Increasing Efficiency of Medical Stretcher Management

Our Lady of the Lake 

5000 Hennessy Blvd, Baton Rouge, LA 70808 

Final Report
Ben Guilbeau, Vivian Ji, Isa Massad 

Corporate Supervisor: Dr. Tonya Jagneaux 

Lean Lead: Lindsey Booty 
Faculty Advisor: Dr. Hyun Woo Jeon 
Submission Date: September 4, 2020
Table of Contents
Background and Motivation [vj] ............................................................................................. 4
Problem Description [vj, bg] ..................................................................................................... 4
Management Objectives [bg] ................................................................................................... 4
Current Status - Analysis & Data Collection ............................................................................... 5
Interview and Surveying [team] ........................................................................................................5
General Economic Data Collected [im, vj]..........................................................................................5
Stretcher Demand [bg, im] ................................................................................................................5
SMAU Current Process [vj] ................................................................................................................6
Radiology Department Current Process [vj] ......................................................................................7
Emergency Department Current Process [bg, vj] ...............................................................................8
Specific Issues Identified to Date [team] ................................................................................. 9
Data Analysis & Findings [vj] ...................................................................................................10
Layout [vj] ...................................................................................................................................... 12
Economic Analysis [vj, bg] ............................................................................................................... 12
Solution Alternatives Identified to Date ....................................................................................13
Centralized Location [vj, bg] ............................................................................................................ 13
SMAU and Radiology Solution [vj, bg] ............................................................................................. 14
Emergency Department Solution [vj, im] ........................................................................................ 15
Alternative Stretcher Solutions [vj] ................................................................................................. 15
Recommendations [bg, vj] .....................................................................................................15
Implementation and Assessment Work Plan [vj] ....................................................................17
References.............................................................................................................................17
Appendices ............................................................................................................................18
Appendix A - Stretcher Survey ........................................................................................................ 18
Appendix B - Rate of movement ..................................................................................................... 18
Appendix C -Time Study .................................................................................................................. 18
Appendix D - Department distances ................................................................................................ 19
Appendix E - Pay Rates of Personnel ............................................................................................... 19
Appendix F - From/To Tables for Weighting Paths........................................................................... 19

2
Appendix G - Possible Alternative Solution Testing ......................................................................... 21
Appendix H - OLOL Blueprints ......................................................................................................... 22
Appendix I - Center of Gravity Calculations .................................................................................... 24
Appendix J - Economic Analysis ...................................................................................................... 25
Appendix K – Data Analysis for Central Location Determination and Related Economic Analysis..... 26

3
Background and Motivation [vj]
Our Lady of the Lake (OLOL) is a hospital known for its excellence in patient care and emphasis on
education located in the heart of Baton Rouge. The hospital cares for adults and children affected by
various illnesses and injuries. Their facility consistently receives awards for “compassionate care, clinical
expertise, leading edge technology and innovation” (About Our Lady of the Lake).

The facility in study is the Our Lady of the Lake Regional Medical Center and is separate from the
Children’s Hospital which is located nearby. Daily operations at the hospital are largely dependent upon
the use of ‘stretchers’, defined as a “device for carrying a sick, wounded or dead person” (Stretcher).
Stretchers are one of the most important resources for transporting patients throughout the hospital.

This study was requested as a result of inefficient stretcher management. The stretchers are critical in
the healthcare industry and departments throughout the facility experience delays and spend excessive
labor dollars retrieving this equipment from all over the hospital. Thus, patient care is negatively
affected in a multitude of departments.

Problem Description [vj, bg]

‘Stretcher management’ refers to the retrieval and storing of stretchers within the hospital. Customer
service representatives, registered nurses, transporters, and housekeeping employees of Our Lady of
the Lake find that locating a stretcher is difficult and time-consuming. Upon receiving the command to
retrieve a stretcher, the worker will search various areas and ultimately find an available stretcher (not
in use and in working condition). Most of the time these stretchers are not made when they are found.
The workers then must “make” them which includes the steps of sanitizing, placing linens, and a pillow
onto the stretcher. Finally, the stretcher is delivered to the area needed for patient care. Waste
reduction and optimization opportunities are most needed in locating and obtaining possession of the
stretcher.

The study will be restricted to the following three departments’ demand within Our Lady of the Lake
Regional Medical Center: the St. Mary’s Admission Unit (SMAU), Radiology, and the Emergency
Department (ED). The PACU – comprised of Main PACU, Tower PACU, and HVI PACU – was not initially
included in this study, but it has become apparent that discrepancies on distribution of stretchers,
whether with a patient or without, once leaving the PACU departments was partially attributing to the
stretcher drop-off locations. It is also evident that inefficiencies in the stretcher management process
are generally attributable to the distance between stretcher disposal and initial stretcher
implementation locations. The myriad causes of this discrepancy are outlined in the Data Collection
section of this report.

Management Objectives [bg]

Our main objective is to obtain a 20% or larger decrease in time to locate a stretcher.

