Pneumatic tube system as a lean healthcare tool
How to make the hospital more competitive also for internal customers? Can facilitating of the distribution system of medicines, biological material, documents help? An interesting solution of the 21st century is the pneumatic tube system connecting the individual organizational units, buildings that may be spaced apart or organizational units such as a laboratory, hospital pharmacy or cord blood bank. This is a solution that can be applied both in the design of a hospital building and in an already existing institution.
In this case the innovation will be pneumatic tube system as an innovative technical solution for the transfer of small and lightweight materials with usage of special pipes. Implemented innovation allows to increase the competitiveness of the hospital among other institutions in Poland. The first institution in Poland equipped with a pneumatic tube system in 2003 was the Bielański Hospital in Warsaw [bielanski.med 2011].
The hospital complex, which uses pneumatic tube, consists of six buildings which include:
- Intensive care unit
- Admission room
- Emergency department (ED)
- Obstetrics and Gynecology ward
- Pediatric ward
- Hospital pharmacy
Pneumatic tube is a system used for sending items, results of medical examinations, surgical instruments, medicines, documents, biological material (blood and urine samples), which meet the transmission requirements from point A to point B with usage of the piping system. In general, the system creates a network of transceiver stations using RFID technology ( Radio Frecquency Identification). It is a technology for remote reading identification of data. This allows for automatic sending and returning of transport tubes to established points. Items for dispatch are placed in special tubes, which protect the item from damage and the environment. They are some kind of piston that is attached directly to the pipeline and is moved by the air that is pumped into the pipe. Pneumatic tube system operates within several buildings allowing for a easy and extremely fast delivery system for needed tools and materials.
Pneumatic tube system – which work unidirectional – contains
- Control panel
- Transceiver stations
- Propulsion devices
- Pipelines and wiring
- Delivery tubes
The installation of a pneumatic mail system connects 3 buildings. The installation of pneumatic mail for medical devices refers to the combination of the mentioned above transceiver points.
The contractor of the installation has certified with appropriate results of laboratory tests that the consistency of the structure of the medical samples won’t change as a result of their transport, i.e. the used pneumatic tube system.
The system is controlled by a central microprocessor unit (this is an industrial computer) type CSS. It controls all components of the installation. It is equipped with microprocessors that work with the same processors in the cards that control the steering and the transceivers. Includes one serial output to enable possibility to connect external dot matrix printer and continuously print any information that contains system installation data. The software installed allows for 24-hour control over the entire system as well as the implementation of additional functions. It is possibility to turn off the station if necessary so that no delivery from the station is sent or accepted by other station. The control panel may indicate the location of a potential issue of the system and may trigger an alarm when occurs a shipping blockage while specifying the section where the tube was blocked. The control unit stores information about shipments made in the built-in memory module (up to 1000 records). The control panel performs simple maintenances. This is self-regulation of mechanical parts.
These stations are used for sending and receiving shipments, automatic unloading of shipped samples and re-shipping of tubes. SATURN type of transceivers were used to the installation. These are fully automatic devices. They have electrically closed and opened transparent doors with overload protection. Transceivers are equipped with a control terminal that informs about the work of a particular station and the whole system. Stations allow for supervised and controlled user access based on the data read from user identification card. This solution secures the shipment from unauthorized access. The container is stored in the station until the recipient has confirmed authorization and to register the actual time and place of delivery. In the absence of reception, the system automatically sends the tube to the addressee.
The main propulsion device is 1600 W SC-30 centrifugal fan. This allows for seamless transport of tubes from the transmitting stations to the receiving stations. It’s equipped with acoustic mufflers (Effectively dampens up to 25 dB) as well as anti-vibration dampers. Shock absorbers are designed to suppress the noise and vibration caused by blower.
Pipelines and wiring
Pipelines allow the transmission of the tubes. Pipes and arches have a certain diameter. The entire pipeline is made of PVC in technology that guarantees smoothness and resistance to abrasion of their internal surfaces. Connections of any branching of the pipes are made with usage of a muff and glued.
