Making a case for case carts

by Mollie Everett

When a case cart system is implemented in the surgical department, instruments and supplies for surgical cases are processed, picked and prepared in the facility’s central processing area and then distributed to the OR on case carts.  The basic function of a case cart system is to ensure that the right instruments and supplies are available at the right time for the right procedure. Case carts may contain supplies for a single case or for multiple cases in separate drawers. After each procedure, used items are then reloaded onto the cart and returned to central services for processing, sterilization, or disposal. Carts can also be kept supplied and available in the OR for the most common emergency procedures. Thus, the humble case cart has landed front and center in the ongoing battle for greater efficiency in healthcare.

The case for a cart system

A centralized material processing system that provides just-in-time delivery of instruments and supplies to the surgical suite offers some compelling advantages:

• Inventory is consolidated and standardized. When supplies are located and cases are prepared in the surgical suites, inventory is harder to manage efficiently. This kind of decentralized supply system is a magnet for redundant inventory, inconsistent sizes and packaging, and unexpected shortages or surpluses. It takes more time to prepare for procedures; inventories take more time to manage; and overstocked or hoarded supplies become outdated or damaged. The result is a system that is time-consuming, labor-intensive, wasteful, and less responsive to emergencies. Ultimately, costs are higher and patient care is compromised.

A centralized supply management system can better monitor par levels, standardize supplies and instruments, and automate reordering. The result is better information for deciding when to change par levels, for example, or to eliminate a little-used item, or to raise or lower costs. An organization’s inventory costs are reduced because less inventory is needed on hand. Creating standardized pick lists discourages people from getting into the habit of ordering many custom items for procedures, and creating a standard nomenclature reduces the confusion of many names for the same item.

• Space is efficiently used. Ideally, the only supplies stored permanently in the surgical department are items that are hard to standardize, such as gloves, sutures, and implants. Everything else is delivered and returned to central service on case carts. This frees critical space in halls and surgical suites for equipment, patient care, and additional processes.

• Time is efficiently managed. Nobody likes to wait—not surgeons, staff, or patients and their families. Since minutes in the OR are valued in the hundreds of dollars, wasted time is wasted money. Reducing the time it takes to clean up after one procedure and prepare for the next—turnover time—is a critical exercise for any surgical department.

Case carts allow supplies for a procedure to be unloaded and then quickly reloaded onto the cart for return to central services. An efficient case cart system can reduce turnover time, possibly allowing more procedures to be performed. With a case cart system, the OR is also more flexible and responsive to changes in scheduling.

• Staff is efficiently deployed. A case cart system removes the burden of supply management from the clinical staff and allows material management employees to do the jobs they are trained and compensated for. The result is improved patient care and lower costs.

• Infection control improves. Hospital-acquired infections are a serious and costly problem for hospitals. These infections are estimated to occur in five percent of all acute-care hospitalizations. Movement within the surgical suite increases the risk of airborne contamination. A case cart system helps reduce traffic into and out of the OR during a procedure because supplies are organized and available. Also, case carts are designed to protect sterile supplies and to contain soiled ones, reducing the potential for contamination on the trip to and from the OR. Tamper-evident locks and seals in a variety of options further protect sterile equipment.

• Information is more effectively captured. Patient charges for supplies can be calculated more accurately when carts are stocked and unloaded in central service. Additionally, integrating the case cart system with patient billing keeps charges accurate and immediate. It also allows the system to track actual usage numbers of supplies for each procedure.

Case closed

The benefits of a case cart system are clear. It saves time and money by appropriately deploying employees, by standardizing inventory and instruments, and supports automation of billing and ordering systems. While the materials management system can be complex, the product that supports it—the case cart—is simple and straightforward. Choosing the best case cart is a matter of assessing the many features of case carts against the needs of the facility and the demands of the system.