4
Current Status - Analysis & Data Collection
Interview and Surveying [team]
Each patient, having different needs and requiring different treatments, moves about the hospital in
very different ways. Therefore, a stretcher is used to link two departments/units as part of a large web
working together to improve a patient’s health. The complexity of stretcher movement led the team to
conduct both informal interviews as well as surveying through SurveyMonkey. The survey questions
consist of 9 simple questions (Appendix A). The results helped our team yield a clearer understanding of
interdepartmental traffic and the inefficiencies therein, documented below.

General Economic Data Collected [im, vj]

Stretchers are often scattered through different locations and most of the time personnel such as
patient transporters, housekeepers, and ER Techs are the ones that look for them. Pay rates for those
members are shown in minimum, average, and maximum hourly pay (See Appendix E). Transporters and
housekeepers are being payed the same at $12 an hour and ER Techs $13.36 an hour. Converting those
pay rates into dollars per minute for patient transporters and housekeepers yields $0.20/min and for ER
Techs $0.22/min. With our research, we have seen that searching for a stretcher and finding one
available for use could take from 7 to 11 minutes. If one staff member were to spend up to 10 minutes
looking for a single stretcher assuming they still have not found the stretcher, patient transporters and
housekeepers would receive $2 and ER techs would receive $2.20. If 30 stretchers were to be retrieved
a day by one transporter, 300 minutes resulting in a payment of $60 can be assumed to have gone
towards unproductive time. That amount of time is considered as unproductive time since stretchers are
still not being utilized by the department that needs them. This unproductive time increases
unnecessary costs. So, if the unproductive time is decreased to a level such that the productive time is
larger, then the pay rates would be fair for the personnel and cost efficient for the hospital.

Stretcher Demand [bg, im]

The Same Day Surgeries Unit (SMAU), Heart and Vascular Admissions Unit (HVAU) and the Emergency
Department (ED) have the highest demand for unoccupied stretchers. These units are where patients
initially check-in upon entering the hospital. These are start point processes, whereas the Radiology
department is a midpoint process. Radiology retrieves patients from SMAU or ED via stretcher, then
returns patients back. Therefore, inefficiencies related to stretcher retrieval are occurring at these three
units the most. SMAU requires 29,930 stretchers each year, and the ED requires 80,300 stretchers each
year. The ‘HVAU’ is the pre-operative department for all surgeries in the Heart and Vascular
Departments (HVI). This unit requires 3,103 stretchers per year (stretcher supply and demand can be
found under ‘weight’ in Figures 1 and 2 of Appendix I).

The biggest demand experienced by Same Day Surgeries is around 85 admissions, and is mostly in the
morning hours. About twenty patients roll out of SMAU at 7 AM every day and the unit continue to
process patients until around 4pm. Currently, about twenty stretchers are made and ready each
morning for the initial wave of patients. The ED is busiest between 11:00 PM and 3:00 AM and has heavy
traffic between 11:00 AM-3:00 AM. Many times, the ED personnel will fetch the stretchers prepared for
the next day’s same day surgeries in the early hours of the morning, leaving SMAU with less than the

5
required number of stretchers. Our goals at this point now include planning how to move stretchers
from the SMAU area to the ED after SMAU has finished work for the day, so that the made and prepared
stretchers needed for the morning are not touched by the ED’s night crews.

The Radiology department typically deals with the retrieving of a patient on a stretcher or removing a
patient using a stretcher from MRI scans or CAT scans being completed. If a patient needs a scan, a
technician or nurse of the Radiology department will retrieve a stretcher, often times having to clean
and prepare one before retrieving the patient, and then transport that patient on the stretcher they are
occupying to the scan room. Once scans are complete, they are transported back to the patient room.
The demand of this department is consistent throughout the day, as they see patients from both SMAU
and ED.

SMAU Current Process [vj]

Patients check into the unit for their scheduled same day surgeries. These patients typically enter their
individual bays before 7:00 AM. SMAU, also known as the ‘post operation suite’, consists of 25 bays.
These bays must each hold one stretcher, made with sheets and a pillow, before the patient enters the
bay and before 7:00 AM when the first round of surgeries kicks off. Then the patients are transferred via
stretcher from their bay to the operation room (OR). After the OR, patients are transferred to the Main
PACU.

The only SMAU bay that is not being used is bay 17 which is blocked off to store 3 stretchers at a time
for immediate use, when needed in the future. The two parallel hallways have a gap where they store
two stretchers throughout the day. If the gap is empty, transporters and housekeepers attain another
stretcher to replenish this area. Transporters are given a cellphone when hired, this is their method of
communication to fulfill tasks. Transporters are alerted to complete a transfer task by a verbal
statement of a nurse or by receiving a call from the nurse station stating that a stretcher is needed. The
cell phone plans are taken care of by the SMAU budget that is under Amanda McMichael’s authority, as
she is the director of SMAU. To track a transporter’s productivity, their task starting time is recorded and
they must sign after completion of the task with an ending time on a clipboard located at the nurses’
station. This allows the director to track each transporters productivity.

