Redesigning an airway cart using lean methodology ★★★★★★

•● The lean methodology, 5S, was used to redesign a difficult airway cart.•● There was an 89% reduction in equipment in the difficult airway cart.•● The equipment reduction allowed all equipment to be stored on one cart.•● Simulations of a scripted difficult airway showed markedly reduced time to acquire equipment with the revised cart compared with baseline.

Study ObjectiveUse lean methodology to create a more efficient difficult airway management equipment transport and setup.DesignThe 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.SettingHospital operating rooms and equipment storage rooms.PatientsSimulated difficult airway scenarios without patient involvement.InterventionDifficult airway equipment 5S process.MeasurementsTotal 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.Main ResultsPreviously, 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.ConclusionApplication 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.