Monday, August 15, 2011

Cart Wars

While not as sexy as the anaesthetic machine, the pulse oximeter or any of the other toys we get to use, the humble anaesthetic cart is an essential player on the anaesthetic team. Basically the cart is where you store your drugs, syringes, needles, ETTs, LMAs etc etc. The surface is where you keep your induction drugs and your emergency drugs. You draw up your medication on the work surface and write your chart up there. Every couple of months, we get some patient with a superbug shows up in the OR, out goes our cart, replaced by what equipment and drugs we anticipate we might need, piled onto a Mayo stand or the machine top and we wish we had been more appreciative of our Friend the anaesthetic cart.

Boy do I need to get a life.

This is all prompted by our recent attempt to get new carts which has stirred up some memories and reminded me again of how and why healthcare is so expensive.

Our hospital is going through accreditation. This is my first as site leader although I have lived through many. Accreditation usually results in a rush of questionable "improvements" which if they were so important should have been done gradually over the last 3 years instead of being rushed into place in the last three weeks.

The carts in our OR are probably the best I have worked with. That is because they were actually custom made in the last millennium. They are a trifle large but have lots of storage space, are well organized and have a large work surface. Unfortunately they don't meet accreditation standards apparently. The problem is that we store our non-controlled drugs out in the open instead of in a drawer. (Our carts actually don't have drawers). Labour and delivery picked up on this first and modified (without asking us) our carts to put little trays in which the drugs could be stored out of sight and mind. Of course everybody on principle hated this if only because Labour and delivery did it and after about fifteen minutes of fruitless discussion at our staff meeting, in the most brilliant move of my administrative career I assigned the biggest loudmouth to design a better cart.

Fortunately someone had already done that. Our friends in the other large city in our province had in an exhausting process, which produced an article in the CJA, had come up with the optimum drug configuration in the cart. Down south went the loudmouth accompanied by two administrators to look at the wonder carts.

Consequently we decided to try out the anaesthetic carts designed by the wise men from the south. First we had to obtain a cart to try out. Our head anaesthetic tech who apparently can do this just picked one she liked in a catalogue and bought one directly from the company for about $2400. Our purchasing department however found out about this and lambasted her. "You should go thru us," they chided, "we can get you a better deal." This they did by going thru a medical supplies company instead of contacting the supplier directly. Cost: $4000.

The new cart arrived early this summer. One of the advantages of the cart is that the top drawer can be locked to keep your drugs safe. It unfortunately has an auto-lock function which means someone immediately auto-locked the keys inside the drawer. Nobody owned up and after a few phone calls, the company sent out a new set of keys and the new cart was back in action. Nobody likes it but I figure if everybody is equally unhappy, it must have something going for it.

The next problem is that the hospital doesn't have any money in its budget for the $44,000 it will cost to get the 11 more carts we need (how about out of the $800,000 I saved by turning down the anaesthetic machines we didn't need or want). And accreditation is coming up in October which means the administration which means me has to figure something out.

I lamented this morning in the coffee room that we could buy an automotive cart at Sears or Costco which would work just fine as an anaesthetic cart. The problem is that there is no way the hospital will spend $500 when it could (not)spend $4000. An OR supervisor at a small hospital near us did just that. She was sick of complaints about the old anaesthetic carts and the lack of money in the budget to buy a "real" cart. So she got her pick-up truck, headed down to Sears, picked up two carts for her two ORs, loaded them in the box of her truck, brought them to the OR, submitted the bill, got reimbursed and her hospital has new "anaesthetic" carts.

I am so jealous.

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