5S for Crash Carts
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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