Carts roll, storage rocks, on evolutionary scale - Products & Services

Medical carts have traveled down a long corridor since the days when they were stainless steel footlockers the size of Volkswagens.

Hard to imagine? Ask longtime industry veteran Warren Armstrong, who remembers that era in the 1950s and '60s: "Originally, medical carts were huge, expensive and heavy," said Armstrong, who is now the president and CEO of Lincolnshire, IL based Armstrong Medical. "In those days, I sold carts that were four or five feet long and four feet high. That type of cart was a monster it was really hard to push. The theory was that you needed a cart to cover the entire hospital. When you got onto the elevator, there was no room for any thing else. By the time you took it up to the fourth floor at the end of the hall, you were dead."

Quite a contrast from today's sleek, slimmed-down models designed to serve specific functions, offered in a rainbow of colors, featuring a variety of drawer sizes and supporting sophisticated electronic equipment. The catalyst for change, Armstrong says, was the professional tool cart long used by garage mechanics.

"In 1970, we saw how the tool cart could be applied to the medical field," he said. "We put on better hardware, casters and made them smaller, about 30 to 40 inches high and 27 inches wide. They took off like gangbusters."

From that point on, medical carts became the preeminent mobile storage system for hospitals and continued to evolve as needs changed. Cart manufacturers say they've responded accordingly as users requested carts for increasingly specific purposes, such as point-of-care, medication dispensing and instrument isolation. Carts have also been stratified across various hospital departments, including ER, OR, ICU, critical care, radiology, laboratory, anesthesia, pediatrics and outpatient care.

Where once a colossal, solitary chest of drawers containing products for nearly every conceivable contingency, the cart-to-patient ratio has shrunk dramatically, says Jane Laycock, product manager for medication carts at Exton, PA based Lionville Systems.

"In the beginning, you had a medication nurse who used two carts to administer drugs to 30 patients," she said. "That started changing in the late '80s and early '90s, when medication nurses became primary care nurses and their scope of responsibilities widened. At that point there was probably one cart for every 10 patients. In 2001 when the VA system started bar-coded charting systems and carts needed to support computers, it became one cart for every four-to-six patients."

Carts on a diet

From a style standpoint, manufacturers have used customer feedback over the years to develop carts that have gone from obese and awkward to slender and nimble. Drawers--once bulky catch-alls for miscellaneous instruments--have slimmed down exponentially and are now designed for meticulous organization.

Dimension-wise, carts continue tobecome narrower and more compact. From the mid- 1990s to 2000, Lionville sold a cart that was 32 inches wide. Now the most popular model is just 22 inches wide--for good purpose, Laycock said.

"Because point-of-care is increasingly being done electronically, carts are being taken into patient rooms, so they need to fit through the door," she said. "It's getting to the point where there will be one cart per nurse."

Back in January, Armstrong introduced a mini-cart that is 34 inches high, but only 18 inches deep and 18 inches wide. "Because the Joint Commission issues citations for earls that aren't locked up, these mini carts can pick up the slack for any department that needs something secured," Armstrong said.

Instrument arrangement has become paramount on ER crash carts, because it's crucial to have the ability to locate an item at a moment's notice, said Candice Mueller, marketing manager for Cedar Falls, IA-based Waterloo Healthcare.

"In an emergency situation, the staff needs to get supplies in a quick and efficient manner," she said. "With the push of a button, our cart doors open like a refrigerator and display five drawers. Each drawer is transparent plastic, so the contents are in full view."

Airy materials like aluminum are also being used to lighten cart weight while retaining its sturdiness. Wheel casters have also improved, dramatically" upgrading cart maneuverability by eliminating "the fishtail effect," Mueller said.

The more extensive color palette offered by today's manufacturers livens up the hospital's decor, but the story goes beyond aesthetics. Hospital personnel can visually identify a cart's contents by shade--usually red for Eli, yellow for isolation, dark blue or green for anesthesia and orange or violet for Latex-free.

The matter of latex allergy in the hospital has also made a difference in the cart world, as manufacturers are responding to hospital demand. Fir example, to keep its utility cads "cleaner between cleaning's," Wilkes-Barre, PA-based InterMetro, better known simply as Metro, says it has been applying Microban antimicrobial protection to its Deep Ledge and BC Series lines.

