Restoring Faith In Mobile Carts One Nurse At A Time
By Health IT Outcomes staff
An investment in new mobile carts proves instrumental in facilitating EMR adoption among nurses at Williamson Medical Center.
In today’s fast-paced healthcare environment, hospitals’ CIOs tend to have their eyes on the prize of Meaningful Use. Selecting, implementing, training, maintaining, or replacing a healthcare IT system often takes up the majority of their days. Michael Spivey anticipated facing this set of challenges when he assumed the role of CIO at Williamson Medical Center, a 185-bed community hospital in Franklin, TN, that employs more than 500 physicians and 1,300 staff to handle 155,000 patient encounters annually. What he found, however, was a challenge of a different kind.
Assessing The Situation
Soon after his arrival at Williamson Medical Center in October, 2011, Spivey learned the nurses had abandoned the hospital’s small fleet of mobile carts some months prior, refusing once and for all to deal with their increasing unreliability. The main culprits were batteries that couldn’t last a full shift, unexpected breakdowns, heavy weight, and unwieldy design. The latter two more than likely contributed to the number of back-pain complaints Spivey heard from the nursing staff.
But the biggest concern was that patient care was being detrimentally affected. “Their absence certainly decreased the efficiency of the nursing staff,” Spivey explains, “which affected patient care because the nurses weren’t getting around to see as many people as they would have otherwise. They weren’t able to document on the carts, which means they had to spend time batch documenting — writing down documentation for two or three patients at a time after making their rounds.”
Vital Role To Play In NEW HIT Adoption
At the outset, Spivey’s main project was leading hospital staff through conversion to the new MEDITECH 6.0 platform, giving the facility access to a full EMR with CPOE. Hospital staff was 12 to 18 months into the MEDITECH conversion when he arrived. “The MEDITECH 6.0 conversion was going to introduce significant changes to the workflows of doctors and nurses,” Spivey explains. “We were looking at a total process upheaval, and we quickly realized that some type of cart was going to be necessary for that project to be successful.”
One of his first meetings with nursing leadership was about their need for new carts in light of the hospital’s imminent EMR capabilities. “They had carts on their radar before I got here,” he says. “We planned to go live on the new EMR on June 1, 2012, and the nurses were concerned about building out new workflows with the existing problematic carts. What was that system going to look like? They already had abandoned their old carts and didn’t know which way to turn.”
Due Diligence A Safe Bet
Spivey decided to devote a significant amount of time at HIMSS, in February, 2012, talking with mobile cart vendors on the show floor. Pressure was mounting for him to make a purchasing decision, and HIMSS seemed a likely place to vet potential suppliers.
“I think I counted 35 cart vendors at HIMSS in Vegas,” Spivey recounts. “It was validation that there were a lot of people out there looking for them. Because there were so many choices, we really needed to do our due diligence and choose the one that was going to fit our specific need.”
Spivey talked with 15 to 20 mobile cart vendors at HIMSS and eventually gravitated toward the booth of JACO Inc., which, according to Spivey, was without the typical tradeshow hype or frills. “The booth was fairly simple,” he explains, adding it was very reflective of the company’s sales team and product line. “We weren’t looking for a lot of bells and whistles. We were looking for a simple, functional cart, one that was reliable and had maneuverability.”
Their straightforward sales pitch and willingness to design a cart specific to his facility’s needs enticed Spivey and his team into further conversations with the company. Spivey decided to include a JACO mobile cart in a demo week at Williamson not long after HIMSS. Nursing staff on each floor of the hospital extensively tested three carts from three different vendors. The IT staff also took time to check out every angle of the carts.
“In the end, it was a consensus choice,” Spivey says. “Four out of five people that looked at the carts selected the JACO UltraLite 520 cart. The fifth-wheel steering mechanism (TRAC steering) was a big win with the nursing staff who participated in the demo. They immediately noticed it made the cart even easier to maneuver. The cart’s metal construction was a hit with maintenance, IT, and nursing. It made it easy to clean and offered a high level of durability, both of which were big drivers in the decision.
Rolling Out Carts Just In Time
Spivey decided to purchase 75 carts in April, 2012, just two months before the hospital’s impending go-live on the new MEDITECH system. While he was enthusiastic about tripling his mobile cart fleet and putting the abandoned carts out to pasture, he also was anxious about having the new carts assembled and ready to use by June 1.
He and his team assembled the carts the weekend before flipping the switch on the hospital’s new EMR the following Friday. “We put together 75 carts in three days with our in-house assembly line,” he says, adding that it turned out to be a great team-building exercise for the IT team. “We were happy the carts came in with zero deficiencies, too,” he notes. “We didn’t have to send a single cart back.”
Winning Nursing Buy-In
Spivey was also pleased that nursing staff had no significant adoption issues with the new carts. Aside from transitional adjustments, such as getting used to keyboard and mouse placement on the carts, the biggest challenge nurses faced was learning when and how to engage the fifth wheel, which enables greater maneuverability around tight hospital corners.
“Nursing staff, with the exception of the subset who became familiar with the fifth wheel’s purpose during the demo, thought it was a brake initially,” Spivey recounts, “but once we taught them what it was, it now stays engaged all the time. It makes it so much easier for nurses to maneuver down the halls.”
Slowly but surely, the nurses’ faith in mobile carts returned. “The nurses were a little skeptical of the carts to begin with because of their past negative experience with the previous fleet,” Spivey says, “but once the reliability was proven, you could really see them start to use them. We watched them transition from plugging a cart in everywhere they went, to charging it once a shift and really trusting it.” In addition, nurses’ previous complaints of cartinduced physical strain all but disappeared, thanks to the lighter weight of the new carts.
Spivey notes the new mobile carts also helped improve the nurses’ efficiency and enabled them to document in real time at the patient’s bedside. “Real-time documentation has helped a lot,” Spivey notes. “Carts at the bedside eliminate wasted time and effort in time-consuming and potentially incorrect batch documentation by the nurses. More importantly, however, they improve accuracy of the medical information being used to treat a patient, because they enable that information to be input at the patient’s bedside, rather than down the hall a few minutes or hours later.
Determining Future Need
Williamson Medical Center hasn’t seen the last of new mobile carts. Spivey has two departments requesting carts that he will include in his 2014 budget, likely resulting in the addition of 25 to 30 carts within the next 12 months. “I’ll absolutely choose JACO carts again,” Spivey says. He is fairly confident the company will also supply any carts needed in Williamson’s planned children’s hospital surgery expansion.
While Spivey will be the first to admit that mobile carts don’t fit into the “bleeding edge” category of his job, purchasing them for Williamson Medical Center during the final stages of an EMR adoption has made him realize how vital they are to effective utilization of the EMR at the patient’s bedside, not to mention the health and happiness of the nurses.