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Designing an Efficient Case Cart Process

OR case cart processes are often messy—staff crisscrossing back and forth collecting supplies and instruments with seemingly no execution plan. Even worse, when the surgical cases are over, there are tons of excess supplies and instruments that are returned unused to be put back on the shelf. The amount of wasted time cuts into the productivity of the Central Sterile Supply Department (CSSD) like a dull knife. Staff frustrations are palpable and often audibly expressed with terms of "lack of respect." Bringing the OR and CSSD teams together to design an efficient process make take some time, it may even require some outside resources, but it is worth the effort.

Preference Card Reviews

A great place to start refining your case cart process is by reviewing the quality of your preference cards. Being that most hospitals have thousands of preference cards, starting with your most-used twenty or so cards will get you off the ground and running. You don't want to create a situation that is too large to sustain change. The utilization of both soft goods and instrumentation should be reviewed. Eliminate waste by removing underutilized items.

Preference Card Design

Preference cards should be designed for utilization by both the OR and CSSD teams. The card format should group like items (e.g., instruments, soft goods, equipment) together and then format to reduce redundant work patterns. Supplies should be placed in an order for picking that allows for the process to be concluded without backtracking.

Sterile Storage Design

The sterile storage area should be labeled by rack or cart, row, and bin location. If you have an instrument tracking system, the labels on your instruments should also have the storage location printed on them. Storage spaces should allow carts to be moved easily between the rows, and if you have a high-density system, the floor should be raised to allow for carts to rolled over the supporting rails.

Just in case items should be deployed in the OR core within an easy distance of the OR rooms that may need them. This will increase the OR comfort zone while helping streamline line overall process.

Case Carts

Case carts should be labeled so that they are easily identifiable from long distances. If using an instrument tracking system, instruments should be scanned to the case carts, and the case carts should be scanned to the individual OR rooms. If you are using a manual system, case carts can be tracked on an OR schedule. Knowing where your instruments are is important, especially when OR rooms change in mid-process.


The one consistent factor often left out of the planning process is the storage of both completed and empty case carts. Designing space for case cart parking is a must. The case cart process should be designed as a high-functioning manufacturing process. Eliminate all waste while honoring the complexity of the OR process. Teamwork is essential for success.

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