog/industrial-visit-report-writing/
• ↑ https://eclass.aueb.gr/modules/document/file.php/ME342/Report%20Drafting.pdf

About This Article

To write a visit report, start by including a general introduction that tells your audience where and when you visited, who your contact was, and how you got there. Once you have the introduction written out, take 1 to 2 paragraphs to describe the purpose of the site you visited, including details like the size and layout. If you visited a business, talk about what the business does and describe any specific departments you went to. Then, summarize what happened during your visit in chronological order. Make sure to include people you met and what they told you. Toward the end of your report, reflect on your visit by identifying any strengths and weaknesses in how the site operates and provide any recommendations for improvement. For more help, including how to format your report, read on! Did this summary help you? Yes No

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Writing a Report – Visit to the Hospital

Mar 15, 2020 | Report Writing | 15 |

Write a report Extended students 150-200 words – 8 Marks for Content and 8 Marks for Language Core Students 100-150 words – 6 Marks for Content and 6 Marks for Language

Model Answer Past paper question

The trip to the big hospital in our city was a truly enlightening and educational experience. The highlight of the visit was the tour of the various departments, where we got to see how a hospital operates and the different specialties that work together to provide patient care.

We had the opportunity to visit the emergency room, where we saw how the staff worked efficiently and calmly under pressure to attend to patients with various medical emergencies. We also had the chance to see the operating rooms, where we witnessed the latest surgical technologies in action and learned about the important role that sterilization plays in preventing infections.

In addition, we learned about the different types of imaging tests, such as X-rays and MRIs, that are used to diagnose medical conditions. We also had the opportunity to interact with some of the medical professionals, including doctors and nurses, who answered our questions and provided us with valuable insights into their careers.

Overall, the trip to the big hospital was an eye-opening experience that gave us a deeper understanding of how a hospital function and the important role that each department plays in delivering quality healthcare. I would highly recommend this trip to other classes as it provides a great opportunity to learn about the healthcare system and the different careers in the field.

About The Author

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A TRIP TO THE HOSPITAL – REPORT

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15 comments.

TRIP TO HOSPITAL

INTRODUCTION This report is based on a trip to a big hospital in our city called “IGMH” last week. This report will highlight mostly on the events that occured during the event and the reccomendations to improve the next trip. This report is submitted to the class teacher.

THE TRIP The whole trip was mostly based on seeing the doctors in action and the doctors giving us talks about their career. They even showed how to talk to patients and how to conduct some tests.

The trip was over all exciting. But the most exciting and the highlight of the trip was getting to watch a doctor in action. The doctor was doing a surgery of a heart and for biology students it benefits a lot.

SUGGESTIONS AND RECCOMENDATIONS

Even though the whole trip helped the students, the time give for the trip is too limited and short. Some of the students were unable to take notes and understand also.

So all of the students reccomend to exceed the time limit given for the student for the next year.

In conclusion, the overall trip was help ful. A student says “I get scared whenever i am in a hospital, but tgis trip helped me to over come it”. The whole trip benefited us even thought the trip was short.

THE HOSPITAL TRIP REPORT BY Zayin INTRODUCTION Recently, our class went a trip to a big hospital in our city. This trip was conducted by our school management for the students who are studying in grade 10, to make them aware about how the equipment of the hospital works and why those equipment are important. The principle purpose of this to highlight the events of our class visit to the hospital and explain why it is other classes. THE VISIT We went to the hospital as part of our lesson on last weekend. As we entered into the hospital, innumerable number of people were involving in varied activities. There was a person chosen from the management of the hospital to give information to us about the treatment they give in the hospital. Then he took us to the laboratory of the hospital and showed us some laboratory equipment that they use to do various experiments. After that he took us to the dialysis room where dialysis patients get their treatment. When we saw them we were very emotional because of the hard time they going through. Then we all went to the national cardio center where they treat people with heart related problems. We were mesmerized after seeing the huge machines they use in there. Finally, we went to the Intensive Care Unit (ICU), where they treat people in critical condition but we were not allowed to go inside that place. RECOMMENDATION Overall everyone who participated in this was elated after the trip as they got to see various equipment they use in the hospital and we learned so much about it, so I recommend it to other classes as it is worth going to a hospital for a class trip.

Trip to IGMH INTRODUCTION The aim of this report is to highlight the events occured during the trip to IGMH, where our class had to gather information for a lesson. In this report, it also gives reason why it is recommended for other classes to go to this hospital.

HIGHLIGHTS OF THE VISIT During our visit, we saw many doctors and nurses rushing through the lobby to get to patients rooms and to do their other duties. We waited in the lobby where we met an expert doctor who was our guide. He was friendly and had rich knowledge about many areas in the medical field. We were able to see doctors and nurses working together and using high-tech medical equipment to treat patients as well as experience how they use said machines. We were also given information and advice on how to deal with patients with different backgrounds, illnesses etc.

RECOMMENDATION AND CONCLUSION Overall, the trip was exciting and informative as we got to learn a lot about the world of medicine and see doctors in different fields in action. I recommend other classes to visit IGMH if they wish to get a first person experience of what and how it is like to work in the medical field.

