Carts & Workstations: Conduit connecting clinical, financial, operational workflow

May 25, 2023
Flexibility, modularity and real-time tracking, transmitting reaches prime time

Healthcare professionals may view carts and workstations as a necessary tool to do their jobs, but they also serve as a conduit that links clinical service (patient care) to financial information (patient billing) and to operational procedures (patient supply).

In short, they represent a multifaceted command center housed in a compact package that helps to circulate patients through the care process.

They include carts and workstations that house information technology, carts and workstations used to pack instruments for sterilization and carts and workstations stocked full of products for medical and surgical procedures.

Improving patient care workflow through effective and efficient use of cart and workstation technology can be a tall but attainable order.

Making them work

Clinicians in Surgical Services and on the Nursing floors, sterile processing professionals and supply chain professionals want to make more effective and efficient use of their cart and workstation capabilities, components and space to improve workflow and the patient care because it affects outcomes all around. That’s why, by and large, they need to concentrate on their product decision-making before any cart or workstation joins their fleet. Bottom line: Plan ahead.

When considering the purchase of carts for medical or other purposes, it's important to assess how they will be utilized in advance to make an informed decision,” recommended Jonathan Sabo, vice president, Marketing & Customer Support, Cardinal/Detecto. “For example, some carts offer slide-out shelves on both sides of the cart, along with ample top counter space, providing increased work surface area for positioning laptops, vital signs monitors and other equipment in confined spaces. These carts may also come with push handles on multiple sides, giving customers the flexibility to choose handles that fit their workflow.

“Customization options are available for some carts, allowing customers to select drawer width, handrails, drawer height configurations, lock types, [radiofrequency identification] options and even unlimited color choices, resulting in a cart that is tailored to their specific requirements,” Sabo continued. “This approach avoids the need for customers to conform to standard features and allows for a cart that is manufactured based on the user's preferences. There may be a wide range of standard models and numerous configurations available, depending on the manufacturer.”

Advanced planning also invites flexibility, according to Sabo.

“In emergency situations, such as in an ER when time is critical, searching for keys or typing in PIN codes to unlock drawers may not be practical,” he indicated. “Some carts may offer unique features, such as a Quick Release plunger with breakaway plastic tags and red/green flag, which allows for instant unlocking of all drawers with a single press of a button, providing immediate access to life-saving drugs and equipment. The lock can be easily reset after the cart is cleaned and restocked, ensuring readiness for future use.”

Clinicians need to be mindful about their equipment selections, particularly around modularity, suggests Tim Ramcoobeer, sales development representative, H+H System Inc.

“Now, more than ever, it is imperative that clinicians be meticulous about the equipment they choose to support their team’s workflow,” he noted. “With all the available options, making that decision isn’t easy but one that will save time, space and lives. I believe there needs to be a shift toward modular carts and workstations. When it comes to a pharmacy that carries out multiple daily tasks – say anesthesia tray swap and medication distribution – it makes far more sense to have a single mobile unit that can achieve both.”

Sound decisions may require a new, more realistic mindset, according to Dave Mikulak, director, Sales, Point of Care, TouchPoint Medical.

“When technology can become part of the conversation and not a piece of equipment that gets in the way of patient care, that’s when clinicians start to make the best, most effective and efficient use of their carts and workstations,” Mikulak insisted. “Space is tight, there is no room for clunky equipment that does not work with the caregiver’s workflow. When they spend more time addressing the technology’s needs, they are taken away from time spent with the patient. Getting a space assessment of the area where the clinician needs the cart or workstation prior to purchase and being able to demo the unit to make sure it fits into their space are great ways to improve workflow and the care they provide to the patient.”

Flexibility is key, particularly for designated use, indicates Ian Loper, vice president, DSI.

“There are boiler plate medical carts in the field used as utility carts and [for] multipurpose use, and then there are specialty carts, specifically designed for certain applications of use,” Loper noted. “Whether it be a mobile computing cart, an isolation cart, a crash cart, an anesthesia cart, a case cart or a supply exchange cart, there is something out there designed specifically for the application of use. The key is to identify the requirement, and make sure all the bells and whistles are included on the specialty cart, so all the tools are available for the clinician at a moment’s notice.”

Adding options

In a world that embraces convenience, flexibility and modularity, clinical and operational end users may be embracing the addition of handheld devices and other options to encourage multipurpose functionality across clinical, financial and operational spectrums.

