Just Say No To Carrier Towers

Small Things Can Have a Major Impact On Operations

Reading Time: 7 min.

Scott Fincher | 02 November, 2023

Carrier Organization is Key

Over the last year, we’ve had the opportunity to visit a couple dozen hospitals across the country. While their sizes, operations, and layouts varied, they all had two things in common. First, staff heavily relied on the pneumatic tube system to efficiently move samples and medications throughout the hospital. Second, they all struggled to some degree with managing empty carriers, as evidenced by the carrier towers that built up throughout the day, most typically in the lab and pharmacy, and sometimes in the emergency department (ED).

For these hospitals, and a few thousand just like them in the U.S. and Canada, the tube system has one simple job, send material from one location to another at any time. This is predicated on ensuring staff always have an empty carrier at their disposal, which is hard to do when dozens of empty carriers are sitting idle, stacked up in towers. We’ll look at this problem and review potential solutions.

Getting Empties Out of The Lab

Labs account for about 30% of any hospital’s carrier transactions, receiving full carriers in, and sending empty carriers out almost exclusively. At certain times of day, staff can’t send the empties out fast enough. Instead, they pile them up in towers on counters, shelves, carts or just anywhere they can. Plus, labs are already constrained in their available work surface and available staff. The lab directors we spoke with would much rather be using available space for clinical purposes, not carrier storage. Stacking carriers by the dozens, these precarious towers can become safety hazards, falling over or blocking people’s movement if stored on carts in hallways, foyers or other high traffic areas.

Meanwhile, there is someone in another department waiting for an empty carrier. When it’s bad - in some hospitals as much as a few times a day - staff from other departments call facilities who must take time out of their day to walk to the lab, pick up empties and manually re-distribute them where needed. Given the size of some hospital campuses, this can span significant distances, covering multiple buildings and may even require crossing roads.

It also nullifies carrier counts, a critical piece of a tube system’s software to define how many empty carriers any given station is expected to have on hand. The software gives those that are deficient priority for receiving empty carriers, with the ability to further prioritize between departments. Manually moving carriers circumvent this automated process and throw carrier counts off. Facilities staff we spoke with must manually count carriers weekly, and in some cases daily, hospital wide. They then manually redistribute carriers where needed. This manual activity of course comes at an operational cost as facilities should be focusing on more important tasks, not manually counting carriers or carting them around the hospital.

Some labs keep empty carriers on hand and staff call the lab directly to request empty carriers. This disrupts workflow and results in a department getting an empty carrier when another department may need it more. Further, by directly sending empty carriers instead of using empty send functionality, usage statistics incorrectly deflate empty send data.

Another workaround is for staff from the sending department to include a piece of paper or label the carrier itself with, “return to” instructions. Facilities staff in hospitals that take this approach note both the paper and the labels end up in blower traps after floating loose in the tube system. This also results in a department getting an empty carrier when another department may need it more along with deflation of empty send data.

On the flip side, for a hospital with a couple thousand transactions per day, the time devoted to this manual process can add up to dozens of hours per month.

Having Empties When You Need Them in The Pharmacy and ED

The pharmacy and the ED have the opposite problem to the lab, requiring a steady supply of empty carriers always on hand. In these departments there can be two problems, too many or not enough.

At certain times of day empty carriers can come in faster than staff can process them. This results in incoming carriers bouncing off those already in a bin, becoming shin-busting projectiles or piling up on the floor creating a work hazard. If they safely land, the carrier can trigger a full bin sensor, disrupting the staff's workflow as they must stop what they are doing to clear the empties out.

Assuming staff can get to the empty carriers, it represents additional work to remove and stack them safely in a designated area. In our visits, we saw dozens and up to hundreds of empties stashed in any available space on carts, shelves or counters, or in drawers and closets.

At other times, particularly if empty carriers are stacking up in the lab, pharmacies and EDs can run out. They are then left with three options to choose from. First, they can call facilities or the lab to get them more, which takes time. Second, they can hand deliver what they would have otherwise sent through the tube system, taking up someone’s valuable time. Third, they can send someone on a foraging mission, which is also time consuming and, like the manual carrier movements noted above, throw off carrier counts.

Getting Rid of Your Carrier Towers

Regardless of the tube system you use, there are steps you can take to address your carrier tower problems ranging from simple to more complex.

We’ve all been trained to prioritize the delivery of a full carrier to its destination. We should consider empty carriers with equal importance. If you don’t have enough, they become scarce resources that people hoard or forage for. Coupled with staff training on hospital tube system policies, your best first step may be to reevaluate the number of carriers you have and your carrier counts by station. All you may need is some more carriers in your system and some purpose built storage solutions to safely house them. Keep in mind, however, it’s a balancing act. You don’t want so many carriers that all you do is create traffic jams at rush hour.

Second is to look at your tube system policies. Color coding by department may be an option. For example, all red carriers go back to the blood bank, green to pharmacy, and so on.

Third is to look at your infrastructure. Hospitals have always been dynamic environments, with expansions, reconfigurations and changes being the norm. With this changing environment, the demands on your tube system may have changed or maybe you have simply outgrown its original design. If the first or second options don’t do the trick, talk to your pneumatic tube system provider about how best to optimize performance by adding carrier tracking capabilities and changing or expanding your tube system infrastructure.

Finally, for those hospitals that warrant it based on transaction volumes above several thousand per day, it may be worth it to consider dedicated infrastructure directly between two high use departments, like the lab and pharmacy.

These are just a few things you can consider if your carrier tower problem has gotten out of hand. Talk to your provider and have them run simulations on any change you are considering. Together you can come up with a plan that will work for you.