– 199 words –

Report: A trip to the hospital Introduction Recently my class has gone on a field trip to one of the most successful hospital in our country which is known as Tree Top hospital. The purpose of writing this report is to highlight the events which had occurred during the trip, also to give some recommendation on how to improve this trip next time. Events of the trip As soon as we arrived at the hospital two staff who work at the hospital greeted us with a polite smile and directed us towards a room and distributed the students into groups. After that students were taken separately for a small tour of the hospital with at least 2 teachers with a group along with a hospital staff who, gave students information about the hospital during the tour. After finishing the small tour of the hospital the group of students were separately taken to the general ward of the hospital to visit some of the patients without disturbing them too much. Furthermore after that students were visited by senior cardiologist working in the hospital who gave students some information on how the human heart works and showed the students a video of a heart transplant surgery which happened at the hospital. Conclusion The trip provided students a variety of information however, the field trip was quite short so students were not able to clear some doubts. I recommend the school to arrange the field trip for a longer period of time next year.

This report is based on a trip grade 10 students visit to our city hospital Muli regional hospital (MRH) last Sunday. Although, we mostly saw the doctors and nurses working together,they also give us information about there career. Also the doctors shows us how they get ready for any surgeries. Another point, they told us how to talk to patients family if the surgery is a success or a loss. Furthermore, doctors also talk us how to react in emergency situation and complicated times. The most highlighting point is they show us a vedio of a surgery. However, the doctors talk very fast. Some students did not understand few things. Also the time was very short we did not saw every where. So many students recommend to take a nother trip and have enough time to understand and take notes. To conclude the trip was enjoyable. Some students ware scared to see the video of the surgery. The whole trip teaches us many thing even it was fast though.

A TRIP TO THE HOSPITAL This report is about the trip we had to the big hospital in our city, written upon the request of our teacher.This includes highlights from the hospital and reasons for recommendation to other classes. INTRODUCTION The trip mostly revolved around the equipment used in hospitals and different methods of treating patients and after they gave us a few lectures on how the machines work we saw a few demonstrations like MRI(Magnetic Resonance Imaging) and a few other machines.

We also got to hear a doctor explain why he chose this career path how he got here and some difficulties he faced getting to where he is now.But Above all it is without a doubt that the main highlight of this trip would be that we got to see a live surgery.There was a man that had to get stitches on his arm as he had got into an accident.Although we had to stay behind a pane of glass there was no doubt that all of us were interested and enjoyed the trip altogether.

RECOMMENDATION The information we learned at the hospital can prove to be an asset and will definitely give a benefit no matter who learns it so the other classes should also get a chance to go on this fabulous trip. CONCLUSION The trip was very interesting and we learned a lot of information in the short time that was available to us and we definitely didn’t feel bored as time for lectures were not too long and demonstrations were not too short and every student that had attended had learned something new and they would surely come again if given the opportunity.

A trip to the hospital INTRODUCTION

The following report purports summarise our findings during our class visit to the big Tree top hospital in our local city the past week. This report will highlight the events that occurred during our visit and followed by recommendations for the next trip conducted by the school.

First and foremost we were given a tour of the large medical facility and a demonstration of the medical equipment. After which we were allowed to follow selected doctors of throughout their daily medical tasks such as surgeries and checkups. We are granted the opportunity to see these heroes in action as doctors and nurses worked together to offer help and relief to the patients.

Secondly we were given a briefing by a board of doctors for students interested in following career paths in the medical sector either as doctors and nurses. The doctors took great care in weighting the pros and cons of a life in this sector.

CONCLUSION AND RECOMMENDATION

In a nutshell this trip was helpful and fruitful. However the time given for us was limited therefore the trip was hasty. Therefore it is the suggestions of students to make this a full day trip rather than a half day trip.

Last week our class visited Newlife hospital. One of the biggest, most developed hospitals in our city. The purpose of this report is to highlight the main events that occurred during the visit. The visit was organized by the science department of our class as part of a project on medical equipment. We arrived at Newlife hospital around 10:30 in the morning and we’re met by the director of the hospital Mr. Ahmed Ali. At first, we were shown a small presentation about the hospital followed by the talk of the director. After that, we had a tour of the hospital under the supervision of hospital staffs The most exciting part of the visit was seeing a live surgery done by the doctors. We also managed to study fascinating facts about different types of machinery and equipment that are used in different laboratories In conclusion, students were amazed to learn new information on medical equipment. However, a large number of students felt that the visit was too short. I suggest that next year’s hospital visit should be well balanced

Chang Gung Memorial Hospital. Report by: Shaffa Introduction. On 13th March our class went on a trip to the “Chang Gung Memorial Hospital”. The purport of this report is to highlight the main aim of the visit and to suggest why it is recommended for other classes. The Trip The trip was mainly aimed for grade 10 science stream students, as this will help them when they choose their career after their exams. First of all, the CEO gave a brief introduction about the hospital and its history. Then, the doctors showed us how the machines are worked and how important their job actually is. They also gave a good impression on the students when they had friendly conversations with their patients. What most of the students found truly eye-catching was a doctor was giving surgery to a heart patient. Some of the students also got to assist them at their work. After the tour, we were given a small test the diagnose our what we have learnt. Conclusion All in all, the trip was very informative and enjoyable. I highly recommend this trip to other classes as this will be great when you take up your career. I personally believe that grade 8 classes should get these opportunities more as it will help them when they take up their streams.