Branches of pipelines are implemented by linear steering. When a tube with a sample is sent from hospital building A to building B, the shipment must be redirected to the corresponding “address” in the steering.
A special system cable is used, which is installed on the pipeline from the outside, making it easy to find when occurs a system issue. The entire structure secures the pneumatic tube system against external pulses.
Delivery tubes are on both sides, pivotally opened to facilitate discharge operations. They are made of high-impact plastic. Tubes consist of a transparent body, making it easy to determine if they are empty or contain a shipment. At each end, they are equipped with programmable integrated circuits. chips. Containers may contain material up to 2.5 kg. The transmission speed is between 7 and 15 m/s and is suitable for medical transportation. Because of the transfer of blood and biological material, speed can’t be too high due to the possibility of destroying a valuable sample of material. Tubes have a simple self-closing system for moving parts, which excludes spontaneous opening of the tubes in the pipeline. In addition, there are special inserts inside the containers to protect the deliveries with the transfer bags. These bags are designed to protect the shipped material from moving during transportation. They are suitable for washing and multiple disinfection. Each tube is described by the name of the organizational unit to which it belongs. All devices consisting of the pneumatic tube system have EMC certificate. It is a certificate of electromagnetic compatibility, which demonstrates their resistance to external electrical fields generated by the operation of other radio link systems, paging, cellular, Power and computer networks and the most important – medical equipment such as computed tomography. These devices aren’t the source of any interference [air-mix 2008].
Improvement of process
Every pneumatic tube system is suited to specific needs of the customer. The extent of the transmission system depends on the reach of the mail (whether it within a single building, two or within a complex of buildings), type of sent items (their weights, sizes) , way of communication (one-way and two-way communication are distinguished). It can be installed in buildings on many floors or it may also be connections between distant buildings. Pneumatic tube system improves many operational processes that can be made at a lower working cost of nurses and doctors, less financial resources and most important – less time resources. Hospital employees are already accustomed to working with pneumatic tube system and judge it as a very useful tool.
To fully realize the medical service such as to take the blood sample from the patient for examination it is needed to contact the laboratory. The blood sample taken from a patient who is in the pediatric ward In the main hospital building on the third floor the nurse must take it to the laboratory, which is located in clinic on the fourth floor. The nurse must cross a very long way to the laboratory. The walking time will take several minutes while the sending blood sample by pneumatic tube system will take her a few seconds. The saved time the nurse can spend with the patient – that is where she should be during her working hours.
Examples of use
- It is also possible to send documents by pneumatic tube system, which may be laboratory tests, patient consent letters for processing personal information or important communications.
- At the reception of a patient on the fourth floor, a nurse can send a document via the pneumatic tube system instead of going down to the ground floor.
- During complicated surgical procedures doctor may need additional instruments that are located in another ward. At this point the minutes are important and the long waiting time for the delivery is bad for the patient.
- Pneumatic tube system Improves process of operation. When in case of a sudden event and run out of the right medicine, which at the moment rescues the patient’s life, nurse by informing the pharmacy can quickly obtain the desired medicine and the patient isn’t exposed to additional health complications.
Thanks to the innovation of pneumatic tube system, the hospital has a better chance of participating in various programs affirming modern hospitals, which can advertise a medical institution, Raise its competitiveness and encourage potential patients to use fast and professional service and health treatments.
Pneumatic tube system is also a convenience for employees. Nurses and doctors have a hard and absorbing job. Each day they struggle with difficult situations and the behavior of patients who have emotional problems. The employee fully utilizes his time resources and strengths, trying to do everything to make the patient feel better, recovered and was satisfied with the course of treatment and the conditions in which he spent time at the hospital. Thanks to it staff increases the quality of provided medical services.
The pneumatic tube system allows to work in better conditions which causes employee to be satisfied and have the strength to perform duties. Employee isn’t exposed to external factors that may endanger health or life, utilizing working time to move between individual wards or buildings to send a document or biological material.
