Optimal Crash Cart Configuration for a Surgical NICU

Abstract

Background: Neonates admitted to cardiac and surgical neonatal intensive care units (NICUs) are at an increased risk of requiring emergency lifesaving interventions that require the use of both Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) algorithms. Clinicians working within the surgical NICU must be able to access emergency equipment and medications quickly in order to respond to critical situations. A crash cart that integrates human factors principles and supports both the NRP and PALS algorithms is necessary to promote patient safety for this high-risk population. Purpose: A multidisciplinary quality improvement project constructed an optimal crash cart configuration that embedded human factors principles and supported clinical workflow by reflecting both the NRP and the PALS algorithms in an NICU that cares for cardiac and surgical patients. Methods: A crash cart working group including frontline NICU staff, simulation experts, and a human factors specialist was formed within a surgical NICU. Human factors principles were utilized to align the organization of the cart with the NRP and PALS algorithms to increase the efficiency and intuitiveness of the cart. The new crash cart configuration was usability tested through simulation, revised on the basis of clinical feedback, and then implemented in a clinical setting. Data were collected following implementation of the new crash cart to validate that the new configuration was viewed as a significant improvement. The Plan-Do-Study-Act cycle was used to make improvements and capture outcome indicators. Results: Evaluation data collected both during usability simulation testing and in situ within the NICU clinical environment indicated that the revised crash cart scored higher on Likert scale response questions than the previous crash cart. Implications for Practice: Human factors science, in combination with frontline user engagement, should be utilized to create intuitive crash cart configurations, which are then tested in a simulation environment and evaluated in situ in the NICU. Implications for Research: Further research around crash cart design within NICUs that use multiple lifesaving algorithms would add to the paucity of research around the impact of human factors theory in the utilization of lifesaving equipment and medications within this specific population.

Improving Usability of the Pediatric Code Cart by Combining Lean and Human Factors Principles

“…Most facilities organize their pediatric and adult code carts by intervention. 18 , 19 One study examined using a color-coded weight-based system to organize resuscitation equipment. They found some improvement in the time it took to obtain intubation equipment and nasogastric tubes.…”

“… 2 , 14 A quality improvement initiative in a NICU used Human Factor techniques to revise their code cart and found users preferred the redesigned cart to their previous cart. 18 After reviewing this literature and discussing it with staff, our institution decided to organize supplies by intervention with a focus on Lean Methodology and Human Factors technique instead of using the color-coded weight-based system. However, further studies could be done on combining these methodologies (Lean, Human Factors, and weight-based color coding).…”

A Novel Approach for More Effective Emergency Equipment Storage: The Task-Based Package-Organized Neonatal Emergency Backpack

“…These factors include, among others, the appropriate choice of backpack/trolley type and storage bags (size, color, type of closure systems), clear labeling of the bags and arrangement of the bags within the backpack. A successful example on how to include human factors in equipment arrangement and to evaluate the approach using in-situ simulation is provided by Lefebvre et al, describing the process of re-designing their neonatal surgical crash cart ( 9 ). To our knowledge, no study has focused on how to arrange equipment in a neonatal emergency backpack and how to consider human factors to optimize equipment preparation.…”

Use of eye-tracking to evaluate human factors in accessing neonatal resuscitation equipment and medications for advanced resuscitation: A simulation study

“…While each NICU has a different code cart design, both carts contain similar equipment with only minor differences (e.g., in specific medications stocked other than epinephrine) ( Figure 2 ). Both code carts have undergone recent evaluation for optimization, with the process for redesigning the Surgical code cart previously described ( 7 ). The Health Ethics Research Board, University of Alberta (Pro00110698) approved the study.…”

“…One common theme in improving human factors include colour coding and cognitive aids to help choose size and weight appropriate treatments ( 3 , 6 ). Local quality improvement initiatives have attempted to optimize code cart organization and improve healthcare provider (HCP) education surrounding the use of this equipment ( 7 ). Simulation have been used to analyze the performance of resuscitation equipment carts ( 4 , 5 ); however, wearable eye-tracking glasses, tracking a person's eye movement and visual attention, might provide more information to inform future design, organization, and education of this equipment.…”