Carts roll, storage rocks, on evolutionary scale

Healthcare Purchasing News, Sept, 2003 by John Andrews

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.