Ventriculostomy supply cart decreases time-to-external ventricular drain placement in the emergency department

Abstract

Background: Minimizing time-to-external ventricular drain (EVD) placement in the emergency department (ED) is critical. We sought to understand factors affecting time-to-EVD placement through a quality improvement initiative. Methods: The use of process mapping, root cause analyses, and interviews with staff revealed decentralized supply storage as a major contributor to delays in EVD placement. We developed an EVD “crash cart” as a potential solution to this problem. Time-to-EVD placement was tracked prospectively using time stamps in the electronic medical record (EMR); precart control patients were reviewed retrospectively. Results: The final cohorts consisted of 33 precart and 18 postcart cases. The mean time-to-EVD in the precart group was 99.09 min compared to 71.88 min in the postcart group (two-tailed t-test, P = 0.023). Median time-to-EVD was 92 min in the precart group compared to 64 min in the postcart group (rank sum test, P = 0.0165). Postcart patients trended toward improved outcomes with lower modified Rankin score scores at 1 year, but this did not reach statistical significance (two-tailed t-test, P = 0.177). Conclusion: An EVD “crash cart” is a simple intervention that can significantly reduce time-to-EVD placement and may improve outcomes in patients requiring an EVD.

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey

“…This highlighted that access to equipment was a cause of time delay and subsequently, creating a ventriculostomy trolley, significantly reduced time to ventriculostomy. 25 In spine surgery, Lui et al paired lean principles with process mapping to identifying time saving areas for patients undergoing lumbar spinal fusion surgery. The study identified that instrument defects were a cause of 66% of the time delay intraoperatively, a crucial finding in streamlining the efficiency of lumbar fusion procedures.…”

Use of specialized trauma carts in the emergency department: A scoping review

“…“Ventriculostomy supply cart decreases time‐to‐external ventricular drain placement in the emergency department,” United States 6 …”

“…Both studies identified increases in resource availability and the potential for increased efficiency in accessing required supplies with the implementation of cart systems. Additionally, Chang et al 6 examined implementation of a ventriculostomy supply cart. They found that improved access to preassembled equipment led to significant decreases in time to intervention.…”

“…systems. Additionally, Chang et al6 examined implementation of a ventriculostomy supply cart. They found that improved access to preassembled equipment led to significant decreases in time to intervention.Studies investigating trauma equipment organizationhave identified better use efficiency along with improved staff and personnel operation.…”

Implementation of a Resident-Designed Procedure Cart in a Busy Emergency Department

“…This team noted they would have to visit approximately two to four supply closets to gather the appropriate materials for commonly performed procedures such as central and arterial lines. Decentralized supply storage has been shown to significantly delay emergency procedures such as ventriculostomy for example [1]. After several months of struggling with this inefficient system, this team proposed the idea of a procedure cart to the Emergency Department staff and administration.…”