Metro officials contend their production agreement with New York-based Microban International is unprecedented in cart manufacturing. By adding antimicrobial agents during assembly, the units will "inhibit the growth of bacteria, mold and mildew that cause odors, stains and product degradation," a company statement read.

Microban produces antimicrobial agents for consumer, industrial and medical goods and licenses its brand name for use with other products.

The E-revolution

Hospital information technology advancements are influencing cart design as well. With the 'advent of electronic patient records, carts are becoming portable computing stations as well as storage vessels.

Peter Block, president of Harwood Heights, IL-based Carstens, says the healthcare industry is just now starting to shift toward a paperless environment. "This is the next great evolution for healthcare," he said. "It may take another 10 or 20 years, but the transition will occur."

Carstens' current cart line is designed to address this transitory phase between electronics and paper with its point-of-care charting system.

"We're offering a migration path on the way to electronic charting," Block said. "We see paper and electronics co-existing for quite some time. Patient charting is notoriously slow to automate--talk to any healthcare facility and they'll tell you how slow and difficult the process is to implement changes by piecemeal."

One reason why conversion to complete electronic charting will take time: It remains a stiff challenge to bring together the diverse disciplines within a hospital, Block said. For in stance, radiology needs high bandwidth for imagery. "Laboratory has its nuances, as does orders and nurse notes have to be converted, too. So as it stands now, data is typically being entered electronically, printed out and put into a paper chart.

"Because these systems are implemented piecemeal, some departments may be auto mated while others are not," he said. "What's more, there is a comfort level with paper and [skeptical] attitudes about the safety, security mad dependability of electronic data storage. We're realistic about this, but are confident that it will slowly change."

Lock and load

Electronic components have greatly improved the accuracy of drug dispensation as well as safeguarding medical cart contents under Joint Commission guidelines.

"The whole idea was to reduce the errors that were occurring with drag dispensation," said Lionville's Laycock. "Before electronics, there was no double-checking capability at the point of administration. Now a bar coding system allows the nurse gets file medical records, see what meds are due, remove them from the drawer, scan them and scan the patient's chart to make sure it's correct."

Modern medication carts are also being made to augment automated pharmacy systems in hospitals. Houston-based S & S Technology offers a cart that safeguards medications from the point of pickup to the patient's bedside.

"Automated medication systems track distribution and capture costs, but offer no protection during delivery," said Michelle Gardner, national sales manager. "We have a cart line that ensures medications are secure every step of the way."

Locking mechanisms have also advanced so that carts can be left unattended without concern about theft. Electronic systems that use push button code entry lessen the need for nurses to carry keys around.

Open drawers are still vulnerable, however, so manufacturers are searching for ways to prevent unauthorized access.

"We developed a feature called a 'door grabber' mechanism that automatically withdraws the doors to lock them," Laycock said. "We're now looking at securing a drawer that isn't fully closed."

Storage efficiency

Cart systems aren't the only modules that have been streamlined. Because of finite storage capacity, hospitals are constantly looking for ways to maximize file space they have for stationary systems. Offsite storage with outside contractors has become common, though that strategy carries with it a loss of control over delicate items like laboratory slides.

"Unlike records, slides are fragile," says Jim Deller, healthcare specialist for Spacesaver Northwest in Seattle. "Thus, laboratory stall" are leery of an offsite storage vendor's ability to handle, store and preserve these items correctly. Damage to a slide can amount to some pretty significant liabilities."

Spacesaver offers high density mad mobile storage systems designed to double a hospital's storage space. With regard to high density slide storage, the hospital's floor structure must first be evaluated in order to determine whether it can handle the slides' heavy weight, Deller said.

"We work closely with the hospital facility department and their structural engineer to make sure floor loading issues are addressed," he said. Flexibility is the key to effective bulk storage, said Deller, pointing out that many storage closets are laid out using a one-size-fits-all mindset.

"Packaging changes constantly and many times a standard shelf or cart just doesn't store items efficiently," he said. "I have yet to see a standard for bulk supply storage. Most hospitals use a combination of wire and wide-span plywood shelves, some use dunnage racks and some use old leftover units from other shelving departments."

However, space constraints can easily be resolved by using shelves of varying directions, Deller said, arranging them in back-to-back or pass-through configurations and using storage accessories such as bin dividers and front-end sorters.

COPYRIGHT 2003 Healthcare Purchasing News
COPYRIGHT 2003 Gale Group