Supporting Digital Workflow: Furniture, Carts & COWs

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The little things in life (and healthcare) really do count. Nearly every solution in the digital hospital from PACS workstations to viewing stations and wireless systems rests on a table, desk or cart. And radiologists sit for hours at a time as they interpret images.

These supporting structures may be overlooked or under-financed in the all-encompassing digital plan. But they can make a world of difference by facilitating adoption of new solutions, improving workflow and enhancing safety.

Take for example Mary Washington Hospital in Fredericksburg, Va., where the right cart allowed the facility to implement barcoding technology and realize dramatic increases in patient safety, productivity and workflow. And Montefiore Medical Center (New York City) touts increased productivity among radiologists since implementing what it dubs the "world's first 100 percent ergonomic radiology department."

But finding (or creating) a solution can be a challenge. Mary Washington Hospital thought it had the solution with its initial foray into COWs (computers on wheels) - a lightweight, ergonomic COW with a notebook, scanner, IV pole and basket. But the cart incited a revolt among nurses. "The 11-inch screen was not a hit with our nurses, who are primarily in their 40s," explains Cecelia Ciarleglio, RN, information systems analyst. So the process began again. At Montefiore, Chief of Radiology Nogah Haramati, MD, and his colleagues invested a solid year in the development of its ergonomic reading room.

Tables & chairs - alleviating the pain

Digital workflow changes the practice of radiology in many ways. Although many changes are positive, there are potentially negative outcomes. Sitting in a standard office chair and interpreting images on a workstation on a conventional table can lead to a range of physical problems. The neck, back, shoulders and wrists are prone to pain and injury in a conventionally furnished digital environment.

A few years ago, stakeholders at Montefiore Medical Center decided the status quo would not suffice and assembled a team to investigate better options for its radiologists. The team included bone and musculoskeletal radiologists, spine rehabilitation physicians and engineers from AFC Industries. The first priority? A new and improved chair. After analyzing dozens of prototypes, the center opted for a chair with fully adjustable height, armrests and tilt.

The team followed a similar process for table selection, searching for a table that fit the chair. After cycling radiologists through multiple options, the center selected AFC Industries' ErgoTier Station. The horizontally and vertically adjustable table provides an optimal viewing arrangement for different radiologists, says Haramati. The surface is configured so that monitors can be placed in arc instead of a straight line for better viewing, continues Haramati.

While Montefiore Medical Center took the slow, team-oriented approach to furniture, Toseef Khan, MD, an independent radiologist with teleradiology provider Virtual Radiologic Consultants (VRC), took the opposite approach. "I saw VRC's Perfect Chair and ErgoPOD 500 Reading Station at the VRC office and knew they were right for me." He realized the right furniture would allow him to efficiently view images and prevent physical damage that might occur as a result of 10+ hours of daily reading. The semi-reclining Perfect Chair positions radiologists underneath the monitors, taking the pressure off of the back. The ErgoPOD Station provides a large surface for all of the 'stuff' of radiology - keyboards, mice and image interpretation tools.

Desert Radiologists, a five-office practice in Las Vegas, employed a middle of the road approach to equipping its sites for the digital world. The practice did not jump into an option, but it did not rebuild from the ground up either. Chief Operating Officer Jerry Hartman, RT, and two radiologists started the process at the Radiological Society of North America meeting in 2004, visiting a variety of vendors for brief demonstrations. After the show, Hartman completed online research and decided the Biomorph Desk led the field. Desert Radiologists purchased a single desk and Freedom Chair from Biomorph. Radiologists rotated through the new arrangement, allowing Hartman to determine whether or not his selection worked for the majority of radiologists.

After a short test drive, most radiologists agreed with Hartman's choice, so the COO took the next step - inviting