Time studies on SMAU transporters show that they currently spend approximately 11.09 minutes
locating one stretcher available for use during peak hours. This time does not include the time to bring
the stretcher back to SMAU for use. They will travel to different hotspots (areas likely to house an
available stretcher) starting from the location the transporters are currently in:

1. The in-patient admit areas known as “floors” which is about 288 feet away from SMAU
2. Outside the ED about 280 feet away from SMAU (Blueprints OLOL).
3. A-Hall which is about 216 feet away from SMAU (Blueprints OLOL).
4. HVI Hallway which is approximately 576 feet away on the third, fifth, sixth, and seventh floors
being the most difficult but most popular dumping spot of stretchers. The HVI hallways and
floors hallways include an elevator wait time and elevator use time. (Blueprints OLOL).
5. Radiology Department which is about 50-100 feet away from SMAU (Blueprints OLOL).

6
The transporters will check these five popular deposit areas in a random order based off their own
preference. Distances were calculated based off the blueprints provided by OLOL.

The transporter will walk between these hotspots until a stretcher is found, which can result in up to 15
minutes of time being used just to locate a stretcher. The staff members walk without a stretcher at
about 4.6 feet per second. Then after retrieving the stretcher, the stretcher walking rate rapidly slows
down due to the limit of the stretcher which is about 2.2 feet per second. These travel speeds were
based off an initial study of 13 occurrences where a staff member had to retrieve a stretcher (Appendix
G). Another time study conducted that was pertinent to transporter time, is the elevator time as stated
above for the two hotspots, the in-patient admissions and HVI hallway. It takes about an average time of
2.34 minutes to wait and go up in the HVI building. It takes an average of 2.25 minutes to wait and go up
to any floor to reach in-patient admit. These times also apply to going back down the elevator. Both
time studies were completed using a stopwatch (Appendix B). From this, you can conclude that the
minimum time set for retrieving a stretcher in the hotspots that utilize the elevators will be at least five
minutes. This time cannot be reduced due to the hospital’s nature of work, therefore the only process
that can be reduced is the time to locate a stretcher.

Radiology Department Current Process [vj]

The Radiology Department is located on the second floor of the hospital. The department uses an online
task completion system that is only viewable via computer or beeper. The system puts out a task that
calls for any transporter or technician to retrieve a patient. This system, however, does not include a
usable stretcher location. This data is not available to the team for further analysis. Staff members will
retrieve the stretchers from the stretcher hotspots throughout the hospital. Once this task is completed,
the staff member logs the task as completed. Each task is marked as completed once the patient is back
in their bed. The issue is that the stretchers are left outside hallways of the patient room, since they are
no longer of use.

Time studies were done on Radiology transporters, who currently spend average about 9.015 minutes
locating one single stretcher available for use during peak hours. This does not include the time it takes
to bring the stretcher back to the Radiology department. They will travel to these areas that usually have
stretchers left behind (starting from the radiology nurses’ station):

1. The hallways in and around the Radiology Department which ranges about 1 to 85 feet
(Blueprints OLOL).
2. The in-patient admit areas known as “floors” which is about 464 feet away which must account
for elevator wait and use time to the fourth, fifth, and sixth floor (Blueprints OLOL).
3. The ER hallway located on the second floor is about 136 feet away (Blueprints OLOL).
4. A-Hall located on the second floor which is about 368 feet away (Blueprints OLOL).
5. HVI Hallways which is approximately 432 feet away which must account for elevator wait and
use time to the third, fifth, sixth, and seventh floors being the most difficult due to elevator use
and distance from the radiology department (Blueprints OLOL).

The transporters will check these five popular deposit areas in a random order based off their own
preference. Distances were calculated based off the blueprints provided by OLOL.

7
The transporter will walk between these hotspots until a stretcher is found, which can result in up to 15
minutes of time being used just to locate a stretcher. The staff members walk at about 4.6 feet per
second. Then after retrieving the stretcher, the stretcher walking rate rapidly slows down due to the
limit of the stretcher which is about 2.2 feet per second. These travel speeds were based off an initial
study of 13 occurrences where a staff member had to retrieve a stretcher (Appendix G). Another time
study conducted that was pertinent to transporter time, is the elevator time as stated above for the two
hotspots, the in-patient admissions and HVI hallway. It takes about an average time of 2.34 minutes to
wait and go up in the HVI building. It takes an average of 2.25 minutes to wait and go up to any floor to
reach in-patient admit. These times also apply to going back down the elevator. Both time studies were
completed using a stopwatch (Appendix B). The Radiology Department is different because they must
both retrieve a patient from a room, and after service is done, return the patient resulting in doubled
elevator time. This time cannot be reduced due to the hospital’s nature of work, therefore the only
process that can be reduced is the time to locate a stretcher.

Emergency Department Current Process [bg, vj]

The emergency department (ED) receives patients at all times of the day through walk-in events and via
emergency medical vehicles. Patients are processed in the ED and are either sent home or sent to
another department in the hospital. All patients requiring attention elsewhere are then transferred to a
stretcher. This stretcher comes from one of various locations throughout the hospital. The locations
include but are not limited to the back hallway on the third, fifth, sixth, seventh, and eighth floor of the
HVI tower, the elevator lobby adjacent to the ED, the former Pediatric Post Anesthetic Care Unit ‘PEDS
PACU’, ‘A-Hall’, Radiology, and various hallways directly connected to the ED.

