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When patients suffer a cardiac arrest, the arrival of a well-designed and well-stocked 'crash trolley' is literally a matter of life or death. This project is commercially developing one of the most vital pieces of kit in a hospital.
The resuscitation trolley, or 'crash trolley' as it is better known, is a familiar piece of mobile storage equipment on hospital wards. Imagine you're in hospital, and your heart stops. A team of medics will rush to your assistance, and shock your heart, give you oxygen, drugs and so on. All the kit that they use is stored on a crash trolley.
The National Patient Safety Agency (NPSA) has long understood the role of good design in reducing medical errors. When, in 2005, the NPSA received figures showing that errors with poorly stocked resuscitation trolleys were adversely affecting patient outcomes, the agency decided to take action. As well as publishing articles targeting the poor design of trolleys, and challenging the industry to come up with better solutions, the NPSA approached the RCA with a brief to redesign the crash trolley to reduce these errors.
Rooted in understanding
The resulting project, called resus:station and now in its second year, is funded by the NPSA and the Helen Hamlyn Trust. A collaboration involving the designers with clinicians and clinical psychologists from St Mary's Hospital in Paddington gave the right mix for a thorough design overhaul. This meant that the design work was rooted in a deeper understanding of the resuscitation process. The designers were able to observe videos of cardiac arrests, attend Advanced Life Support courses, interview different clinical staff and even observe actual resuscitation attempts.
This led to a great deal of concept work, with ideas being generated using co-design methods with St. Mary's clinicians. These designs were gradually whittled down to one concept by getting input from a broader selection of clinicians from other hospitals and professional groups. This design was made into a working 'phase one' prototype.
Range of benefits
The new trolley has been designed with the system of resuscitation at its heart. Its features can be divided into 'low-tech' and 'hi-tech' categories. The low-tech benefits are that all the equipment is laid out openly to allow instant access. The trolley can also divide into three separate units, so each team member can have their own specialised kit beside them. Hi-tech features include a touch screen which helps the resuscitation team through the process, and which logs each event as it happens. The trolley uses Radio Frequency Identification (RFID) technology to keep track of all the equipment on the trolley.
The phase-one prototype has been tested in several different simulated resuscitation scenarios, in St Mary's and elsewhere. User feedback has been positive. The design has also won a Medical Futures Innovation Award for Anaesthesia and Critical Care, a prestigious accolade in this field. Testing the trolley in situ led to suggestions for improvements. These have been incorporated into five 'phase two' prototypes to be built in partnership with a manufacturer, Bristol Maid, and given a more formal test study at St Mary's Hospital in October 2007. The aim is to gather an evidence base to show how the new design can improve resuscitation.
As key steps are taken towards commercialising the concept, the entire project demonstrates that adopting a systems design approach rather than simply addressing a standalone piece of medical equipment leads to far more tangible innovation in patient safety.