First of all, pneumatic tube system is used to send any blood or urine samples and swabs from patients to the laboratory which is located in a separate building on the third floor.
Everyday the nurses send deliveries. As often as the biological material are sent paper documents, test results, medical certificates or prescriptions. Surgical equipment, surgical sutures, other items or instruments that may fit in the transport tube are less commonly delivered. The delivery system works 24 hours a day. Estimating that on average 90% of patients are in the ward and that everyone has to have their blood tested, the number of blood samples sent to the lab is high. This is the amount that medical personnel would not be able to deliver (all samples) in as short a time as a pneumatic tube system.
Based on the conducted research, it can be stated that pneumatic tube serves the hospital primarily for the transmission of samples with biological material. System replaces the work of nursing staff so that the patient has the opportunity to interact more intensively with the nurse. Also often sent are documents, these are referrals for research to the lab and the results of the research.
Evaluation of the effectiveness of implemented innovation
Traveling was associated with considerable physical effort, which depends on the age of the nursing staff is larger or smaller range, so times are different. There are other factors that affect the travel time that extends that time. These factors are:
- Employees conversation
- Nurse conversation with a randomly encountered patient who wants to know some information
- Elevator breakdown
- Accident while walking (fall from the stairs or slipping)
- Emergency assistance
Taking into account the above factors, a study was conducted to measure the time which was needed to finish the delivery. Several transceiver points were taken into account and the traveled distance was repeated.
Pneumatic tube system is a mechanical system and therefore there is the possibility of issues and temporary downtime. Sometimes there are situations in which it is impossible to use system. Such situations are:
- When an employee loads a heavier material into the transmission tube than indicated in the technical specification
- When an employee tries to send more than one tube at a time
- When the transfer tube isn’t adequately closed or one of the three parts of the tube is missing
- When occurs lack of electricity in the hospital
- When stopping of work occurs due to issue of the control panel system
- When the propulsion device overheats due to overwork
- When the piping system gets damaged
Thanks to the hospital’s additional financial resources for the purchase of the system, the medical institution saved large amounts of material, financial and time resources while improving own image among the direct recipients of services, i.e. patients.
As a result of the implementation of pneumatic tube system, there was a triple reduction in time needed to deliver materials to the selected organizational unit. Pneumatic tube system improved the efficiency of the hospital’s processes. There was a reduction in the transit time of samples between organizational cells. The transport of material is more efficient and doesn’t involve the working time of the nursing staff. The hospital no longer has loses in form of damaged laboratory samples or destroyed medical equipment. Employees fulfill their duties without neglecting any. The number of medical incidents has decreased since the introduction of system. Patient satisfaction increased during hospital treatment. Pneumatic tube system leads to the unification of the method of transport of materials, which makes uniform quality and maintain a certain level, which is in line with the expectations of the recipients. In this case, the client is both a patient and an employee. Employee is an internal customer. Based on the developed survey and graphs, the results of the employee satisfaction with the usage of pneumatic tube system are mostly positive. System has improved their work, they are satisfied, it is 68% of employees. The tube system is an improvement in the patient’s treatment process. Implemented lean management reduces the sample transfer time from the customer and faster intervention of the doctor after receiving the results of the materials collected for the research. Innovation also allows to minimize the patient’s waiting time for the results of laboratory tests. The efficiency of transport of the material has been improved and the number of incidents and minor issues at work has decreased. An additional advantage of system is that in case of a issue, it possible to quickly find the point where it occurred while during the traditional method of transport it is difficult to determine who was responsible, made a mistake and at which stage of the process it occurred, so the material was delivered to another ward or delivered differently than expected. Everyone has assimilated most of the necessary knowledge needed to handle pneumatic tube system and most of the staff are satisfied and accustomed to this innovation.
- Bielański.med 2011, Hospital emergency ward, http://www.bielanski.med.pl/historia-szpitalny-oddzial-ratunkowy.html
- Air-mix 2008, Technical specification
- Graban M., 2011, Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction wyd.1, Wyd.ProdPublishing, Wrocław