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Technology improves YNHH's crucial behind-the-walls tube system

Each day, hurtling through galvanized metal tubes behind the walls of hospital buildings new and old, thousands of pneumatic tubes carry specimens to Laboratory Medicine for testing and thousands more arrive at stations on patient care units bringing the medicines that will help patients heal.

Driven by air and sucked along by vacuum pumps, tubes in the complicated system are vital to caregivers who are trying to help patients get better. But sometimes, the highly-trafficked tube highway breaks down, costing time and money and interrupting patient care.

As dependable as the tube system was and is, when it breaks down, it can cause major hardship — and many of the break-downs are preventable. Two years ago, Richard D'Aquila, president and COO, made improving the tube system a priority and assigned the challenge to the Operational System Redesign Group (OSRG) which is responsible for finding solutions to chronically unsolvable problems.

"We had to solve why the tube system was down so often," said D'Aquila. "The OSRG formed a team to focus solely on how to fix the system so that medicines are delivered quickly, specimens arrive in Lab Medicine in one piece for testing, and most importantly — our nurses are not pulled away from their patients to go to Pharmacy Services because the tube system is down."

Led by Nicholas Zauner, manager, Maintenance and Mechanical Systems in Plant Engineering, and Susan Maxwell, RN, director, Women's Nursing Services, the team studied the system intensively. They found the main culprits for downtime included improper preparation of the tubes which opened mid-trip; inefficiencies caused by two departments — not one — responsible for the system; and a lack of 24 x 7 x 365 monitoring.

Zauner, who joined YNHH in 2010 from Turner Construction, has a background in mechanical, electrical and plumbing systems. With Turner, he worked on the construction of Smilow Cancer Hospital, and knows the building and its tube system well. An interest in applying technology to problems helped Zauner help the tube team find the answers that would begin to eliminate system delays.

"Our team quickly realized our solutions had to be operational, technical and behavioral," explains Zauner, who points out that as recently as 2009, the tube system carried 2,300 tubes a day and today carries more than 5,000.

Plant Engineering has now taken 24/7 responsibility for maintenance of the tube system and one of its first fixes was to install a new server dedicated to monitoring the tube system to enhance speed and security. The hospital also purchased a mobile computer that tracks all traffic on the system, and trained five Plant Engineering employees on it so they can monitor the system from anywhere in the hospital. Many times, they are able to resolve the problem quickly from the laptop.

What they can track on the laptop are tubes that are now outfitted with an RFID (radio frequency identifier) chip that tells the computer every time an employee enters a tube into the system and tracks the tube's journey. Prior to use, senders first swipe their badge at the proximity reader on the station. When they send their tube, the system records the RFID chip in the tube with the name of the person who sent it.

This new feature — currently being enabled — is called "Who Tube" because the new system knows who sent the tube and where it is supposed to go. The Plant Engineering technicians round frequently and train staff to safely and securely package what they are sending. If there is a problem, the computer track back to who sent it and a technician will work with staff to ensure that everyone has been trained properly to eliminate downtime.

"Users of the system will be responsible for what they send through the system and how they send it," comments Zauner.

Because the health of the tube system is critical to the health of patients, the system now sends texts to the stations alerting staff that the system is down and when it is expected to be back in action.

"For many years, we did not make progress on fixing the tube system which has an impact on patient care," said D'Aquila. "We made fixing the tube system a priority and this creative team of employees persevered and both improved its efficiency and lowered its costs. In the coming year, we are going to work on other challenges like the tube system and I expect that with employees' help, we are going to successfully resolve them, too."

Yale-New Haven Hospital news release

Yale-New Haven Hospital is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine. Yale-New Haven was founded as the fourth voluntary hospital in the U.S. in 1826. Today, the hospital's two New Haven-based inpatient campuses include Yale-New Haven Children's Hospital, Yale-New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties. YNHH's York Street campus and associated ambulatory sites are Magnet-designated by the American Nurses Credentialing Center.

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