Building Surgical Case Carts from The Customer Up

Case carts are crucial within a hospital or surgery center. A fully stocked cart, with all of the necessary supplies and instruments for a surgical case, needs to get to the OR on time to maximize efficiency. Carts getting to the OR late or without crucial items can cause chaos in the OR and plays havoc with the surgery schedule. Metro decided to go directly to the users to find out the biggest problems with the carts they were currently using and work on real solutions. Here are the biggest problems Metro heard from customers and distributor partners.

Case Carts are Missing Items

Case carts house many vital components for a surgery including surgical packs, supplies, and instruments. Most carts have no system that tells an outside observer if something is missing. Many hospitals use orange traffic cones on the tops of carts to indicate there are missing items!

Metro designed their new CaseVue™ Surgical Case Carts with four color indicators clearly visible on the top of the cart that identifies the status of the cart. If it has a green indicator showing, the cart is ready for use. Orange means there is a missing product, blue indicates a cancelled case, and red indicates biohazard waste on board and that the cart needs cleaning. The colors can also be customized to your facility needs.

Case Carts are Bulky, Heavy, Noisy, and Hard to Maneuver

With all of the labor shortages healthcare facilities are facing, keeping workers healthy is particularly important. A fully loaded cart can weigh hundreds of pounds so designing the cart ergonomically with maximum maneuverability is imperative.

The new CaseVue™ Surgical Case Carts offer two exclusive ergonomic features. The swing up handle allows for workers of various heights to steer the cart easily. The optional 5th wheel steering assist is ground-breaking, assuring maximum control in transit.

The Thermoplastic Rubber casters were designed to mitigate vibration noise from being transferred to the cart body. The doors bumpers, reinforced floor, and contoured side panels along with the new casters make this cart one of the quietest available in the market.

After Cleaning, Cart Handles are Too Hot to Handle

Case carts go through the cart wash after each case. Many facilities have potholders available so that health- care workers can touch the newly cleaned carts without getting burned.

Metro has cool touch, antimicrobial handles on all of their case carts so no need for potholders. The case carts are also constructed of Type 304 Stainless Steel which has superior corrosion protection. These carts can go through the cart wash several times a day so being more rust resistant helps these carts last longer.

CME Corp has a list of criteria we use to choose our strategic manufacturer partners. Working collaboratively with CME as partners as well as offering superior products are two of the top criteria. We are a proud strategic partner of Metro’s. For more information about the new CaseVue™ Surgical Case Carts or any Metro product, please contact CME at 800338-2372 or visit www.cmecorp.com.

Changing case carts is challenging and a CME Account Manager can help arrange a 30-day demonstration to help make that decision easier.

Diagnostics Challenges with Elderly Patients

State-of-the-art diagnostic technologies are a must, but patient engagement is just as important.

A 70-year-old patient walks into the physician’s office complaining of stomach pain. There’s a chance they have hearing loss, making communication difficult. They might have comorbidities and are taking multiple prescription medications, each with its own side effects and drug interactions, making it difficult to isolate the problem at hand. They could have memory loss and find it difficult to recall when their symptoms began. Nor can the doctor get a good read on their circumstances outside the office, such as their housing situation, access to nutritious food, and social or family relationships.

Taking all these factors into consideration, the odds of misdiagnosis, underdiagnosis or overdiagnosis is high.

In July, the National Academies of Sciences hosted a workshop on “Advancing Diagnostic Excellence for Older Adults.” In the Proceedings, published in November, there’s little mention of diagnostic technologies. Rather, the emphasis was on the interaction between the care team and patient. According to one participant, the vulnerability of older adults due to isolation, challenges related to hearing, cognition and mobility, as well as complications from medications create challenges in caring for this population and highlight the need for whole-person care.

What’s the problem?

In a six-year-old study, researchers from Australia combed literature for data on the rates of misdiagnosis of common diseases in older populations. While admitting that literature was limited, they concluded that clinically significant rates of overdiagnosis and underdiagnosis exist for Parkinson’s disease, heart failure, acute myocardial infarction, dementia and chronic obstructive pulmonary disease.

They concluded that the presence of physical comorbidities was consistently associated with lower accuracy regarding the diagnoses of COPD, dementia, Parkinson’s, heart failure, stroke/TIA (transient ischemic attack) and acute myocardial infarction, possibly because complaints and fatigue due to concurrent diseases mask features that support or refute the index diagnosis.

“Our results emphasize the need for clinicians to be systematic and circumspect in verifying past diagnoses or making a new diagnosis in older patients,” they wrote.

Barriers

But doing so isn’t easy. At the workshop, participants identified the many challenges facing healthcare providers as they pursue correct diagnoses for their elderly patients, including: ʯ Atypical medical presentations among older adults. For example those with acute myocardial infarction may present with shortness of breath instead of chest pain, and hyperthyroidism may present as weight loss instead of other common symptoms. ʯ The fact that common symptoms such as fatigue or apathy have many possible causes, and older adults – particularly those with cognitive impairments or hearing or vision problems – may have difficulty articulating them.

The Society to Improve Diagnosis in Medicine

The Society to Improve Diagnosis in Medicine (SIDM) catalyzes and leads change to improve diagnosis and eliminate harm from diagnostic error. We work in partnership with patients, their families, the healthcare community, and every interested stakeholder. SIDM is the only organization focused solely on the problem of diagnostic error and improving the accuracy and timeliness of diagnosis. In 2015, SIDM established the Coalition to Improve Diagnosis to increase awareness and actions that improve diagnosis. Members of the Coalition represent hundreds of thousands of healthcare providers and patients – and the leading health organizations and government agencies involved in patient care.