Visit to the hospital Report by:Enaash

Introduction

This report purports to highlight the events occured and what we learned from the visit to “IGMH” which is a well-known hospital in our city and to suggest how the visit could be improved.

Our class which is of twenty students had a thirty minutes visit to “IGMH” last Thursday. This acclaimed hospital was colossal and we were thrilled by the means of improved services of the hospital as we reached our destination. We were enthusiastic to see how doctors and nurses were actively engaged in their works. Moreover, we got the opportunity to interview some of the doctors regarding their career.

The overall visit was considerable. However, the visit intervened our school session. Further more, the visit was too short as the duration was thirty minutes.

Recommendation

I am of the opinion that the duration of the visit should be extended to at least one hour. Also, it would be more effective to visit the hospital during weekends as it would not intervene our school session.

AMINATH MAISA REPORT: A TRIP TO THE HOSPITAL

Introduction: Recently all the students of grade 10 went on a school trip to ADK hospital. This report aims to highlight the details and present what we learned from the whole trip. About the trip: As we arrived in the hospital, we were asked to choose a medical section we would like to see. A vast majority of students went with the operating room while a significant number of students decided to see the laboratory. In the operating room the students were stunned as they witnessed doctors and nurses working together with all the high-tech medical equipments. A doctor explained clearly how each equipment was used. Moreover students that decided to go to the laboratory were even allowed to handle some equipments and test them. Suggestions: Eventhough we managed to study fascinating facts, many students felt that the overall time for the trip was too short. Perhaps we could consider asking for more time in the next trip. Furthermore a number of students found that the teachers could have organised the schedule in a better way. This way none of the students will get lost and have a better sense of where they should be at the right time. Conclusion: All things considered the trip was really useful. We all got insight into the important medical things. For the reasons I have mentioned I highly recommend other classes having this kind of trip to a big hospital.

A visit to the hospital Recently our IGCSE english class went to the city hospital to know how the hospitak is functioned Firstly we went to the reception and our english teacher sought the permission for the visit. Then we went to the labourtary. The labourtary technician showed us how the machineries works and the procedure of blood testing. Next we visited the x-ray room. After wards we were taken to the wards. And there were so many patients lying on the bed. Finally we visited to the emergency room. They all were fully hygined. Also the staffs were very friendly to each other. Furthermore, the staffs of the hospital were very patient to the patients. The hospital facilities and services is very good. It would have been better if we get more time to spend in the hospital and to ask question about the hospital

TRIP TO THE HOSPITAL INTRODUCTION The aim of this report is to highlight what we learned during the trip to ADK, where our class had to gather information for a lesson. The purpose of writing this report is to highlight the events which had occurred during the trip, also to give some recommendations on how to improve our next trip. Almost all the students went on this trip. THE TRIP The whole trip is mostly based on seeing doctors in action and the doctors giving out their information’s about their career. They also showed how to talk to a patient and how to conduct some tests. we went separately to different places of the hospital so our one of the classmate said that he saw doctors and nurses working together and using all that high-tech medical equipment to treatment. Even one our classmate had fear of visiting a doctor, but after this experience has changed him completely. SUGESTIONS AND RECOMMENDATIONS I suggest for next trip we all want to see all the places all together not in different groups so we can see all the things. As all of us was in different group they saw something else and we saw something else. And their recommendations was really good.

Last week our class visited TTS hospital. One of the biggest, most developed hospitals in our city. The purpose of this report is to highlight the main events that occurred during the visit. The visit was organized by the school for our class as part of a project on medical equipment. As we arrived in the hospital, we were asked to choose a medical section we would like to see. A vast majority of students went with the operating room while a significant number of students decided to see the laboratory. In the operating room the students were stunned as they witnessed doctors and nurses working together with all the high-tech medical equipments. A doctor explained clearly how each equipment was used. Moreover students that decided to go to the laboratory were even allowed to handle some equipments and test them.

Introduction; The main aim of this report is to higlight about our trip to ADK hospital as a part of our biology studies and also to present the importance of recommending ot to other classes. The Visit; First of all, we were really fascinated to see an extremely developed hospital and, a vast majority of students were stunned to see the arrangements of the hospital. Moreover, we met specialists in different medical fields and got to clear some of our doubts from the topics of biology related to medical science. Also, the manager gave a tour of the overall hospital so we got a clear view of how the hospital runs. Furthermore, we saw the various types of machines and got to know the uses and how it works. Many students got emotional by seeing the patients and made dua for their recovery. Moreover, we were excited to meet the staff and workers of the hospital and they were helpful and kind ,which made our trip much more comfortable. We found that the hospital was hygiene and the staff took good care of the patients. We also got to interview some of the patients according to the disease they are suffering from so that we can get to know the symptoms and the way they handle the disease more clearly. Conclusion; To sum up we can say this was really a useful visit for us as biology students. I strongly recommend this trip to other classes also if the students are interested in medical field ,because this could be a helpful guideline for the students interested in this field.

