ONLY Hot Swapping on Carts really improves Efficiency and Patient Outcomes:

When choosing a battery system for an IT Cart, the discussion is too often just about price. Understandable from a Hospital budget point of view. Understandable from a Cart sales point of view, they want the business, the cheaper the battery the more competitive their offer seems. The result is that Hot Swapping is not really considered – unless the Hospital insists.

However, why does a Hospital want mobile IT? Why invest multiple millions in Software, Training and Infrastructure? Carts and Batteries represent a tiny proportion of this investment.

The motivation is a mix of achieving:

  • Higher Productivity through efficiency
  • Improved Patient Outcomes by reducing Errors.*
  • Improved Data to use technology to further drive the above two.

Central to this is the behavior of the Nurse. If a modern nurse should spend 50% of the time on documentation, surely much of that documentation should be in Real-Time – at the Point of Care. Ideally scanning Patient IDs and Medications and entering notes and tasks immediately.

The reality is still, even in sophisticated markets, that the nurse takes down a note at the patient bedside, goes to the Desktop or the cart, usually plugged in to charge in the corridor, logs in and enters the information a 2nd time – after the event. Leaving the cart, the nurse logs out again.

This reality, constantly repeated, represents a staggering waste of time, reduction in potential efficiency, and an increased likelihood of mistakes – some with enormous consequences for the patient*

So why don’t the Nurses simply take the cart with them all the time? The reason lies in the nature of the block battery. Whilst these are initially a good solution, after a short period, these increasingly need plugging in, all the time or their performance will drop rapidly. Hospital staff know this and have been conditioned to plug in over the last 15 years. So the electrical sockets in the corridor become cart magnets. The Cart ends up staying there most of the shift. Often, Data security requires the nurse to log out, since the cart is in a public space.

In consequence, to save maybe 20% (a minuscule saving in terms of the overall project) of the cart price, on a cheaper block battery; the cart is actually no longer fully mobile; the work flow of the nurse is structurally inefficient; and the desired patient outcome improvement falls well beyond expectations for the whole 5-7 years of the cart life. Whilst completely understandable from a commercial Buyer-Seller-Budget situation (The attraction of low Price); from a Return on Investment angle – the true benefit of going Digital, it is utterly Counter-productive. The Hospital’s Healthcare goals have been side lined by the logic of a battery v battery sale.

Would any Health Technology Manager seriously implement such a workflow?


Hot Swapping means the cart is with the Nurse – potentially 24-7 – no more walking back and forth, unplugging and re-plugging, logging in and out – Documentation is immediate at the point of care.

The result is Massive time saving and accurate patient data input. A good Hot Swap battery will last the whole shift, the single swap at the start of a new shift is 10-15 seconds. Not long in comparison to the time repeatedly wasted walking to/plugging and logging in and out, and it is not – as often postulated- too complicated for the highly educated modern nurse.


*studies in both the UK and the USA document a 15% decrease in the death rate if full digitalisation is achieved. A Dutch paper claimed that an average Hospital in the Netherlands can avoid up to 800 errors daily and save Nurse 100 hours daily by going fully digital.