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

## TL;DR

This paper describes using human-centered design to improve ICU care for patients with acute respiratory failure by identifying and addressing system-level barriers.

## Contribution

The novel contribution is the development of a prototype system-level intervention to optimize ICU utilization through journey mapping and human-centered design.

## Key findings

- Key barriers to high-value care include lack of ICU admission criteria and poor interdepartmental communication.
- A four-component intervention was designed to address ICU overuse and improve care coordination.
- The intervention includes explicit ICU admission criteria and re-engineered rapid-response teams.

## Abstract

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.

The online version contains supplementary material available at 10.1186/s12913-025-13864-6.