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Health Care Comes Home: The Human Factors (2011)

Chapter: 7 conclusions and recommendations.

7 Conclusions and Recommendations

Health care is moving into the home increasingly often and involving a mixture of people, a variety of tasks, and a broad diversity of devices and technologies; it is also occurring in a range of residential environments. The factors driving this migration include the rising costs of providing health care; the growing numbers of older adults; the increasing prevalence of chronic disease; improved survival rates of various diseases, injuries, and other conditions (including those of fragile newborns); large numbers of veterans returning from war with serious injuries; and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as its quality and cost.

The committee was charged with examining this major trend in health care delivery and resulting challenges from only one of many perspectives: the study of human factors. From the outset it was clear that the dramatic and evolving change in health care practice and policies presents a broad array of opportunities and problems. Consequently the committee endeavored to maintain focus specifically on how using the human factors approach can provide solutions that support maximizing the safety and quality of health care delivered in the home while empowering both care recipients and caregivers in the effort.

The conclusions and recommendations presented below reflect the most critical steps that the committee thinks should be taken to improve the state of health care in the home, based on the literature reviewed in this report examined through a human factors lens. They are organized into four areas: (1) health care technologies, including medical devices and health information technologies involved in health care in the home; (2)

caregivers and care recipients; (3) residential environments for health care; and (4) knowledge gaps that require additional research and development. Although many issues related to home health care could not be addressed, applications of human factors principles, knowledge, and research methods in these areas could make home health care safer and more effective and also contribute to reducing costs. The committee chose not to prioritize the recommendations, as they focus on various aspects of health care in the home and are of comparable importance to the different constituencies affected.

HEALTH CARE TECHNOLOGIES

Health care technologies include medical devices that are used in the home as well as information technologies related to home-based health care. The four recommendations in this area concern (1) regulating technologies for health care consumers, (2) developing guidance on the structure and usability of health information technologies, (3) developing guidance and standards for medical device labeling, and (4) improving adverse event reporting systems for medical devices. The adoption of these recommendations would improve the usability and effectiveness of technology systems and devices, support users in understanding and learning to use them, and improve feedback to government and industry that could be used to further improve technology for home care.

Ensuring the safety of emerging technologies is a challenge, in part because it is not always clear which federal agency has regulatory authority and what regulations must be met. Currently, the U.S. Food and Drug Administration (FDA) has responsibility for devices, and the Office of the National Coordinator for Health Information Technology (ONC) has similar authority with respect to health information technology. However, the dividing line between medical devices and health information technology is blurring, and many new systems and applications are being developed that are a combination of the two, although regulatory oversight has remained divided. Because regulatory responsibility for them is unclear, these products may fall into the gap.

The committee did not find a preponderance of evidence that knowledge is lacking for the design of safe and effective devices and technologies for use in the home. Rather than discovering an inadequate evidence base, we were troubled by the insufficient attention directed at the development of devices that account, necessarily and properly, for users who are inadequately trained or not trained at all. Yet these new users often must

rely on equipment without ready knowledge about limitations, maintenance requirements, and problems with adaptation to their particular home settings.

The increased prominence of the use of technology in the health care arena poses predictable challenges for many lay users, especially people with low health literacy, cognitive impairment, or limited technology experience. For example, remote health care management may be more effective when it is supported by technology, and various electronic health care (“e-health”) applications have been developed for this purpose. With the spectrum of caregivers ranging from individuals caring for themselves or other family members to highly experienced professional caregivers, computer-based care management systems could offer varying levels of guidance, reminding, and alerting, depending on the sophistication of the operator and the criticality of the message. However, if these technologies or applications are difficult to understand or use, they may be ignored or misused, with potentially deleterious effects on care recipient health and safety. Applying existing accessibility and usability guidelines and employing user-centered design and validation methods in the development of health technology products designed for use in the home would help ensure that they are safe and effective for their targeted user populations. In this effort, it is important to recognize how the line between medical devices and health information technologies has become blurred while regulatory oversight has remained distinct, and it is not always clear into which domain a product falls.

Recommendation 1. The U.S. Food and Drug Administration and the Office of the National Coordinator for Health Information Technology should collaborate to regulate, certify, and monitor health care applications and systems that integrate medical devices and health information technologies. As part of the certification process, the agencies should require evidence that manufacturers have followed existing accessibility and usability guidelines and have applied user-centered design and validation methods during development of the product.

Guidance and Standards

Developers of information technologies related to home-based health care, as yet, have inadequate or incomplete guidance regarding product content, structure, accessibility, and usability to inform innovation or evolution of personal health records or of care recipient access to information in electronic health records.

The ONC, in the initial announcement of its health information technology certification program, stated that requirements would be forthcom-

ing with respect both to personal health records and to care recipient access to information in electronic health records (e.g., patient portals). Despite the importance of these requirements, there is still no guidance on the content of information that should be provided to patients or minimum standards for accessibility, functionality, and usability of that information in electronic or nonelectronic formats.

