CVL / Airway Cart Restocking for Patient Charge Items

A Kaizen from East Tennessee Children’s Hospital and their PICU. Here is an example that is good for patients and staff (less delay) and is good for the organization (better charge capture).

Before there were multiple methods of informing Central Supply of the need for cart refills.  Nursing could call down to Central Supply, fax a tick sheet or transport the cart to the bar code reorder workstation. The nurses were unsure of the “correct” method of ordering.  This caused confusions for both Central Supply staff and the PICU nurses.  Now the Central Supply and PICU nurses worked together to create one method that works for both departments. Patient charges are now captured on a charge sheet and entered into the reorder workstation without moving the cart.


  • Chuck JaegerReply

    From my perspective, there is not enough content to determine what has changed. The “before” picture has the clipboard present near high noon location. Is the “after” showing that there is no more need for a cart nor items, just the clipboard is needed?

    • Mark GrabanReply

      Chuck – I had neglected to include some of the additional text sent along with the Kaizen. See if that helps.

      When doing a Kaizen writeup (the actual image here), we need to strike a balance between making the Kaizen understandable without getting too wordy. I think the actual Kaizen report would be more clear with a bit more explanation… that’s the coaching I would give to the creator of this.

  • Isaac MitchellReply


    Thanks for your feedback on our documents. I always say if one person has a question then there are 10 others with that same question. In the before picture, this kaizen could be better explained with the value stream map and spaghetti diagram showing the multiple methods of ordering. There were really two big issues going on with this example:

    1) No best practice or standard method. There were four different methods and ways to charge for the supplies causing confusion, variation and lost charges.

    2) Wasted Motion: Nurses would roll this cart back and forth to the supply room where the barcode reader was located to order supplies. This could be over 100ft depending on the room location. Now they just take the clipboard and enter charges.

    Thanks again for the feedback on our kaizen.


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