Pediatric Orthopaedic Practitioners Society POPS

Question from POPS member Dominika Maglasang

Posted almost 2 years ago by Suzanne Hilt

I wanted to find out more about what other institutions are doing about re-using EZ-On vests and Hippo/Conventional Carseats. Also what other conventional carseats are other institutions using now that the Diono RXT has been recalled and can't be ordered? I have an informal process at our institution in which Ortho is the owner of the process and the items are reused. We're exploring developing a different process if possible and getting the items housed in Central Supply. I have several questions as you can see. Who owns the process (Ortho/Rehab/Social Work)? How do the items get cleaned between patients? Does anyone have a system where the items are housed in Central Supply and it's charged per use/per patient and given to them? Are the items billed and how? If items are loaned out what processes do you have (if any) for damaged items or items that have been in motor vehicle accidents?

I'd appreciate any info and suggestions.

Thank you very much,


Anne Stuedemann over 1 year ago

Great questions Dominika! I emailed our Center for Childhood Safety Manager. This team is in charge of all our inpatient car seat needs here at Mercy. She is out for a conference so I will try to get back to you early next week with a response.

Anne Stuedemann over 1 year ago

The following is how my hospital addresses the issues you presented. Our Car Seat Program Coordinator responded to your questions. We are very blessed with our amazing car seat team/program!

1. What are other conventional car seats that institutions are using now that the Diono RXT has been recalled and can't be ordered?

The seat that works best is determined by how the child is casted. We are always looking for car seats that are wider and more shallow to accommodate certain casts. One we’ve used with some success is the Evenflo Symphony. I talked with the Evenflo rep at a conference several years back and asked what she thought about how we were using this seat and she said it was fine. Of course, Evenflo will not put that in writing. And, of course, Diono too doesn't recommend using their car seats beyond what their instructions say. I recently attended a conference and there are a couple of special needs restraints being used by other programs in the country.
a. Columbia Spirit
b. R82 Wallaroo – sometime at the end of this year/beginning of next year, they will have an insert for spica casts…probably something like the hippo insert I would imagine but no confirmation on that.
c. Merritt Wallenberg – this seat should be shipping soon. It is a convertible seat designed for children in spica casts. I don’t know a lot about the seat at this point but I do know that it will require 1:1 education with the parents. This seat is different than most convertible car seats for use with spica cast patients. If you would like more information about this seat, you can contact the manufacturer or download the instruction manual – 92 pages. It will absolutely require 1:1 installation instruction by a CPST as it seems to be quite complicated.
d. R82 is working on a replacement for the hippo car seat that was discontinued a couple of years ago. The new and improved version should be out sometime next year. I’ve been told it will be at the beginning of the year but I would not hold your breath.

2. Who owns the process (Ortho/Rehab/Social Work/Specialty team)?

We have car seats in our Distribution/central Supply available to any patient who needs one. For our casted patients, depending on the type of cast and the age/wt of the child, a booster seat or a conventional car seat (perhaps their own) many work. We have 2 convertible car seats – Evenflo Sureride and Evenflo Symphony – in Distribution along with the Graco Turboobooster (high back booster seat). Our staff on the Orthopaedic unit are pretty good at assessing the patient’s needs. If they think a conventional car seat will work, they will ask the parents to bring their car seat to the bedside. If that doesn’t work, they’ll try the Evenflo Symphony. We also have both sizes of the modified E-Z-On vest, for children who need to lie down in their vehicles, in distribution. Any conventional car seat or vest is provided to the patient and does not need to be returned. If a conventional car seat will not work for that patient, we keep 1-3 loaner Hippo car seats in the unit for patient use. Unfortunately, there are times when the seats are not available. Car Seat Program staff can also assist patients at their or the staff’s request. We (car seat team) will assist with fitting and installation, as needed.

3. How do the items get cleaned between patients?

The hippo car seats are returned to the Ortho Clinic and the Car Seat Program maintains them. We (car seat team) clean them, dress them, and put back on the unit for the next patient. We send the fabric covers and harnesses to a laundry service where they clean them according to manufacturer’s instructions. This process takes some time, however, and they are not always returned to the Car Seat Program in a timely manner.

4. How do we charge these items to the patients/Are the items billed and how?

All car seats ordered from Distribution are provided to patients who need them regardless of ability to pay. The seats and vests (in distribution) are no-charge items. We also do not charge a rental fee for our loaner restraints.

5. If items are loaned out what processes do you have (if any) for damaged items or items that have been in motor vehicle accidents?

Part of the education to the caregivers is to contact the Car Seat Program if they’re involved in a MVC to determine whether or not the seat must be replaced. The hippo car seat instructions follow the NHTSA criteria. In all honesty, only 2 families in the last 15 years have been involved in a MVC – per parent report. This is not usually an issue for us. An issue that does arise, on occasion, is the return of a VERY filthy car seat. We have had them returned in very disgusting condition or smelling strongly of smoke. If we cannot properly clean, we would throw the seat away. We do not ask for reimbursement from the family.

Dominika Maglasang over 1 year ago

Hi Anne, Thank you so much for spending the time to answer all of my questions. We have been struggling with getting a more formal process in place for our spica cast patients. Your information is greatly appreciated. Thank you again for doing this!

Amanda Mccullough over 1 year ago

Dominika, we have gone back and forth over this issue at our hospital so I appreciate the question! Our SW team houses the seats (spica car seats, EX on vests, or conventional car seat that may work with cast). We are somewhat of a smaller institution so this seems to work for us for now. When we loan out either the seat or vest, we ask for a $25 deposit that is refunded once the seat/vest is returned. Parents also have to show proof of residence and we get a copy of their drivers license. We do this because car seats have disappeared before in the past. Note: I know some institutions that actually will have a contract that states if car seat is not returned, they will be billed for price of the seat. We have not had an issue yet of damaged seat/vest. We have spoken with local DME companies to start discussing the possibility of them stocking some spica car seats however currently, Medicaid doesn't cover them as DME, so if parents could not afford to rent them, our hospital would foot the bill. This has been an interesting topic that has come up over the years, so I am curious to see how other institutions operate.

Only active members can comment on this announcement.

Learn more about membership