Once a patient is placed on a stretcher, a nurse must move the patient to their next unit. No transporter
personnel can move patients from the ED because patients may be unstable and require medical
attention in-route. Most patients go to in-patient units located throughout the hospital where patients
are monitored and treated. When this occurs, stretchers should return to the ED as the patient is
transferred to a bed for their stay.

Stretchers remain in the in-patient units due to a combination of the following reasons:

• Reason A: personnel choose to avoid the effort required to push the stretcher back
• Reason B: personnel are required to move quickly back to their units, and walking rate is faster
without a stretcher, so the stretcher is left

No patients can move out of the ED into another unit without the use of a nurse. No new patient can
enter the ED unless there is space to process them. Until a processed patient is transported out of the
ED into another unit, new patients cannot enter. As a result, nurses must hurry to and from the in-
patient departments to open space in the ED. The time ‘saved’ to walk back without a stretcher is not
truly saved but moved to a later time when that stretcher is needed at the ED and someone must
retrieve it. This is how the Emergency Department’s discrepancy most often occurs between the point-
of-use and the storage location for stretchers.

8
Time studies were conducted on ER transporters, who currently spend about an average of 7.93 minutes
locating one single stretcher for available use. This time does not include the time to bring the stretcher
back to the Emergency Department for use. They will travel to these areas that usually have stretchers
left behind (starting from the ED Nurse’s Station):

1. The in-patient admit areas known as “floors” which is about 632 feet away from the radiology
nurses station (Blueprints OLOL).
2. Outside the ER hallway which is about 48 feet away (Blueprints OLOL).
3. A-Hall which is about 496 feet away
4. HVI Hallway which is approximately 416 feet away which must account for the elevator wait and
use time to the third, fifth, sixth, and seventh floors being the most difficult but most popular
dumping spot of stretchers (Blueprints OLOL). These hallways include elevator wait time and
elevator time.
5. Radiology which is about 260 feet away

The transporters will check these five popular deposit areas in a random order based off their own
preference. This is extremely inefficient for the ER since patients are usually at critical level at entry and
need the stretcher immediately most of the time.

Specific Issues Identified to Date [team]

The exception processes include the disposal method of stretchers when they are no longer needed. The
three PACUs: Main PACU, Tower PACU, and HVI PACU each have their own method of disposal. After a
surgery is completed in the OR they are transferred to the PACUs and in some cases the patient is
moved onto a bed rather than the stretcher they came transferred on. This empty stretcher is then seen
as an obstruction and waste of space so registered nurses must dispose of them from the OR and PACU.
If the time is before 12 pm, they will walk to the radiology department and dispose of them in the
hallway. If is after 12 pm when the A-Hall officially closes from patient use, they will dispose of the
stretchers in room 2200 of the A-Hall. The distances were calculated using an architect ruler and
consisted from the MAIN PACU to the following locations: of 592 feet to Radiology, 296 feet to A-Hall,
688 feet to the ER hallway, 280 feet to Floors, and 620 feet to the HVI building (OLOL Blueprints). The
Floors and HVI building hotspots have additional time due to elevator wait time (Appendix B).

If the patient is transferred from the OR into the PACUs on their stretchers, the method of stretcher
disposal differs. The PACU is where a patient is monitored and where a decision is made for the next
steps of the patient’s care. Some patients get discharged, some move to inpatient rooms called ‘floors’
for further monitoring, and some go to critical care in HVI. These steps all depend on the patients' state
of health after surgery. These stretcher transfers are done by registered nurses due to the amount of
care needed for the patient, if something were to go wrong during the transfer, a registered nurse
would have the appropriate knowledge to care for the patient whereas a transporter would not. Once
the patient reaches the designated room they are assigned to, stretchers are left behind in the nearest
hallway of that area. These disposal areas are the hotspots to transporters, housekeepers, and
technicians of SMAU, Radiology, and the Emergency Department. They retrieve these stretchers after

9
they are left in those scattered hotspots throughout the hospital, much of which are spots that violate
fire safety codes. Then the cycle continues.

Fire safety codes are provided by the National Fire Protection Association (NFPA 101-2012). A code
states, “Wheeled equipment (such as equipment and carts currently in use, equipment used for patient
lift and transport, and medical emergency equipment not in use) that maintains at least five feet of clear
and unobstructed corridor width is allowed, provided there is a fire plan and training program
addressing its relocation in a fire or similar emergency”. This provides the clearance for a stretcher to be
left in a hallway with five feet of clearance. This lets us know that the HVI hallways is a dwell point for
stretchers to be left, where staff members know no codes are being violated. Whereas, in the main
hallways, stretchers should not be left behind. Also, stretchers have been seen in corridors designated
as egress access when the NFPA 101-2012 states, “Exits, exit accesses, and exit discharges (means of
egress) are clear of obstructions or impediments to the public way, such as clutter (for example,
equipment, carts, furniture), construction material, and snow and ice”. Egress corridors can’t be a place
to leave behind stretcher no matter how wide the corridor is.

