Do you know that cables of the Left Ventricle Assist Device (LVAD) could potentially cause falls and tripping hazards? Determined to eliminate fall risks, a dedicated multidisciplinary team from Heart and Lung Transplant Unit, Nursing, Support Services, and Process Transformation and Improvement, kickstarted an innovative quality improvement project to look at ways to improve patient safety. This initiative has earned the team, the Team Excellence Assessment (TEA) Star Award!

Before: Disorganised and Hazardous Environment
There were significant challenges in the setup of the LVAD before the project commenced. After a patient receives an LVAD implantation, he would need to stay in the hospital for a few weeks or longer if necessary. The device works continuously 24/7 and requires a constant supply of power. 

“While the patient is warded, there are several long cables connecting their LVAD to essential equipment such as a controller and power module. The trolley holding the equipment was ill-equipped for the task of transporting the LVAD equipment, resulting in an inefficient and disorganised working environment,” shared team leader, Janna Tan from Mechanical Circulatory Support, Heart and Lung Transplant Unit.

Old trolley setup: Cables haphazardly strewn across the floor or looped around the trolley and devices, leading to the risk of falls as well as frequent breakage and replacements of cables.

The process of organising and tidying cables during the setup, transportation, and storage of LVAD equipment proved time-consuming and diverted valuable resources from quality patient care. Exposed cables, especially those lying on the floor, could pose potential safety concerns such as risk of fall and trips, and if ran over by other trolleys, the cables could also be easily damaged and lead to risk of electrical fires and equipment malfunctions. 

After: A Harmonious Intervention
Looking beyond the solution of tidying cables, the team was also concerned about the overall care of LVAD patients. They identified the root causes to be the lack of cable hanging and placement space to effectively organise the multiple plugs and cables. Hence the team partnered and worked with trolley vendors to specially customise and design a LVAD trolley to incorporate features such as drawers for cable storage, hooks for temporary cable hanging and single multi-plug extensions. 

(L-R) A sketch of the prototype and the end product of the custom designed LVAD trolley.

The prototype trolley was meticulously tested in Ward 56 for over two months and was further improvised into the end product upon feedback gathered. “Through everyone’s dedication, we transformed the way LVAD cables are managed, ensuring safer and more efficient care for our patients. We are happy to have embarked on this improvement journey and very proud of our new LVAD trolley!"  

Sharing the new trolley design with ward members.

With cable wires neatly arranged, cleaners in the ward are now able to clean and maintain the space easily, which contributed to better infection control standards. It also allowed patients to identify the correct switch easily. While the cable organisation may be a seemingly simple solution, it has streamlined the admission process of patients on LVAD, saving an impressive 33 man-hours per LVAD admission annually. More importantly, the risk of tripping or falling due to messy cables has been brought down to zero, from more than 70% of surveyed patients and staff who said they have tripped or nearly tripped on cables.

Interestingly, Janna shared that the story of the LVAD trolley really began with the team listening and interacting with patients, with one patient who inspired the team to improve safety and efficiency at the hospital by transforming the way they managed the LVAD cables.

Moving forward, the team plans to share the design of the new LVAD trolley with other VAD centres in the region.

Members of the project team (L-R): Kerk Ka Lee (facilitator), Sharon Neo (member) and Janna Tan (team leader) from Heart and Lung Transplant Unit, as well as Wirdawati Bte Salimin (member) from Ward 56. Not pictured are members Ngai Khai Loong, Operations (Support Services) and Jacqueline Huo, Process Transformation and Improvement.