Where do I get this? 
So many locations to get all these different items from!
Oh no, am I spending too much time finding these?
Oh dear I forgot that!
For many years, these were the things which ran through the minds of some of our colleagues’ when they rushed about in the Cardiothoracic Intensive Care Unit (CTICU) preparing for intervention procedures.  
Thanks to Revivors, a team which came together to identity the causes and brainstorm ideas, the procedure preparation in the CTICU is now streamlined with almost zero human error, providing the staff with ease of locating the items for intervention procedures and saving more time that can be spent on patient safety and care instead.


Prior to the project, a common issue raised in most of the debriefing sessions held after the emergency, urgent and elective procedures was ‘delay to procedures’. Reasons such as ‘unsure how to go about preparing for the procedures’, ‘having to go to different locations to collect items’, ‘staff forgetting items needed for procedures’, and ‘unavailable requisites’ came up often.

Team Revivors recognised the pressing need in improving the preparation processes in the CTICU, especially since time is of essence in any intervention to the patients. They adopted a Plan-Do-Check-Act structured improvement methodology to guide them in their thinking process where they gathered data, analysed the situation and identified the main root causes of the problem. The team came up with several creative solutions and set out to evaluate their effectiveness. One simple solution turned out to be a brilliant idea – Implementation of the Requisite Boxes. 

The before

CTICU nurses used to have to go to several locations to locate the items needed for the intervention procedures and sometimes, they even had to race against time in critical situations. 
NHCS CTICU - Requisite Boxes 
Implementation of Requisite Boxes for preparation of procedures at CTICU.

The after
The concept of the Requisite Boxes is fairly straightforward. The team filled up boxes of the requisites needed for each procedure and placed them at one accessible spot. What used to take the nurses to prepare for the procedure in nine steps is now shortened to just five, freeing up time and mental bandwidth for them to concentrate on patient care  and other tasks.

Staff Nurse Kimbell Tan, who led the team in the project, added, “The streamlined preparation process in CTICU has overall reduced the stress and anxiety not just for the existing staff, but also provided ease for the new staff who are struggling to cope and learn the processes in CTICU.”

Team Revivors, who had won numerous awards for their quality improvement project, had also recently won the Singapore Health Quality Service Award (SHQSA)’s Team Merit Award held on 15 January 2019.

“The best ideas and the most useful and ground-breaking are often, though not always, in one sense, very simple ideas.” – Joe Grant. 

Indeed, sometimes the simple ideas can turn out to be the best ones. Great job, team Revivors!