The stretcher management process is inhibited by a lack of accountability. No one is incentivized to

return stretchers to their origin units, and there are no disciplinary actions taken when a stretcher is left
at the patient’s destination. When a stretcher is left outside a patient’s in-patient room, the staff
person who left it there has no fear of negative repercussions. The behavior is very difficult to change
because all staff leave stretchers, and little to no research is done to determine why and how a stretcher
got left where it should not be. The rules for stretcher storage are ambiguous because they cannot be
followed – there are simply too many stretchers for the spaces and distances required to accommodate.

Data Analysis & Findings [vj]

The distances between departments and between hotspots data was found using the blueprints of OLOL
and Excel. These feet measurements are compared to the rate of walking without and with a stretcher
to calculate an average time per minute it takes for transporters to walk between spots for a retrieval of
a stretcher. Each department suffers from the amount of time taken to find this equipment, especially
during peak patient hours.

Specific problem areas that were identified from the analysis with respect to the objectives was that the
retrieval times was based off convenience. At times stretchers would be exactly where they initially
checked. The root causes of the increase in stretcher retrievals are when PACU registered nurses
dispose of the stretchers in far locations due to patient transfer to those units. These units include: HVI
critical care units located on different floors on the far east side of the hospital and the inpatient floors
unit that are also located on different floors on the far southwest side of the hospital. These stretchers
get left in the hallways outside of these units.

Demand-Weighted Center of Gravity [bg]

For a more analytical approach to finding a centralized storage location, we are implementing a
demand-weighted center-of-gravity study. The concept is simple and involves first thinking of the
hospital as a coordinate grid with its origin at some point to the bottom and left of the departments in

10
question (as they appear on the blueprints). From there, all we need is the stretcher demand per day at
the three stretcher implementation departments (ED, HVAU and SMA), as well as the average quantity
of stretchers at each stretcher relief locations (at which point the stretcher’s use is discontinued because
the patient is removed). The relief locations are the in-patient units called ‘Main’, ‘Towers’ and ‘HVI’. We
treat each stretcher as having a weight of one and use this weight to determine the moments in the x-
and y-directions that the stretchers in each department cause. We consulted data sent to us by OLOL
which contained all the moves patients made to new departments in 2019. This was the data that made
the demand centers and supply centers and their yearly stretcher quantity very clear.

First, we analyzed the implementation locations (SMAU, HVI and ED). By finding the coordinate of the
department’s centers in feet away from the origin in the x- and y-directions, and then multiplying that
coordinate value by the total weight of stretchers (equivalent to the stretcher demand each year) in that
department, we determine the moment in each direction caused by that department. Then, we sum
the moments in the x-direction of SMAU, HVI and ED and divide by the total weight of stretchers (one
unit each) in those departments to get the center of gravity for those departments. We do the same
with the moments in the y-direction and combine that with the center in the x-direction to get the
center of gravity for implementation departments. The center of gravity is a misnomer that, in this
instance, means the stretcher demand-weighted center of gravity between the three departments. It is
the point that most efficiently services the two departments when used as the stretcher storage location
based on individual department demand. If stretchers were stored here, the total movement of
stretchers from storage to their implementation points would be minimum. It is the center of gravity for
stretcher demand. Please see Appendix I for the demand center of gravity calculations.

We then analyze the relief locations. We find the coordinate of each department’s centers in feet from
the origin in the x- and y-direction. Extra feet will be added to departments on higher floors to account
for elevator use. Next, we multiply a department’s coordinate x-value and y-value by the total weight of
stretchers (one unit each) in that department. This gives us the total moment in either direction. By
summing all moments in the x-direction and dividing the total weight (one unit each) of all stretchers in
relief locations, we get the center of gravity in the x-direction. By doing the same with the moments in
the y-direction, we get the center of gravity in the y-direction which when paired with the x-direction
center gives the final center of gravity of stretchers in relief departments. Again, the center of gravity is
a misnomer that, in this instance, really means the centroid position of stretcher supply between the
two departments. It is the point that, if stretchers were stored here, total stretcher movement from the
relief locations to storage would be minimum. This is the optimal storage location based on department
supply.

Relief locations are on multiple floors. Therefore, an elevator factor was added to the coordinates of
these departments based on how many patients were deposited to each of the floors in 2019. We took
the average time traveling to each of the floors in the elevator and, using the elevator speed and
walking speed, converted elevator time into an equivalent distance. This distance was added to the x-
coordinate of the department. This was conducted for each of the relief locations/in-patient
departments: HVI, Towers and Main.

11
Finally, by averaging the demand center of gravity and supply center of gravity, we find the optimal
storage location to be at (478.5, 160.3). This coordinate is in feet from our pre-set origin and locating
stretchers here will allow for the minimum stretcher movement from storage to implementation
departments and from relief departments to storage. Please see the calculations models in Appendix I.

