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 an airway emergency (anaphylaxis), cardiac arrest (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 co-design methods and usability testing within hospital environments.

BACKGROUND Healthcare simulation has expanded dramatically; however, little is known about the scope of simulation in acute care hospitals. METHODS A descriptive, cross-sectional online survey was used. Participants included nurse executives from acute care hospitals in California. RESULTS Most organizations (96%) used simulation primarily for education, 37% used simulation for health system integration and systems testing, 30% used it for error investigation, 15% used it for research, and 15% used it for patient/family education. CONCLUSIONS Organizations have a substantial opportunity to increase the scope of simulation beyond education to include systems integration, clinical systems testing, and other translational simulation activities. This targeted focus on patient safety and quality will allow hospitals to improve financial performance and maximize scarce resources.

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