Consequently, some portals have been constructed based on the continuity of care record. However, recent research has shown that records and portals based on this model are neither understandable nor interpretable by laypersons, even by those with a college education. The lack of guidance in this area makes it difficult for developers of personal health records and patient portals to design systems that fully address the needs of consumers.

Recommendation 2. The Office of the National Coordinator for Health Information Technology, in collaboration with the National Institute of Standards and Technology and the Agency for Healthcare Research and Quality, should establish design guidelines and standards, based on existing accessibility and usability guidelines, for content, accessibility, functionality, and usability of consumer health information technologies related to home-based health care.

The committee found a serious lack of adequate standards and guidance for the labeling of medical devices. Furthermore, we found that the approval processes of the FDA for changing these materials are burdensome and inflexible.

Just as many medical devices currently in use by laypersons in the home were originally designed and approved for use only by professionals in formal health care facilities, the instructions for use and training materials were not designed for lay users, either. The committee recognizes that lack of instructional materials for lay users adds to the level of risk involved when devices are used by populations for whom they were not intended.

Ironically, the FDA’s current premarket review and approval processes inadvertently discourage manufacturers from selectively revising or developing supplemental instructional and training materials, when they become aware that instructional and training materials need to be developed or revised for lay users of devices already approved and marketed. Changing the instructions for use (which were approved with the device) requires manufacturers to submit the device along with revised instructions to the FDA for another 510(k) premarket notification review. Since manufacturers can find these reviews complicated, time-consuming, and expensive, this requirement serves as a disincentive to appropriate revisions of instructional or training materials.

Furthermore, little guidance is currently available on design of user

training methods and materials for medical devices. Even the recently released human factors standard on medical device design (Association for the Advancement of Medical Instrumentation, 2009), while reasonably comprehensive, does not cover the topic of training or training materials. Both FDA guidance and existing standards that do specifically address the design of labeling and ensuing instructions for use fail to account for up-to-date findings from research on instructional systems design. In addition, despite recognition that requirements for user training, training materials, and instructions for use are different for lay and professional users of medical equipment, these differences are not reflected in current standards.

Recommendation 3. The U.S. Food and Drug Administration (FDA) should promote development (by standards development organizations, such as the International Electrotechnical Commission, the International Organization for Standardization, the American National Standards Institute, and the Association for the Advancement of Medical Instrumentation) of new standards based on the most recent human factors research for the labeling of and ensuing instructional materials for medical devices designed for home use by lay users. The FDA should also tailor and streamline its approval processes to facilitate and encourage regular improvements of these materials by manufacturers.

Adverse Event Reporting Systems

The committee notes that the FDA’s adverse event reporting systems, used to report problems with medical devices, are not user-friendly, especially for lay users, who generally are not aware of the systems, unaware that they can use them to report problems, and uneducated about how to do so. In order to promote safe use of medical devices in the home and rectify design problems that put care recipients at risk, it is necessary that the FDA conduct more effective postmarket surveillance of medical devices to complement its premarket approval process. The most important elements of their primarily passive surveillance system are the current adverse event reporting mechanisms, including Maude and MedSun. Entry of incident data by health care providers and consumers is not straightforward, and the system does not elicit data that could be useful to designers as they develop updated versions of products or new ones that are similar to existing devices. The reporting systems and their importance need to be widely promoted to a broad range of users, especially lay users.

Recommendation 4. The U.S. Food and Drug Administration should improve its adverse event reporting systems to be easier to use, to collect data that are more useful for identifying the root causes of events

related to interactions with the device operator, and to develop and promote a more convenient way for lay users as well as professionals to report problems with medical devices.

CAREGIVERS IN THE HOME

Health care is provided in the home by formal caregivers (health care professionals), informal caregivers (family and friends), and individuals who self-administer care; each type of caregiver faces unique issues. Properly preparing individuals to provide care at home depends on targeting efforts appropriately to the background, experience, and knowledge of the caregivers. To date, however, home health care services suffer from being organized primarily around regulations and payments designed for inpatient or outpatient acute care settings. Little attention has been given to how different the roles are for formal caregivers when delivering services in the home or to the specific types of training necessary for appropriate, high-quality practice in this environment.

Health care administration in the home commonly involves interaction among formal caregivers and informal caregivers who share daily responsibility for a person receiving care. But few formal caregivers are given adequate training on how to work with informal caregivers and involve them effectively in health decision making, use of medical or adaptive technologies, or best practices to be used for evaluating and supporting the needs of caregivers.

It is also important to recognize that the majority of long-term care provided to older adults and individuals with disabilities relies on family members, friends, or the individual alone. Many informal caregivers take on these responsibilities without necessary education or support. These individuals may be poorly prepared and emotionally overwhelmed and, as a result, experience stress and burden that can lead to their own morbidity. The committee is aware that informational and training materials and tested programs already exist to assist informal caregivers in understanding the many details of providing health care in the home and to ease their burden and enhance the quality of life of both caregiver and care recipient. However, tested materials and education, support, and skill enhancement programs have not been adequately disseminated or integrated into standard care practices.

