Our 22-OR surgical department here at Johns Hopkins Hospital in Baltimore is preparing for an expansion into a new facility. Once it's completed, a few years from now, our department will have moved into two new hospital towers containing 30 new ORs. Clearly, this move will create significant changes in the way our department functions and the way our staff does business. As a result, it's necessitated considerable advance planning to make sure the new facility will meet our day-to-day needs.

For us in materials managment, one issue of importance was planning what type of case carts we'd be using to transport surgical instruments and supplies to procedures. This wasn't a trivial question. Given our case volume, which determines how many carts a facility should optimally have on hand, we were looking at an order of perhaps 150 more carts.

Additionally, case starts depend on case carts. Since surgery can't begin unless instruments and supplies have been delivered, the efficient use of a cart can influence decisions in planning the traffic flow of a new facility, or be influenced by the workflow of an existing facility. Transporting case carts, or procedure carts, from where they're prepared to where they're used touches on issues of inventory management, ergonomics, staff productivity and even infection control. Here's some advice on choosing a cart that fits your facility.

Motion studies
When we began considering the replacement of our case cart system, we stepped back to take a look at what we have now and how functional that is, which aspects of it work and which don't work quite as well. Then we'd know what to keep in mind in working out the logistics of cart use in a new environment.

At present, after our carts are prepared in the storage area, it's a short elevator ride one floor down to the ORs. It's also an easy trip from the OR to central processing. But if you're looking at a slightly longer path, or one that takes you through more than just a hallway or elevator, you'll probably want to consult with your infection control personnel, as we did when planning the purchase for the new facility.

Your infection control experts will be able to provide recommendations on keeping a cart's contents sterile in transit to the OR and secure when leaving it as well as what will be necessary to clean the cart between uses.

We're always dealing with space issues where we are, and it's likely that we'll always be dealing with space issues, wherever we are. If you find your facility in a similar situation, remember to keep the space that carts occupy in mind. Where will they be stored before they're prepared and while they're waiting for use in a surgical procedure? Will they impede traffic or present a tampering risk?

Test drive
There are a lot of choices on the case cart market, so how do you choose? You may have spent an afternoon wandering the aisles of the AORN exhibit hall and noticed which manufacturers offered a sturdy product while narrowing down which types were similar. You've probably talked with your colleagues and your counterparts at other facilities for their insights. If you're in materials management, you most likely also know which vendors you've made good deals with and obtained quality equipment from in the past.

We had contacted our selected vendors and they brought carts from their product lines for trials at our facility. Our managers reviewed cost considerations while seeking input from the carts' eventual users.

What the nurses and techs think is, of course, critical, especially since the cart's size and capacity - does it fit through doors, in ORs and onto elevators? Does it offer enough space to hold everything you'll need for a procedure or a day of procedures? - is the most important factor in your decision.

The second most important aspect is its functionality. Your staff should find it easy to maneuver and brake, and find its features useful and effective, whether that means doors and drawers that stay open and lock securely, or shelves that rearrange or provide thorough access to their contents. Take it for a test drive to get a sense of its durability and construction.

Open and shut
One very big decision you'll have to make in terms of capacity and functionality is whether to buy open or closed carts. Each has its own benefits and shortfalls.

Open carts are understandably lighter in weight and easier to move. They take up less space and are often less expensive. The contents of the cart are readily visible, but the cart will need a cover - and custom, tamperproof covers are available for most open carts - as an infection control and security measure.

Closed carts are generally heavier and more expensive, providing more security and protection against contamination of sterile supplies going to the OR or contamination by used instruments going to processing. Closed carts can also be more challenging and time-consuming to wash, whether manually or by an automated machine, since their hinges and doors create many more surfaces to disinfect and clean.

When it comes to washing carts, many hospitals have automated washers, which are more efficient in terms of time and labor than washing by hand, though they do take up floor space, which must be planned for. If you're buying new carts, your vendor should be able to direct you to an automated system. If you already have the machine, make sure that the carts you're considering are compatible with it.

Armstrong Medical Industries, Inc.
A-Smart Premier Carts
(800) 323-4220
www.armstrongmedical.com
Price: $1,200 to $1,500
FYI: Armstrong's A-Smart aluminum carts are dependable, durable and rust-resistant, says the company. Available in 14 colors with hundreds of accessories and a variety of locking options, the carts are manufactured to ISO 9001:2000-certified standards. Standard features include double side-wall construction, stabilizing frame and bumper, soft-grip handles, swivel casters and ball-bearing drawer slides.