Layout [vj]
The distances between departments is extremely vital in the stretcher movement process. Figure 1
offers a simplified layout view of the second floor of the hospital. The three departments of Emergency,
Radiology, and SMAU are shown. The red arrows show the flow of patients leaving the Main PACU. At
the end of these arrows show dwelling points of the stretchers since they are no longer of use by any
department. The nurses that drop off patients to their admit rooms will move the patient from the
stretcher to their beds. The three PACUS: Main, Tower, and HVI are also displayed here.

Figure 1: Simplified Layout of the Second Floor of OLOL

Economic Analysis [vj, bg]

The spending of each department can be greatly decreased if the hospital makes an initial investment.
SMAU is using their budget towards phones and a phone plan for each transporter. This may presently
seem like a good use of the budget, but with time those bills will begin to build as an unnecessary cost
factor. Simply put, transporters are wasting time walking around the hospital searching for a stretcher.
Patients are waiting to be transferred and rooms are being occupied when they don’t need to be. There
are many small factors such as these that affect one another, and these are all surrounding the stretcher
inefficiency.

12
We performed a cost analysis for creating one stretcher storage location. Ultimately, we found that by
storing all stretchers at point (479, 160) on the second floor of the hospital, there would be savings in
labor costs, distances walked by personnel, and time spent retrieving stretchers. We conducted our
comparison on a state in which all stretchers brought to in-patient units were left at those in-patient
units. This is not actually the case, but it is very close to it as our observations showed few employees
bringing stretchers back to the origin unit after delivering a patient. Ultimately, there was no data
except for the data collected in observations to tell us how often a stretcher returned with the
employee after depositing a patient. In this comparison, each year the cost savings in labor would be
about $55,000. Those moving the stretchers would spend 3,600 hours fewer moving stretchers each
year, and would walk about 45,000,000 fewer feet, equivalent to 8,500 miles (see Appendix J for savings
overview). This is a 65%-time savings from the current state of the process and well above our 20%-time
savings goal.

For further analysis, we can determine how many miles each transporter would save every year, and the
ergonomic benefits could be substantial. This $55,000 dollar labor savings likely pales in comparison to
the benefit of increased productivity. For further cost analysis, we can determine about how many more
patients could be serviced if 3,600 hours each year were given back to patient care.

Furthermore, stretcher bed lifts would consolidate space. The total cost for buying and installing a 3-
stack lift is just under $24,000. If ten were purchased, the savings from labor alone would cause the
investment to be recouped in 5 years and 5 months. If ten 5-stack lifts were purchased (each costing just
less than $31,000 to purchase and install), the savings from labor alone would pay off the investment in
6 years and 7 months (see Appendix J). The primary limiting factor for the 5-stack stretcher bed lift is the
height requirements; it is not determined whether a room in the area could fit them. This semester, the
team will analyze the costs more thoroughly, incorporating electricity costs of these lifts, and
incorporate interest rates into the recuperation cycle.

Solution Alternatives Identified to Date

Centralized Location [vj, bg]
A centralized location would be the optimal solution for stretcher management. The hospital currently
does not offer a permanent storage location and many of the dwelling points of those stretchers violate
safety codes. Figure 2 shows a simple solution of two storage units to be used by the three departments
of our study. These units are currently not being used by the hospital. The PEDS ER waiting room can be
designated as the Emergency Department’s storage unit for stretchers. As their patients tend to be
more critical in timing, their stretchers should be readily available at any time of the day and night. This
unit would be only accessible by Emergency Department staff. It is shown in red stripes on the top area
of the figure and is not being currently utilized by staff or patients. This area, and many other pediatric
areas have not conducted any productive work in months due to the pediatric unit being moved to a
new hospital. Refer to Emergency Department solution section below for more details. A centralized
location for SMAU and radiology that would serve those departments most optimally would be the PEDS
PACU shown in red stripes. Refer to SMAU and Radiology Solution section below for more details.

13
 Figure 2: Layout of the Second Floor of OLOL with centralized locations

SMAU and Radiology Solution [vj, bg]

Through the objectives and problems encountered, the alternative solution that the team has identified
and are considering is the permanent use of PEDS PACU as a storage location for stretchers. This room
has had an unproductive few months, due to the new pediatric hospital being open.

Stretcher lifts are known for vertical storage solutions in hospitals. They “save up to 70% of floor space
per unit” and are known to “reduce required time to retrieve beds” (3 Position Hospital Stretcher Lift).
They also reduce clutter that prevent the violations of fire and other health codes in the hospital. The
stretcher lifts have a dimension of 10 feet in length, 3 feet 5 inches in width, and 8 feet in height, each
taking up approximately 34.17 square feet (3 Position Hospital Stretcher Lift). A total of nine stretcher
lifts can easily fit into the PEDS PACU room. These stretcher lifts will take up a total of 307.5 square feet,
still leaving plenty of space in the room for other needed equipment. These bed lifts individually each fit
three stretchers, so 27 stretchers can be stored in PEDS PACU at any one time using these lifts, which
would be plenty to accommodate current demands of the SMAU and Radiology department.