Recommendation 5. Relevant professional practice and advocacy groups should develop appropriate certification, credentialing, and/or training standards that will prepare formal caregivers to provide care in the home, develop appropriate informational and training materials

for informal caregivers, and provide guidance for all caregivers to work effectively with other people involved.

RESIDENTIAL ENVIRONMENTS FOR HEALTH CARE

Health care is administered in a variety of nonclinical environments, but the most common one, particularly for individuals who need the greatest level and intensity of health care services, is the home. The two recommendations in this area encourage (1) modifications to existing housing and (2) accessible and universal design of new housing. The implementation of these recommendations would be a good start on an effort to improve the safety and ease of practicing health care in the home. It could improve the health and safety of many care recipients and their caregivers and could facilitate adherence to good health maintenance and treatment practices. Ideally, improvements to housing design would take place in the context of communities that provide transportation, social networking and exercise opportunities, and access to health care and other services.

Safety and Modification of Existing Housing

The committee found poor appreciation of the importance of modifying homes to remove health hazards and barriers to self-management and health care practice and, furthermore, that financial support from federal assistance agencies for home modifications is very limited. The general connection between housing characteristics and health is well established. For example, improving housing conditions to enhance basic sanitation has long been part of a public health response to acute illness. But the characteristics of the home can present significant barriers to autonomy or self-care management and present risk factors for poor health, injury, compromised well-being, and greater dependence on others. Conversely, physical characteristics of homes can enhance resident safety and ability to participate in daily self-care and to utilize effectively health care technologies that are designed to enhance health and well-being.

Home modifications based on professional home assessments can increase functioning, contribute to reducing accidents such as falls, assist caregivers, and enable chronically ill persons and people with disabilities to stay in the community. Such changes are also associated with facilitating hospital discharges, decreasing readmissions, reducing hazards in the home, and improving care coordination. Familiar modifications include installation of such items as grab bars, handrails, stair lifts, increased lighting, and health monitoring equipment as well as reduction of such hazards as broken fixtures and others caused by insufficient home maintenance.

Deciding on which home modifications have highest priority in a given

setting depends on an appropriate assessment of circumstances and the environment. A number of home assessment instruments and programs have been validated and proven to be effective to meet this need. But even if needed modifications are properly identified and prioritized, inadequate funding, gaps in services, and lack of coordination between the health and housing service sectors have resulted in a poorly integrated system that is difficult to access. Even when accessed, progress in making home modifications available has been hampered by this lack of coordination and inadequate reimbursement or financial mechanisms, especially for those who cannot afford them.

Recommendation 6. Federal agencies, including the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services, along with the U.S. Department of Housing and Urban Development and the U.S. Department of Energy, should collaborate to facilitate adequate and appropriate access to health- and safety-related home modifications, especially for those who cannot afford them. The goal should be to enable persons whose homes contain obstacles, hazards, or features that pose a home safety concern, limit self-care management, or hinder the delivery of needed services to obtain home assessments, home modifications, and training in their use.

Accessibility and Universal Design of New Housing

Almost all existing housing in the United States presents problems for conducting health-related activities because physical features limit independent functioning, impede caregiving, and contribute to such accidents as falls. In spite of the fact that a large and growing number of persons, including children, adults, veterans, and older adults, have disabilities and chronic conditions, new housing continues to be built that does not account for their needs (current or future). Although existing homes can be modified to some extent to address some of the limitations, a proactive, preventive, and effective approach would be to plan to address potential problems in the design phase of new and renovated housing, before construction.

Some housing is already required to be built with basic accessibility features that facilitate practice of health care in the home as a result of the Fair Housing Act Amendments of 1998. And 17 states and 30 cities have passed what are called “visitability” codes, which currently apply to 30,000 homes. Some localities offer tax credits, such as Pittsburgh through an ordinance, to encourage installing visitability features in new and renovated housing. The policy in Pittsburgh was impetus for the Pennsylvania Residential VisitAbility Design Tax Credit Act signed into law on October 28, 2006, which offers property owners a tax credit for new construction

and rehabilitation. The Act paves the way for municipalities to provide tax credits to citizens by requiring that such governing bodies administer the tax credit (Self-Determination Housing Project of Pennsylvania, Inc., n.d.).

Visitability, rather than full accessibility, is characterized by such limited features as an accessible entry into the home, appropriately wide doorways and one accessible bathroom. Both the International Code Council, which focuses on building codes, and the American National Standards Institute, which establishes technical standards, including ones associated with accessibility, have endorsed voluntary accessibility standards. These standards facilitate more jurisdictions to pass such visitability codes and encourage legislative consistency throughout the country. To date, however, the federal government has not taken leadership to promote compliance with such standards in housing construction, even for housing for which it provides financial support.