Artromick International, Inc.
Avalo Procedure Carts
(800) 848-0403
www.artromick.com
Price: $850 to $1,100
FYI: Artromick's Avalo Procedure Carts can be adapted to a multitude of applications, says the company. Their huge capacity ensures their ability to organize surgical supplies large and small. To enhance security, each Avalo series procedure cart is equipped with a keyless lock system as a standard feature, eliminating the need to search for keys or to change unreliable locks.

Blickman, Inc.
CCC2 Multipurpose Case Cart
(800) 247-5070
www.blickman.com
Price: $2,776
FYI: Blickman's multipurpose closed cart is built with a stainless steel, welded angle frame chassis, which absorbs impact from the wheels and bumper frame, and comes standard with 6-inch, cart washable, maintenance-free casters. A hasp lock is standard on both paddle-latch doors. All Blickman products are backed by a lifetime limited warranty, says the company.

Case Medical, Inc.
SteriTite Case Carts
(888) 227-2273
www.casemed.com
Price: $2,600 to $4,800
FYI: Case Medical offers a line of stainless steel case carts in open and closed configurations. Available components include stainless steel casters with nylon wheels, a stainless steel bumper, full push handles and adjustable shelves with an optional pullout feature. Tall closed carts can be affixed with a hitch for pulling several carts at a time, says the company.

Herman Miller for Healthcare
Case Carts
(800) 628-0058
www.hermanmiller.com
healthcare
Price: $1,300 to $2,000
FYI: A Herman Miller spokesman says that since the company's case carts are designed for "over-the-road" applications where central processing distributes them to offsite locations, they're strong enough for in-house use. The carts' modular interiors optimize storage capacity and thorough cleaning, and accommodate drawers for case organization. Herman Miller offers custom capabilities and a clinical staff for protocol consulting.

Imperial Surgical, Ltd.
Case Carts
(800) 661-5432
www.surgmed.com
Price: $1,100 to $3,000
FYI: Imperial Surgical has been manufacturing and selling case carts and other stainless steel hospital equipment worldwide since 1935. The company offers equipment custom fabricated to individual specifications or a range of standard models in stock for immediate delivery. Imperial Surgical is accredited with the ISO 13485 Quality System and its products (excluding casters) are backed by an all-parts warranty for three years.

InnerSpace Corp.
Harmony V Keyless Entry Cart
(800) 467-7224
www.innerspacecorp.com
Price: not disclosed
FYI: InnerSpace's Harmony V cart features a push-button entry system with a programmable automatic re-lock. Available in white, red, blue and yellow, the cart offers many additional accessory options. InnerSpace says Harmony V carts start at "an exceptional price" with group purchasing discounts available.

InterMetro Industries Corp.
Case Carts
(800) 433-2232
www.metro.com
Price: $2,500 to $3,500
FYI: Metro says its high- and low-profile case carts have been improved inside and out. Access to cart contents has been simplified with adjustable pullout shelves. Ergonomic, full-length handles allow for better cart control and double-paneled doors provide optimum strength. Stainless steel construction and removable shelves make units cart-washable and drain holes beneath facilitate drying.

NK Medical Products, Inc.
MC8224 Anesthesia Cart
(800) 274-2742
www.nkmedicalproducts.com
Price: $1,539
FYI: NK Medical's five-drawer anesthesia cart features double-wall, heavy-duty steel construction with electronically welded seams for strength and stability, says the company. A removable ABS plastic top allows for thorough cleaning and rubber corner bumpers offer protection. Keyed or keyless locking systems are available, and the cart can be obtained in a range of colors.

Pedigo Products, Inc.
Surgical Case Carts
(800) 822-3501
www.pedigo-usa.com
Price: $1,200 to $2,500
FYI: Pedigo's stainless steel surgical carts (model CDS-242 is pictured) are washable, durable and easy to maneuver, says the company. They are available in sizes and configurations to fit any facility's particular case load. Custom sizes are available and carts can be adapted to fit cart washers and elevator systems.

TBJ SPD
Kangaroo Closed Case Carts
(509) 747-5027
www.tbj-spd.com
Price: $2,500
FYI: TBJ's Kangaroo Closed Case Carts reduce the space that case carts occupy by over 80 percent, says the company. Just a few Kangaroos move shelving with supplies between storage and the point of use, allowing large quantities of items to be moved in a single motion, reducing handling costs and improving turnaround time. These space, workflow and time savings result in savings on your budget's bottom line.

Waterloo Healthcare
Split Drawer Procedure Cart
(800) 833-4419
www.waterloohealthcare.com
Price: $400 to $1,800
FYI: Waterloo Healthcare's carts can be tailored to numerous applications, including critical care, IV therapy, casts and trauma, says the company. Generous amounts of storage space and several custom configurations are available to fit any need, and lightweight aluminum unicarts with keyless entry increase mobility and security.