Source: Society to Improve Diagnosis in Medicine , www.improvediagnosis.org ʯ Age-related physiological changes, which may cause false positives on tests if using normal ranges based on younger persons. ʯ Hearing loss, which can make it difficult for patients to keep up with a conversation, particularly in potentially stressful situations (such as a doctor visit). ʯ Diminished cognitive function, which has been associated with a high rate of adverse drug reactions in older adults. ʯ Multiple chronic conditions. Clinicians may assume that a condition is discrete and can be managed in isolation. But that’s not always the case with older adults.

Whole-person care

One workshop participant – Beverly Canin, co-chair at SCOREboard Patient Advocate Board – observed that the most difficult part of being a patient is being treated as a number or a body part, according to the Proceedings. (SCOREboard’s mission is to improve aging and cancer research and care delivery.) That’s especially true for older adults, who often already feel marginalized, she said. Patients often report that clinicians are interested in symptoms and clinical data instead of their story, but studies have shown that more than 80% of diagnoses can be made just by listening.

Charlie P. Hoy-Ellis, assistant professor at the University of Utah, expressed support for person-centered diagnosis of lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults. Social positions over the life course can result in profound influences in health and well-being, he said. As an example, queer people experience stressors – acute or chronic – associated with being a minoritized population, which can be implicated in chronic health conditions such as asthma, diabetes or depression.

Sonja Rosen, M.D., chief of geriatrics at Cedars-Sinai, noted that researchers and health system leaders have refined evidence-based geriatric care models with four features known as the 4Ms, which might help improve diagnosis. (4Ms is a framework for care devised by AgeFriendly Health Systems, an initiative of the Institute for Healthcare Improvement, The John A. Hartford Foundation in partnership with the American Hospital Association and the Catholic Health Association of the United States.) The 4Ms are: ʯ What Matters. What Matters to each older adult, their goals and preferences for care, guides the healthcare team and aligns care to what really matters to them. ʯ Medications. Age-related changes can increase the chances of side effects from medications. The health team monitors all medications, decides if medications are still necessary, and ensures older adults’ medications do not interfere with What Matters, Mentation or Mobility. ʯ Mentation (mind and mood). The health team pays attention to this aspect of care, screening for changes that could be related to dementia, depression and delirium. ʯ Mobility. Staying active and moving daily is how older adults stay strong, maintain function and do What Matters. The healthcare team ensures safe mobility to keep older adults moving.

Patient engagement

Speaking with Repertoire, Jennie-Ward Robinson, PhD, CEO of the Society to Improve Diagnosis in Medicine

POC testing of long-term-care patients

Repertoire asked Jeff Reid, senior commercial marketing manager, Sekisui Diagnostics, to comment on the role of point-of-care diagnostics in the diagnosis and treatment of elderly people.

“In the past 40 years, the life expectancy in the United States grew slightly over 4%, which is a fairly consistent rate for other developed countries around the world. As life expectancy continues to rise in developed countries, so will the number of elderly patients. A high number of these elderly patients are found in nursing homes and residential care facilities. In fact, 70% of people who reach the age of 65 will need long-term care at some point.

“These types of care settings rely heavily on point-of-care testing. Not only does point-of-care testing help differentiate between a medical condition and a cognitive factor, but it also helps improve decisions around empirical therapy. Since elderly patients have an increase in comorbidities that require diagnosis, they have a higher chance of receiving unnecessary treatment. This causes the patient to be at a high risk of receiving unnecessary medications, which can lead to an increased risk of adverse drug effects and cognitive impairment. It is crucial for nursing homes and long-term care facilities to make the most informed decision around treatment, which can be done through point-of-care testing.”

(SIDM), said the Society is a firm supporter of the 4Ms as a guide that may be leveraged toward accurate diagnoses. “Diagnosis is a complex issue,” she says. “Particularly among the aging population, who bring the sum of their lived experiences to the diagnostic process. It is important to include family and caregivers with the patient to reduce the risk of diagnostic error.”

The elderly population presents their health-related complaints, influenced by social determinants of health, which have shaped the course of their health concern, she says. “Perhaps they have been impacted by limited income, transportation, access to care, difficulty articulating symptoms, memory loss, hearing loss. In addition, other factors may threaten and complicate an accurate, timely diagnosis. But we also have to ask, ‘How prepared are clinicians to recognize and value these social determinants, and communicate across these boundaries?’ In addition, what are the implications for these considerations among communities of color, who represent high growth rates within aging populations?”

If clinicians were equipped to capture the life course experiences of patients and their families, along with recognition of the social determinants of health, these resources could become critical assets to foster the construction of a timely and accurate diagnosis and satisfaction with their health care. “SIDM advocates for a balanced interaction based on shared decision making, which supports patient involvement in constructing their diagnosis.” Among other solutions, many healthcare providers have launched responsive solutions that encourage patient engagement in their care. “SIDM supports this approach!” she says.

“Imagine a world where we could attain diagnostic excellence! In that world, clinicians could be better informed by patients’ and families’ experiences. Further, this approach is growing in models within medical education that bridge families and communities with their providers. The goal is to improve dialogue, listening, and the likelihood of a satisfied patient less likely to experience harm.”

Resources:

“Diagnostic errors in older patients,” International Journal of General Medicine, www.ncbi.nlm.nih.gov/pmc/articles/PMC4881921/

Advancing Diagnostic Excellence for Older Adults: Proceedings of a Workshop in Brief, National Academies of Sciences, Engineering, Medicine, https://nap.nationalacademies.org/catalog/26789/ advancing-diagnostic-excellence-for-older-adults-proceedings-of-aworkshopSociety to

Improve Diagnosis in Medicine, www.improvediagnosis.org/about

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