Universal design, a broader and more comprehensive approach than visitability, is intended to suit the needs of persons of all ages, sizes, and abilities, including individuals with a wide range of health conditions and activity limitations. Steps toward universal design in renovation could include such features as anti-scald faucet valve devices, nonslip flooring, lever handles on doors, and a bedroom on the main floor. Such features can help persons and their caregivers carry out everyday tasks and reduce the incidence of serious and costly accidents (e.g., falls, burns). In the long run, implementing universal design in more homes will result in housing that suits the long-term needs of more residents, provides more housing choices for persons with chronic conditions and disabilities, and causes less forced relocation of residents to more costly settings, such as nursing homes.

Issues related to housing accessibility have been acknowledged at the federal level. For example, visitability and universal design are in accord with the objectives of the Safety of Seniors Act (Public Law No. 110-202, passed in 2008). In addition, implementation of the Olmstead decision (in which the U.S. Supreme Court ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities) requires affordable and accessible housing in the community.

Visitability, accessibility, and universal design of housing all are important to support the practice of health care in the home, but they are not broadly implemented and incentives for doing so are few.

Recommendation 7. Federal agencies, such as the U.S. Department of Housing and Urban Development, the U.S. Department of Veterans Affairs, and the Federal Housing Administration, should take a lead role, along with states and local municipalities, to develop strategies that promote and facilitate increased housing visitability, accessibil-

ity, and universal design in all segments of the market. This might include tax and other financial incentives, local zoning ordinances, model building codes, new products and designs, and related policies that are developed as appropriate with standards-setting organizations (e.g., the International Code Council, the International Electrotechnical Commission, the International Organization for Standardization, and the American National Standards Institute).

RESEARCH AND DEVELOPMENT

In our review of the research literature, the committee learned that there is ample foundational knowledge to apply a human factors lens to home health care, particularly as improvements are considered to make health care safe and effective in the home. However, much of what is known is not being translated effectively into practice, neither in design of equipment and information technology or in the effective targeting and provision of services to all those in need. Consequently, the four recommendations that follow support research and development to address knowledge and communication gaps and facilitate provision of high-quality health care in the home. Specifically, the committee recommends (1) research to enhance coordination among all the people who play a role in health care practice in the home, (2) development of a database of medical devices in order to facilitate device prescription, (3) improved surveys of the people involved in health care in the home and their residential environments, and (4) development of tools for assessing the tasks associated with home-based health care.

Health Care Teamwork and Coordination

Frail elders, adults with disabilities, disabled veterans, and children with special health care needs all require coordination of the care services that they receive in the home. Home-based health care often involves a large number of elements, including multiple care providers, support services, agencies, and complex and dynamic benefit regulations, which are rarely coordinated. However, coordinating those elements has a positive effect on care recipient outcomes and costs of care. When successful, care coordination connects caregivers, improves communication among caregivers and care recipients and ensures that receivers of care obtain appropriate services and resources.

To ensure safe, effective, and efficient care, everyone involved must collaborate as a team with shared objectives. Well-trained primary health care teams that execute customized plans of care are a key element of coordinated care; teamwork and communication among all actors are also

essential to successful care coordination and the delivery of high-quality care. Key factors that influence the smooth functioning of a team include a shared understanding of goals, common information (such as a shared medication list), knowledge of available resources, and allocation and coordination of tasks conducted by each team member.

Barriers to coordination include insufficient resources available to (a) help people who need health care at home to identify and establish connections to appropriate sources of care, (b) facilitate communication and coordination among caregivers involved in home-based health care, and (c) facilitate communication among the people receiving and the people providing health care in the home.

The application of systems analysis techniques, such as task analysis, can help identify problems in care coordination systems and identify potential intervention strategies. Human factors research in the areas of communication, cognitive aiding and decision support, high-fidelity simulation training techniques, and the integration of telehealth technologies could also inform improvements in care coordination.

Recommendation 8 . The Agency for Healthcare Research and Quality should support human factors–based research on the identified barriers to coordination of health care services delivered in the home and support user-centered development and evaluation of programs that may overcome these barriers.

Medical Device Database

It is the responsibility of physicians to prescribe medical devices, but in many cases little information is readily available to guide them in determining the best match between the devices available and a particular care recipient. No resource exists for medical devices, in contrast to the analogous situation in the area of assistive and rehabilitation technologies, for which annotated databases (such as AbleData) are available to assist the provider in determining the most appropriate one of several candidate devices for a given care recipient. Although specialists are apt to receive information about devices specific to the area of their practice, this is much less likely in the case of family and general practitioners, who often are responsible for selecting, recommending, or prescribing the most appropriate device for use at home.

Recommendation 9. The U.S. Food and Drug Administration, in collaboration with device manufacturers, should establish a medical device database for physicians and other providers, including pharmacists, to use when selecting appropriate devices to prescribe or recommend

for people receiving or self-administering health care in the home. Using task analysis and other human factors approaches to populate the medical device database will ensure that it contains information on characteristics of the devices and implications for appropriate care recipient and device operator populations.

Characterizing Caregivers, Care Recipients, and Home Environments

As delivery of health care in the home becomes more common, more coherent strategies and effective policies are needed to support the workforce of individuals who provide this care. Developing these will require a comprehensive understanding of the number and attributes of individuals engaged in health care in the home as well as the context in which care is delivered. Data and data analysis are lacking to accomplish this objective.