Inside the department of Radiology is a nurses’ station, that has the space for six stretchers to be used.
Since Radiology is a midpoint process, a set of 6 stretchers should be stored permanently in the
Radiology department itself. The technicians and transporters should be retrieving stretchers from the
department nurse’s station and continuing the given task. Once the process is complete, the employees
should be bringing those stretchers back to the nurses’ station rather than leaving the stretcher in
hallways, which were then taken by other department personnel. The process should be enclosed where
the stretchers leaving the Radiology Department will always be coming back, and only be used by
Radiology staff.

14
Emergency Department Solution [vj, im]
Through the objectives and problems encountered, the alternative solution that the team has identified
and are considering is the permanent use of the PEDS ER waiting room as a storage location for
stretchers. This room has had an unproductive few months, due to the new pediatric hospital being
open. Having the PEDS ER waiting room as a new storage location for stretchers could decrease the
retrieval time of stretchers and make it more efficient when personnel is looking for a stretcher. Also,
the route to retrieve or store a stretcher would be shorter since the storage would be located nearby.
This room is being renovated to become a conference room, but the team believes that the room should
be designated for stretcher storage only.

With a designated stretcher inventory room, staff members will spend no time in searching aimlessly for
a stretcher to use. They will know the permanent location, and this in turn will allow staff members to
know where to dispose of one after use is complete. This room can save time if one transporter is
assigned to work in cleaning and making of the stretchers. The hired transporter has an average pay rate
of $14.25 per hour. This assignment of one transporter for this room will save the time of many other
more important staff members into putting time for patient care. Other staff members include but are
not limited to registered nurses, surgeons, and technicians.

Alternative Stretcher Solutions [vj]

If assigning a specific room to store stretchers is not a viable option for the hospital, a simpler approach
would be to assign a new role to one individual, specifically a “stretcher transporter” role. This would
increase all other staff members’ productive work and be much more beneficial. The individual’s role
would be to consistently find and move stretchers, not based on demand, but resource fulfillment. This
will ensure that stretchers are returned to departments outside of critical production time, so they will
be prepared for future use rather than present. They will be readily available in their individual
departments through the lean concept of rapid setup.

Stretchers that are broken are left around in hallways of the hospital and stay in those spots for months.
If these stretchers had a permanent storage location or a stretcher transporter, broken stretchers could
be taken there for maintenance or be taken care of by the stretcher transporter. This will be cost
efficient, due to the cost of each stretcher.

Many transporters, technicians, and housekeepers of the hospital use nonproductive pathways to
retrieve stretchers. The pathways of the staff increase the retrieval time. The unnecessary pathways will
be eliminated, and a more streamlined pathway will replace that.

Recommendations [bg, vj]

We recommend dedicating the previous PEDS PACU room to stretcher storage. This location is very
close to the coordinate (479, 160) which is where our center of gravity calculation showed to be the
optimal storage location. By installing at least ten 3-stack or 5-stack stretcher lifts in this room, a
centralized stretcher storage location would be created that is extremely efficient compared to the
current state. Holding staff accountable for what they do with stretchers will be much more straight
forward. Everyone will know that a stretcher left in an in-patient hallway is in the wrong spot. Further,

15
transporters or other stretcher management staff leaving in-patient units without a stretcher can be
confronted regarding their failure to fulfill their task.

The recommendations we are advising towards will most likely reduce overall stretcher retrieval times
by over 20%. Evidence to support that it will achieve the objective fully is shown in Appendix G. It will
increase the hospital’s organization, capacity, and downtime. Most importantly, the hospital will be able
to increase the number of stretchers available at any given time.

A performance evaluation was conducted to understand its overall effect on the current process. We
compared the current state to our solution state. The current state assumes all stretchers are left at the
patient destinations and are not brought back to the origin units. This is consistent with our
observations. We noticed stretchers were almost exclusively being retrieved from the final units when
needed by staff at the origin units. Our solution state – as shown in the section ‘Economic Analysis’ --
provides a 65% decrease in stretcher retrieval time and a 3,600-hour labor savings resulting in almost
$55,000 saved in labor alone. We will conduct sensitivity analysis this semester to determine the effect
of changing the current state assumption. For example, we can assume 10% or 20% of staff are
returning stretchers to origin units in the current state, and then compare each of those to our central
location solution. The excel data containing the relevant calculations are available in Appendix J.

The recommendations are both economically feasible and justifiable. Quantitative and qualitative costs
and benefits are documented above in section ‘Economic Analysis’. These benefits will show immediate
results. Employees will be recorded to have a much higher productive work time, and this will result in a
high patient turnover benefit as well.

The alternatives considered to this recommendation was propagating a new role for stretcher
transporters. This alternative was not chosen over the others simply because this solution is not a viable
long-term solution. This role would purely be a temporary role to fix the underlying problems at the
hospital. This would only be profitable and beneficial until a certain point. Our team wants to advise
towards a more permanent solution that will be profitable for years. It may at first seem to be too large
of an initial investment, but the hospital processes need change in order to be more efficient in the
future.

