Advances in mobility would seemingly signal that carts are ready to go the way of the dinosaur, but that's necessarily been the case. While mobile devices in some cases compete with carts, you're still likely to see carts barreling down the halls of whatever acute-care facility you find yourself in.
Providence Hospital in Columbia, S.C., like many hospitals, has generations of carts in the halls. "We started out years ago with carts that were basically a box on wheels, and then we moved onto mounting laptops on the carts, and some of those are still in use," says Tony McNeil, information technology manager. "We have four different variations of carts, and we recently purchased more [from CorLogix] because we use them constantly, even while we're testing mobile devices in some areas."
The reasons carts are holding their own in this era of burgeoning mobile options are the focus on bedside medication administration and the need to capture information directly from bedridden patients to ensure the accuracy and timeliness of the process, as well as get boxfuls of medications to a patient floor instead of making multiple trips to a cabinet.
Carts, moreso than mobile options, enable nurses and other in-house caregivers to take their luggage with them for medication administration-the meds themselves, bad code scanners to confirm nurse and patient identity, and a full-sized keyboard to click through eMar and electronic health record applications to document care processes and add any additional notes while directly observing the patients.
The focus on being at the bedside has led to an increase in the use of mobile carts at the point of care, according to HIMSS Analytics, the research arm of the Chicago-based Healthcare Information and Management Systems Society. In terms of mobile technology penetration at the point of care, mobile carts were used at the POC by 45 percent of responding organizations in 2011, up from 26 percent in a similar 2008 study. Wireless laptops were next at 38 percent in 2011, compared with 29 percent in 2008.
Accountability is key
"Every player in this market-providers, patients, payers, regulatory agencies-is being forced to be more accountable for their actions, and that is what's pointing providers to the bedside," says Rob Drewniak, director of strategic and advisory services at Hayes Management Consulting, who previously served as a hospital CIO, among other roles. "Data flow is the key, and to capture that data you're going to need something next to the bed.
Mobile carts play into that need very well. But carts are today's solution, not necessarily tomorrow's. Untethered mobile devices are proliferating and will continue to proliferate, and at some point they're going to be the norm at the bedside."
But for now, being full-featured at the bedside is considered critical by some providers, for a variety of reasons. Ocean Medical Center, which has 600 carts moving through its various acute care departments, tested an idea to replace some carts with small notebooks or tablet PCs, but decided to hold on to its Rubbermaid carts after nurses complained about not being able to read the text on mobile device screens. "We have an aging workforce just like everyone else," says Joan Harvey, R.N., clinical nurse specialist at the center. "The average age of the nursing staff is getting close to 50, and eyesight was a big issue-many needed a full 17-inch screen and bigger fonts to do their jobs."
Screen size is not the only factor that tipped the scales in favor of carts at Ocean Medical. The most obvious was the rigors of medication administration-the Rubbermaid carts lets caregivers load up on medications for multiple patients, and also provide a convenient way to keep wireless barcode scanners handy for wristband scans.
The set-up enables nurses to work through the hospitals medication administration software (from Siemens Corp.) in real-time and have the active worklist on screen while administering meds.
After four months of deploying the carts, medication administration errors decreased significantly, and instances of the wrong patient receiving a medication was reduced to less than 1 percent of all medication administrations.
Critical byproduct
But a critical byproduct of creating a functional mobile work area is that nurses are spending much more time face to face with patients. Instead of jotting down notes and then documenting at a nurse station, nurses are making observations and doing the mundane task of typing in front of the patient, which gives them more time to interact and observe, making for more thorough clinical notes and also reassuring patients and their families, Harvey says. "Carts helped us move everything we do to real-time-documentation, assessments and all the other clinical processes we perform," Harvey says.
Mobile carts haven't gone through the dramatic makeovers of mobile computing devices and other hardware, but they have incrementally improved over the years-getting lighter yet sturdier, and improving battery life. And cart vendors have also stepped up their game by customizing their wares to fit the unique needs of their clients.
When Good Samaritan Hospital in Vincennes, Ind., was in the market for carts three years ago, Vice President and CIO Chuck Christian and his staff put together a cart fair at the hospital and surveyed nurses multiple times about the array of options available. But the model they liked best, from CompuCaddy, had one problem: the wheels didn't roll well across the floors at Good Samaritan, which has a mix of linoleum and carpet in care areas.
However, the vendor came back and told Christian it would replace the wheels with another set, which sealed the deal.
Besides being lightweight and having a low center of gravity to prevent tipping, the CompuCaddy carts have a built-in battery gauge, a small but important feature, and run on lead acid batteries that provide a 10 to 12 hour charge.
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