National data regarding the numbers of individuals engaged in health care delivery in the home—that is, both formal and informal caregivers—are sparse, and the estimates that do exist vary widely. Although the Bureau of Labor Statistics publishes estimates of the number of workers employed in the home setting for some health care classifications, they do not include all relevant health care workers. For example, data on workers employed directly by care recipients and their families are notably absent. Likewise, national estimates of the number of informal caregivers are obtained from surveys that use different methodological approaches and return significantly different results.

Although numerous national surveys have been designed to answer a broad range of questions regarding health care delivery in the home, with rare exceptions such surveys reflect the relatively limited perspective of the sponsoring agency. For example,

• The Medicare Current Beneficiary Survey (administered by the Centers for Medicare & Medicaid Services) and the Health and Retirement Survey (administered by the National Institute on Aging) are primarily geared toward understanding the health, health services use, and/or economic well-being of older adults and provide no information regarding working-age adults or children or information about home or neighborhood environments.
• The Behavioral Risk Factors Surveillance Survey (administered by the Centers for Disease Control and Prevention, CDC), the National Health Interview Survey (administered by the CDC), and the National Children’s Study (administered by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency) all collect information on health characteristics, with limited or no information about the housing context.
• The American Housing Survey (administered by the U.S. Department of Housing and Urban Development) collects detailed information regarding housing, but it does not include questions regarding the health status of residents and does not collect adequate information about home modifications and features on an ongoing basis.

Consequently, although multiple federal agencies collect data on the sociodemographic and health characteristics of populations and on the nation’s housing stock, none of these surveys collects data necessary to link the home, its residents, and the presence of any caregivers, thus limiting understanding of health care delivered in the home. Furthermore, information is altogether lacking about health and functioning of populations linked to the physical, social, and cultural environments in which they live. Finally, in regard to individuals providing care, information is lacking regarding their education, training, competencies, and credentialing, as well as appropriate knowledge about their working conditions in the home.

Better coordination across government agencies that sponsor such surveys and more attention to information about health care that occurs in the home could greatly improve the utility of survey findings for understanding the prevalence and nature of health care delivery in the home.

Recommendation 10. Federal health agencies should coordinate data collection efforts to capture comprehensive information on elements relevant to health care in the home, either in a single survey or through effective use of common elements across surveys. The surveys should collect data on the sociodemographic and health characteristics of individuals receiving care in the home, the sociodemographic attributes of formal and informal caregivers and the nature of the caregiving they provide, and the attributes of the residential settings in which the care recipients live.

Tools for Assessing Home Health Care Tasks and Operators

Persons caring for themselves or others at home as well as formal caregivers vary considerably in their skills, abilities, attitudes, experience, and other characteristics, such as age, culture/ethnicity, and health literacy. In turn, designers of health-related devices and technology systems used in the home are often naïve about the diversity of the user population. They need high-quality information and guidance to better understand user capabilities relative to the task demands of the health-related device or technology that they are developing.

In this environment, valid and reliable tools are needed to match users with tasks and technologies. At this time, health care providers lack the

tools needed to assess whether particular individuals would be able to perform specific health care tasks at home, and medical device and system designers lack information on the demands associated with health-related tasks performed at home and the human capabilities needed to perform them successfully.

Whether used to assess the characteristics of formal or informal caregivers or persons engaged in self-care, task analysis can be used to develop point-of-care tools for use by consumers and caregivers alike in locations where such tasks are encouraged or prescribed. The tools could facilitate identification of potential mismatches between the characteristics, abilities, experiences, and attitudes that an individual brings to a task and the demands associated with the task. Used in ambulatory care settings, at hospital discharge or other transitions of care, and in the home by caregivers or individuals and family members themselves, these tools could enable assessment of prospective task performer’s capabilities in relation to the demands of the task. The tools might range in complexity from brief screening checklists for clinicians to comprehensive assessment batteries that permit nuanced study and tracking of home-based health care tasks by administrators and researchers. The results are likely to help identify types of needed interventions and support aids that would enhance the abilities of individuals to perform health care tasks in home settings safely, effectively, and efficiently.

Recommendation 11. The Agency for Healthcare Research and Quality should collaborate, as necessary, with the National Institute for Disability and Rehabilitation Research, the National Institutes of Health, the U.S. Department of Veterans Affairs, the National Science Foundation, the U.S. Department of Defense, and the Centers for Medicare & Medicaid Services to support development of assessment tools customized for home-based health care, designed to analyze the demands of tasks associated with home-based health care, the operator capabilities required to carry them out, and the relevant capabilities of specific individuals.

Association for the Advancement of Medical Instrumentation. (2009). ANSI/AAMI HE75:2009: Human factors engineering: Design of medical devices. Available: http://www.aami.org/publications/standards/HE75_Ch16_Access_Board.pdf [April 2011].

Self-Determination Housing Project of Pennsylvania, Inc. (n.d.) Promoting visitability in Pennsylvania. Available: http://www.sdhp.org/promoting_visitability_in_pennsy.htm [March 30, 2011].

In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost.

Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives.

Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.

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