Medical carts are designed with a wide range of optional accessories available for customization, including defibrillator shelves, IV poles, bin organizers, catheter holders, sharps container holders, cardiac boards, oxygen tank holders and waste bins,” Cardinal/Detecto’s Sabo countered. “These accessories are often side mounted, allowing for flexibility in loading and accommodating various devices and supplies needed for portable patient care. Some carts may feature a unique corner extrusion mounting system that provides easy attachment of optional accessories in customized locations. This allows users to slide the mounting rail up or down to the desired height for the accessory, providing versatility and adaptability.

“Electronic carts may offer different unlocking methods to choose from, such as one lock and individual drawer sensors, individual drawer locks and individual drawer sensors, or simply one lock,” he continued. “Detailed employee audit tracking may also be available to track drawer openings and closings, helping to mitigate theft of sensitive items, such as narcotics, with the use of included PC software. These features and options offer customization and convenience for users of medical carts, allowing for efficient organization and storage of essential equipment and supplies in a manner that best fits their needs.”

H+H’s Ramcoobeer recognizes how technological development and advancement has progressed during the last 15 years to the point that supporting devices no longer need to be confined to a department.

“These tools are now handheld and mobile to allow for on-the-go workflow,” he indicated. “Especially with the development of various mobile tray-checking options, there is the ever-increasing need to have a mobile unit support all aspects of that process. [We] addressed this by being able to prove that a unit not only houses the technology needed to verify medication accuracy but also modular components – such as subdivisible bins and integrated narcotics boxes -- to then support the next phase of that process, drug replenishment. In doing so, clinicians can work confidently knowing that there is a place for everything and everything is in its place.”

TouchPoint’s Mikulak acknowledges the dynamics of healthcare technology trends.

“Workflows and tracking are among the most critical features requested by clinicians and healthcare systems,” he observed. “Workstations must allow for future integration of technological advancements. Touchpads, cellular phones and other system communication devices should not only be stored on workstations but integrate with systems and allow for charging to increase effectiveness. Inventory tracking, real-time location services, integrated cart health systems and smaller user-friendly cart adaptations will benefit the caregivers.

“Workstations must be designed to allow for integration and expansion of new features based on the system and caregiver workflows,” Mikulak continued. “Patients are a critical user of workstation technology as providers update information, integrate real-time patient monitoring and allow for real-time access to scans, labs and other features for patient training and knowledge. The workstation is the central hub for all caregiver interfaces within the healthcare system, charting, bar-code scanning, RFID tracking and medication management at the location of the patient.”

DSI’s Loper envisions tech-festooned carts and workstations as “smart” products with an operating system that empowers them and the clinician end user to help them do their jobs.

Demanded features

What do end users want to see on their cart and workstation products, if possible?

“Key capabilities revolve around the technology platform identified by the healthcare system, according to TouchPoint’s Mikulak.

“EMR, medication management and system integration within the facility infrastructure is paramount,” he said. “Healthcare systems continue to evolve and advance their technology, but it cannot create a negative impact on the patient care or caregiver interface. User features must be intuitive, controllable and ergonomic. Information displays, touchscreens and storage systems must be intuitive with easy understanding and limited training for proficiency. Personalization of these features should allow for caregiver control of screen layout, lighting control, setting changes and storage of this information based on RFID or user access control settings.

“Easy-to-read cart health is critical, by informing the caregiver of battery life, cart issues, interface with other systems like service and other related warnings and cautions, ensuring that the caregiver can focus on patient care,” Mikulak added. “Large worksurfaces that are not limited by keyboard or monitor placement to allow for caregivers to prepare medications and other tasks without the need to reset your workstation.”

Convenience coupled with security is paramount, according to Cardinal/Detecto’s Sabo.

In the current crisis of drug diversion, ensuring added security combined with quick access to drawer contents is crucial,” he said. “Added security and speedy drawer access don’t have to be mutually exclusive. Electronic carts now offer unique and sophisticated ways to securely lock up drawer contents, including theft-prone narcotics, while providing quick access for verified healthcare professionals. Features such as drawer alarms for forced entry, open drawer alarms, and an audit trail of drawer opens with time/date and personnel access information ensure narcotic safety and staff accountability. User setup can be easily done at the cart or with included Windows software.

As opioid abuse and drug-related deaths continue to be a pressing issue, healthcare providers must take aggressive steps to prevent drug diversion, Sabo argues.

“Electronic carts now offer multiple unlocking and access authorization methods, such as individual PIN entry on a touchscreen keypad, touchless RFID card badge scanner, or a combination of both for dual entry protection,” he noted. “This allows for specific drawers on the cart to be unlocked based on individual needs and security levels, enabling quick access to basic supplies while keeping controlled substances safely locked away. Alarms can also be set up to alert staff about drawers left open, using audible alerts, as well as e-mail and text notifications to pre-assigned admin personnel.”

