title: Redesigning an airway cart using lean methodology.
abstract: OBJECTIVE
  Use lean methodology to create a more efficient difficult airway management equipment transport and setup.
  
  
  METHODS
  The 5S steps of sort, set in order, sweep, standardize, and sustain were used to create a redesigned airway cart. The 5S steps provided the framework to separate the needed from unneeded equipment, logical equipment placement on the cart, and a plan to maintain improvements. Simulations were utilized to compare the revised airway cart to the previous airway equipment storage.
  
  
  METHODS
  Hospital operating rooms and equipment storage rooms.
  
  
  METHODS
  Simulated difficult airway scenarios without patient involvement.
  
  
  METHODS
  Difficult airway equipment 5S process.
  
  
  METHODS
  Total pieces and cost of airway equipment before and after intervention. Walking distance and time to retrieve equipment, setup equipment, and setup defect rate during a simulation.
  
  
  RESULTS
  Previously, airway equipment was stored in 4 locations which was reduced a single difficult airway cart. The total pieces of equipment stored was reduced 89% and the cost of disposable equipment inventory was reduced 81%. Simulations looking at the acquisition and setup of equipment during a difficult airway scenario revealed a 39% reduction in equipment set up time, a 77% reduction in non-valued-added set up time, and a 74% reduction in walking distance. There was no difference in set up defect rates.
  
  
  CONCLUSIONS
  Application of this lean method resulted in a revised single cart with equipment pared down to only what is needed, arranged according to frequency and order of use in a difficult airway. In a simulated difficult airway, there was a reduction in non-value-added time and walking distance to retrieve the equipment.
authors.affiliation: Virginia Mason Medical Center, Seattle, WA. Electronic address: Wade.weigel@vmmc.org.
authors.forename: Wade A
authors.initials: WA
authors.lastname: Weigel
mesh_terms: D058109:Airway Management / Q000191:economics / Q000295:instrumentation*; D003198:Computer Simulation; D004209:Disposable Equipment / Q000191:economics; D004864:Equipment and Supplies; D006801:Humans; D007442:Intubation, Intratracheal; D020704:Laryngoscopes; D009873:Operating Rooms / Q000458:organization & administration; D012121:Respiration, Artificial / Q000295:instrumentation; D013242:Sterilization