Standardizing Crash Carts Using Collaborative Design Methods and Usability Testing
TimeFriday, April 1612:50pm - 1:10pm EDT
Crash carts are mobile containers of medications and supplies used to resuscitate patients in emergencies within health care facilities. Contents and organization of carts often differ across hospitals and even departments within the same hospital. To support our team members in emergencies across our multi-hospital system, we created a system safety initiative to standardize and optimally organize adult crash carts. Our team established a three-phase user-centered research and design approach. First, we facilitated a collaborative design workshop with front line stakeholders to develop an initial cart organization. Second, 59 clinicians across 8 departments interacted with a cart mock-up and provided feedback. Finally, 18 clinicians participated in usability testing of the updated cart in 3 separate full simulations of realistic patient emergencies including anaphylaxis, ventricular fibrillation, and sepsis using manikins. Observations and feedback from all three research phases contributed to a final medical supply list and crash cart design for our hospital system. This work also provides guidance for using collaborative design methods and usability testing within hospital environments.
Clinicians handling emergency situations need access to the right supplies and equipment to treat a patient quickly. A committee in our hospital system including respiratory care, anesthesia, ER/trauma, and critical care leaders endeavored to standardize the contents and organization of the crash carts across 8 of our hospitals. The team identified this need for standardization for multiple reasons, including:
• Maintaining best practice and hospital guidelines
• Improved outcomes
• Staff training
• Co-utilization of staff between sites
• Reduced waste of supplies
• Reduced cost
Our system pharmacy department had already standardized crash cart medications. The Crash Cart Standardization Committee came together to examine our supply lists from each hospital, evaluate the differences, and draft one consolidated list of supplies to meet the needs of all. The committee enlisted the support of the Simulation team and Human Factors Engineering to evaluate the updated list of supplies and help determine how to organize the supplies to best support health care team member workflows.
• Evaluate proposed standardized list of supplies/equipment for an adult crash cart
• Design and organize the supplies/equipment in an adult crash cart to support emergency events
• Test the usability of a newly organized adult crash cart during various types of emergency event(s)
We drew methods from our simulation and human factors areas of expertise to create a participatory, user-centered design and evaluation process. We conducted a three-phase approach including:
Phase 1: Collaborative Design Workshop
Eight clinicians from ED, ICU, Pharmacy, Anesthesia, Respiratory Therapy and Cardiac Cath Lab met for a 2.5 hour workshop. During that time, simulation and human factors facilitators led them through the following activities:
1. Review new, standardized supply/equipment list for adult crash carts
2. Use tips and tricks to optimize organization, including human factors principles
3. Brainstorm new ideas or identify must-haves for the crash cart
4. Develop an initial draft using actual supplies/equipment and adult crash cart
Many applicable design ideas were generated in the workshop, including:
• Overall organization strategies
• Job aids
• Pre-configuration of supplies and equipment
• Location/positioning of some supplies outside of cart
• Supplies/equipment to add
Phase 2: Hands-On Cart Prototype Evaluation
The simulation and human factors engineer brought the mock-up crash cart based on the workshop design to 8 different hospital departments for front-line user feedback. Fifty-nine clinicians explored the configuration, thought aloud about their experiences using crash carts and offered suggestions, and answered interview and survey questions. This phase generated additional updates to the cart design.
Phase 3: Usability Testing via Patient Emergency Simulations
Three separate clinician teams of 6 participated in 1-hour simulations of patient emergencies. Nurses, pharmacists, ED physicians, anesthesiologists and respiratory therapists participated in the simulations. Three types of emergencies (anaphylaxis, ventricular fibrillation, and sepsis) were chosen to require use of a variety of supplies within the carts. Participants used the redesigned crash cart in a simulated ER and OR to treat a high-fidelity manikin. The human factors engineer and simulation team members gathered observations of performance with the carts as well as subjective feedback following the sessions.
Observations and feedback from all three phases contributed to a final medical supply list and crash cart design for the hospital system. The work also created a structure for conducting future in-hospital collaborative design and testing methods.