For H+H’s Ramcoobeer, the issue boils down to two words: Space constraints.

It seems to be a daily conversation with clinical staff that space is a major limiting factor in the speed and accuracy at which they can deliver patient care,” he noted. “Unfortunately, space, or the lack thereof, isn’t a quick, cheap, or easy fix. To make the most of the space that is available, we always hear the need for workstations that are both modular and scalable.”

DSI’s Loper acknowledges durability remains an ongoing concern because mobile carts can take a beating.

“Whether it’s crashing into walls, being rolled over a bumpy floor, drawers being slammed, exposure to cleaning chemicals, outdoor elements, humidity, etc., any and all carts in a hospital need to be able to take a beating,” he said. “In comes quality of design, quality or materials used, and quality of care for the rolling assets.

“Carts are tools, and they need to be designed for the application with the right materials, with the right casters, with the right locking device and with the right accessories,” Loper continued. “Not all manufacturers have this area of expertise pinned down. If a crash cart goes wrong, what’s the worst-case scenario? If a workstation in the SPD tips over, what’s the worst-case scenario? If an anesthesia cart is compromised and can’t be open, what’s the worst-case scenario? What’s the after-sale service look like after a cart is sold? Who is the rep and are they accountable? These are just some of the questions that should be considered during the evaluation process of determining which manufacturer to partner with on this large and important investment.”     

Design tips

Cart and workstation makers consistently search for relevant and useful design tips from customers to improve ergonomics and workflow, which aren’t always so overt.

Cardinal/Detecto’s Sabo turns to recent events and issues as instigators.

In light of recent events such as the COVID-19 pandemic and concerns about healthcare-associated infections (HAIs), the importance of hygienic cleaning in medical facilities has become more critical than ever,” he said. “Modern medical carts are designed with the busy clinical user in mind, prioritizing hygienic features that are easy to clean and disinfect.

These carts feature wipe-down surfaces made of materials such as ABS with smooth-molded contours that are easy to clean, ensuring effective disinfection. Additionally, features such as steering locks for the wheels and parking lots are beneficial for nurses maneuvering their carts in busy medical environments. Some carts offer push handles on one side, while others provide the option of guide handles on multiple sides or other variations, catering to different user preferences.

“Soft close drawers are a convenient feature for nurses, allowing them to close drawers easily with a gentle bump using their hips when their hands are often occupied with other tasks,” Sabo continued. “Keeping up with the demand for wireless connectivity, some carts come with built-in Wi-Fi, enabling cart updates for user access and other functions to be managed through a centralized point. The onboard user interface of these carts is designed to be user-friendly, with full-color touchscreens, beautiful graphics, and easy navigation, similar to popular consumer devices like Apple products. These features enhance the overall usability and convenience of the carts in healthcare settings, prioritizing hygiene, ease of use, and efficiency.”

TouchPoint’s Mikulak concentrates on physical harm and injury prevention as key.

“Overuse injuries are extremely common in the healthcare environment,” he indicated. “User-specific height adjustability of the worksurface is a standard expectation with expansion into electronic lifts to decrease lift injuries. Mobility and maneuverability relating to handles, handle locations and caster selection [must] ensure the workstations can be configured to optimize the transport ergonomics. Keyboard location and tilt options for user adjustment [must] decrease the risk of carpel tunnel and other overuse injuries. Visual interfaces like the touchscreen need to be placed and oriented for quick easy visualization, and computer monitors require adjustability to include positioning for caregivers with glasses or multifocal lenses. Positioning and expansion of the workstations require significant ergonomic thought to ensure that walking, reaching and bending can be minimized by providing a central system to assist in repetitive daily operations.”

DSI’s Loper also impresses the importance of eliminating potential injury.

Adjustable height workstations are mission critical for a prep and pack tech workstation in a Sterile Processing department,” he said. “Everyone is a different height, so to optimize employee productivity, ergonomics come into play. It’s not a one-size-fits-all scenario for workstations where healthcare workers sit most of the day cleaning, sorting and organizing sterile instruments. Having the ability to adjust the height of the workstation should be mandatory.” 

H+H’s Ramcoobeer focuses on the limited options available for medication and inventory labeling as particularly irksome.

“All too often teams are forced to tape labels onto bins and medication trays,” he said. “These fashioned labels then deteriorate or fall off, leaving clinicians with no way of quickly identifying what they need, sometimes in life-or-death circumstances.”