Hospitals Tune up Cart Strategies

Howard J. Anderson, Executive Editor
Health Data Management Magazine, February 1, 2009

Hospitals are having a tough time recruiting and retaining nurses. So they're on the lookout for ways to improve nurses' efficiency. One important step involves cutting the time nurses waste walking around in search of all the equipment and information they need.

As a result, a growing number of hospitals are using mobile carts that give nurses easy access to information systems, diagnostic equipment, bar code readers and more. Carts will have a long-term role in hospitals because they're extremely helpful to nurses, predicts Laura Jantos, principal at ECG Management Consultants, Seattle.

An emerging trend in the use of carts is the expansion of their functions, Jantos adds. "Hospitals are trying to use the carts as a nurse station," she says.

By using a cart for multiple purposes, hospitals avoid having nurses and other caregivers carry a hand-held computer and walk around to retrieve the equipment and supplies they need.

For example, to enhance the functionality of some of its mobile carts, Northside Hospital in Atlanta has mounted blood gas analyzers on them. This streamlines tasks for respiratory therapists.

Mobile carts also will play a key role as hospitals roll out electronic health records and computerized physician order entry, Jantos contends. That's because carts can help provide better access to data at the point of care. In many cases, hospitals are using a variety of brands and styles of carts to meet the needs of various departments, the consultant notes.

When it comes to meeting clinical needs, a one-size-fits-all approach won't work, many hospitals have learned.

West Georgia Health System in LaGrange, Ga., for example, is ramping up its use of carts as it phases in a clinical information system. Some organizations, including St. Joseph Hospital in Orange, Calif., are using their carts to address specific challenges, such as streamlining emergency department registration. Others, including the University of Colorado Hospital in Denver, are taking the extraordinary step of placing a cart in every inpatient room.

Maximizing Utility

For about two years now, Northside Hospital in Atlanta has used a variety of carts throughout the hospital. Now it's looking for ways to maximize the utility of the devices.

"The biggest change in our use of carts is our attempt to do more with each cart," says Bill Siebert, technical services coordinator. "When we first got our carts, our primary goal was to use them for one function. Now we're trying to use them for more functions and share them among clinicians."

Respiratory therapists are highly mobile, going from floor to floor to visit patients, document therapy and take blood gas readings, Siebert notes. So the hospital worked with its cart vendor, Flo Healthcare, Norcross, Ga., to create a customized mount to accommodate a blood gas analyzer on the back of each cart the therapists use. "Now the therapists can do the blood gas analysis as they roll their cart around and complete documentation and administer medications," he says.

Because the blood gas analyzers lacked a wireless network interface, Siebert had to get creative in adapting them for use on mobile carts. "I used a crossover cable to connect the wired network interface from the analyzer to the laptop on the cart, and then shared the wireless connection from the laptop with the analyzer," he explains. "So the analyzer can now upload the test results to the laboratory system server wirelessly."

That's a vast improvement from the tedious old, time-consuming method of downloading data from the analyzer after a therapist finished rounds.

Siebert expects to eventually add wireless access via the carts for other diagnostic equipment, perhaps including blood pressure monitors.

Northside's 200 carts give therapists, nurses and others access to electronic health records, medication management and other applications from McKesson Corp., San Francisco.

Carts can help address a wide variety of needs, from providing easy access to patient-specific medications to offering timely clinical data at the point of care. So the 427-bed hospital uses carts from several vendors to meet each department's specific needs.

For example, nurses involved in medication management use carts from Rubbermaid Medical Solutions, Huntersville, N.C. These carts have separate, lockable medication drawers for each patient, a feature that many other carts lack, Siebert says.

A robot in the pharmacy sorts medications and places them in the drawers, which are then sent to each floor for placement on the appropriate cart, Siebert says.

In the surgical suite, the hospital uses Flo carts to give staff easy access to a patient tracking system. These lightweight carts are much easier to move around the operating rooms and recovery areas, he notes.

In the emergency department, the hospital uses carts from Infologix Inc., Hatboro, Pa. Registration staff members wheel the carts into exam rooms to gather information from patients. These carts are equipped with document scanners that staff members use to copy insurance cards and other identification, saving a walk down to the copy machine, Siebert adds.

Virtually all of the carts at the hospital are equipped with laptop computers. The hospital considered using hand-held computers in certain areas, including the OR suite, but rejected them primarily because of concerns about battery life, Siebert says. The laptops on the carts are linked to large batteries that last eight to 10 hours per charge.

The technology services coordinator says that if tablet computer vendors successfully improve the devices' battery life and reliability, the hand-held computers could supplant the use of carts in some areas. Meanwhile, the hospital is educating nurses to plug in computers on carts when they're not in use to ensure batteries don't run out of power during a long shift.

Tablets on Carts

While many hospitals, including Northside, use laptop computers on their mobile carts, West Georgia Health System has mounted tablets on its 72 carts.

Nurses using the hand-held devices had complained that the 14-inch monitors on the tablets were too small for frequent use, says Cinda Morrow, manager of the clinical information services department. So the hospital mounted the tablets on carts equipped with 17-inch monitors. Nurses can remove the tablets for such tasks as bedside documentation of care.

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