By December 3, 2008 6 Comments Read More →

5S for Crash Carts

BBC NEWS | Health | Breathing life into resuscitation

Thanks to my old boss, Mike, for sending this my way. Here’s an article (with pictures, better photos here) from the BBC about a revolutionary new design for hospital “crash carts” that are used to help resuscitate patients… changes that appear to incorporate Lean concepts.

For the last 60 years the design of the resuscitation “crash” trolley, which contains all equipment and drugs needed for cardiopulmonary resuscitation – needed when someone’s heart or breathing stops – and for emergency care has not changed.

It sounds like many would say “the carts have always been set up this way”… but things could be better. What’s wrong with the existing carts and process?

Medics and safety experts agree the situation is less than ideal and warn that the current trolley’s layout is confusing and dangerous – and that vital equipment is often missing.

Mr West said: “The trolleys are basically tall with metal and closed drawers.

“The problem with the existing model is that everything is stowed away.

“Not being to see all the equipment might mean that you take a while to find all the kit you need

“You never seem to have everything you need….

If the layout is confusing and inconsistent, that could be fixed. If items are often missing… that’s a process and management challenge. Why wasn’t somebody auditing the carts or why wasn’t there a better process for restocking items after use? The “missing items” problem could be solved without a whole redesign of the cart.

But, redesigning the cart sounds like a good idea. With items stowed away, it’s very difficult to visually inspect or visually manage the supplies. When things are all in drawers, missing items don’t jump out at you until it might be too late. It’s a good general Lean principle (one I’ve helped put in practice many times) to get items out from behind closed cabinet doors and closed drawers. Make things more visually apparent and obvious… it also makes it easier to find items when they’re needed… speed means everything when a patient is in distress.

Why would we want to redesign the cart?

“But data suggests that poor design of crash trolleys may directly influence the risk of an adverse event for the patient, preventing a successful resuscitation attempt.

That’s a fancy way of saying, “someone could die.”

The new cart design is much more visual and logically laid out:

“The design solutions are intuitive and simple so that any member of a team can use the trolley without instruction.

Well, I’d still hope the hospital is training people…. but intuitive is good, especially if you get trained and don’t get frequent practice using the cart.

“For example, the trolley has no drawers and all medical equipment is highly visible and easy to locate in an emergency.”

That’s exactly how it should work.

The cart has items laid out in the order of use, from top to bottom, organized around the cart in three major, separate types of use:

As well as alerting medics when equipment is out-of-date or missing, the trolley also splits into three sections so that equipment can be used in the order needed and by separate groups working on the patient.

Kit is separated depending on whether it is needed to clear an airway, gain intravenous access to give fluids and drugs and defibrillation equipment to restart the heart.

This seems like very good progress. I wonder how quickly the new design could spread to the U.S. or other countries. I still think hospitals should go through a “5 Whys” exercise on the following process problems:

  • Why are supplies missing from existing carts?
  • Why are there expired meds on the carts?

Solving the root cause of these problems (and the root cause is most likely process, not technology) would help hospitals who do not or cannot buy the newly designed carts. Probably a good exercise to go through even WITH the new carts. Just because things are visual doesn’t guarantee that there will be a good process in place.

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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6 Comments on "5S for Crash Carts"

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  1. Dean Bliss says:

    Yet another good example of how Lean techniques can help those of us in healthcare to eliminate waste in the things we do. And this one has a direct corrolation to patient safety.

  2. Dan says:

    I don’t know. It’s a nice redesign, but when you consider how many crash carts are stocked in a large hospital that could be pretty damn pricy. Where I worked we very rarely had outdated meds, untested equipment, etc.

    Everything was tested every beginning of shift and logs were kept — pretty simple stuff. The only time I saw outdated stuff was when I first started and I noticed the defib pads were roughly a year past date. I brought it to the safety officer’s attention and he told me he didn’t know defib pads expired. I gave a quick in-service to the department and that was the last time that happened. I haven’t worked in that hospital in over a year and I could still walk up to any cart and break it open and go straight to anything I need. Maybe other hospitals aren’t as good, but then a new fancy box won’t solve that problem (like you said, it’s a process issue).

  3. Mark Graban says:

    Dan – I agree completely. There are MANY process improvements that could be made without buying new carts. But, if they do work better, maybe new hospitals could incorporate these carts from the beginning?

  4. Anonymous says:

    I showed this to a doctor at our hospital and he asked a good question: How do you prevent people from borrowing things from the cart for non-emergency purposes? Sure it’s visual, but it doesn’t keep things secured.

  5. Rick Bohan says:

    Anon posts:

    “I showed this to a doctor at our hospital and he asked a good question: How do you prevent people from borrowing things from the cart for non-emergency purposes? Sure it’s visual, but it doesn’t keep things secured.”

    (This question always gets brought up when I suggest shadowboards, putting tools where they are easy to see, etc.)

    I assume the crash carts aren’t locked up. What keeps someone from taking things from it now?

    If folks do take things from crash carts, isn’t it better that the fact something is missing be very visible?

    Whatever the configuration of the crash carts, I assume someone is checking them regularly to make sure they are complete. Making everything visible just makes this activity easier and decreases the liklihood of “audit errors”.

  6. JB says:

    I like the cart a lot. Maybe you could even put a color in the back of each compartment that would provide a visual of when the supplies were gone or running low.

    Just walking by a cart with red or yellow etc. exposed could flag someone to refill it.

    Just a thought.

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