These stretcher lifts abide by the hospital policies and government regulations. OLOL will be able to
consistently meet Joint Commissions standards. These standards are extremely vital to the daily
hospital’s activities. If they are caught in violation of any codes, fines will be given, and the amount paid
could have been used towards eliminating the violation causes and building profit. These stretcher lifts
are greatly advertised to reduce clutter which directly addresses NFPA 101. They are also advertised as
clearing up to 70% of floor space. This is extremely vital to a massive hospital with many departments
and employees, where halls must be clear of obstructions if emergencies were to come about.

All possible solutions have been discussed with our sponsor, Lindsey Booty. After suggestions given by
Lindsey, the team shifted towards a focus on demand-weighted center of gravity for a storage room
solution. Through the analysis of the Epic patient movement data, coordinates pointed towards viable
storage room solutions. Conveniently, the coordinates from section “Demand-Weighted Center of
Gravity” has resulted in the Peds PACU still being a viable option. Justifications of the economic analysis
are shown in Appendix J shows the balance sheet return value of the 3 stretcher lift investment within 5
years and 5 months.

16
Implementation and Assessment Work Plan [vj]
As the Fall semester begins, the work plan has slightly changed as a result of COVID-19. Originally what
was planned to be an implementation at Our Lady of the Lake hospital, will now be exhibited with Simio,
a simulation software. Our Simio model will be a flexible and detailed simulation and optimization
model for the use of stretchers. This simulation will be used to refine our analysis and recommendations
further on and to assess whether they have achieved our objectives. This assessment will be performed
towards the end of the semester through verification and validation, with time for improvements in the
implementation based on that assessment. Provided below is an overview of the planned activities
along with important dates for the remainder of the semester in order to accomplish the goals of the
project.

Figure 3: Fall 2020 Work Plan

References
“3 Position Hospital Stretcher Lift.” SouthWest Solutions Group, 2020, https://fetchbim.com/ssg-st327-
32n.

“About Our Lady of the Lake.” Our Lady of the Lake, 2020, ololrmc.com/about-us/.

Bradley-Blewster & Associates. Our Lady of the Lake RMC. Updated 2018. Baton Rouge, Louisiana.

NFPA 101-2012: 18/19.2.5.1; 7.1.10.1; 7.5.1.1

17
NFPA 101-2012: 18/19.2.3.4 (4)

“Our Lady of the Lake Regional Medical Center, Baton Rouge, LA.” Our Lady of the Lake Regional Medical
Center, 2020, ololrmc.com/?utm_source=local-listing.

“Stretcher.” Merriam-Webster, Merriam-Webster, 2020, www.merriam-

webster.com/dictionary/stretcher.

Appendices
Appendix A - Stretcher Survey

Appendix B - Rate of movement

Appendix C -Time Study

18
Appendix D - Department distances

Appendix E - Pay Rates of Personnel

Appendix F - From/To Tables for Weighting Paths

HVI In-Patient
From/To OR PACU ER Radiology SMAU
Tower Tower
SMAU 0 0 75 0 0 25 --
Radiology 0 0 0 0 0 0 0
ER 25 70 0 0 -- 0 5
PACU 0 50 0 -- 0 0 50

19
Filled out by Christy Phillips (RN of OLOL)

From/To HVI SMAU ER Floors A-Hall Radiology

Main
PACU 10 20 - 50 20 -
Tower
PACU 10 20 - 50 20 -
HVI PACU
50 5 - 25 20 -
Assumptions were made for now based off the team’s observations.

Waiting on response to be filled out by Amy Prejean (RN Main PACU of OLOL)

From/To Radiology

ER 25%
HVI 15%
SMAU 0%
Floors 10%

A-Hall 30%
OR 20%
Filled out by Joseph Cutrer (Radiology (MRI) Technician of OLOL)

From/To ER HVI SMAU Floors A-Hall OR

Radiology 25 15 0 10 30 20

Filled out by Joseph Cutrer (Radiology (MRI) Technician of OLOL)

20
Appendix G - Possible Alternative Solution Testing

21
Appendix H - OLOL Blueprints

22
23
Appendix I - Center of Gravity Calculations

Figure 1: Center of Gravity for Demand

24
 Figure 2: Center of Gravity for Supply

Figure 3: Optimal Stretcher Storage Location

Appendix J - Economic Analysis

Figure 1: Cost Comparison with Centralized Stretcher Storage Location

Figure 2: Time Return on Investment 3-Stretcher Lift

Figure 3: Time Return on Investment 5-Stretcher Lift

25
Appendix K – Data Analysis for Central Location Determination and Related Economic
Analysis
Central Location Determination

Figure 1: Main In-patient Demand by Floor

Figure 2: Main In-patient Elevator Factor Calculations

Figure 3: Elevator Factor by Department – Numbers in Yellow Added to X-Coordinate of Department

Figure 4: Supply Units Coordinates

Figure 5: Demand Units Coordinates

Figure 6: Center of Gravity Calculation

26
 Figure 7: Sample Distance Calculation for Current State

Figure 8: Sample Distance Calculation for Solution State (Dist. Between Main IP and Storage Location)

Figure 9: Sample Current State Cost Calculation (SMA Demand)

Figure 10: Solution State Cost Calculation

Figure 11: Comparison and Final Savings with Solution State

27