title: Design and implementation of a low-cost multimodal procedure cart for an internal medicine ward.
abstract: BACKGROUND
  General internists perform a large number and variety of procedures in the ward and emergency department settings. Initiatives are needed to facilitate learning and increase efficiency of procedural skill acquisition by trainees. In this article, we describe our experience developing and implementing a low-cost multimodal procedure cart in an academic health sciences center. We also provide pilot data on perceived usefulness by trainees.
  
  
  METHODS
  We performed a needs-assessment survey of residents, which indicated that the inconsistent location of materials and time needed to gather them were frustrating. Furthermore, residents reported that having easily accessible educational materials would improve their experience performing procedures. Based on this information, a portable cart was designed and implemented that had all materials required for common ward procedures, as well as multimodal educational materials, including evidence-based checklists, a hard-copy procedure manual, and a portable computer for viewing videos and logging procedures. The cart was equipped for the most commonly performed bedside procedures. After 2 months, we electronically surveyed residents on their experience with the intervention. Measures included self-reported frequency of use, satisfaction, perceived improvement in efficiency, and perceived improvement in patient safety.
  
  
  RESULTS
  Residents perceived that the cart increased efficiency. The ready availability of educational materials was also noted as an advantage. Despite its perceived usefulness, trainees did not use the cart as frequently as anticipated. The cart continues to be in use > 1 year later, with modifications made based on feedback.
  
  
  CONCLUSIONS
  In this article, we outline suggestions for successful implementation of a similar initiative based on our experience. We describe how a procedure cart can be inexpensively designed and instituted to facilitate more efficient performance of medical procedures and enhance education. Such an intervention may be beneficial in an academic as well as a community setting.
authors: Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. david.frost@uhn.on.ca
authors: David W
authors: DW
authors: Frost
authors: Sherman
authors: S
authors: Quan
authors: Dalila
authors: D
authors: Villalobos
authors: Dante
authors: D
authors: Morra
authors: Rodrigo B
authors: RB
authors: Cavalcanti
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D001296:Audiovisual Aids; D002983:Clinical Competence; D003258:Consumer Behavior; D017598:Efficiency, Organizational; D006739:Hospital Administration; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D019095:Point-of-Care Systems / Q000458:organization & administration*; D017751:Safety Management / Q000379:methods