Hello!

Last week, we talked about the fancypants pneumatic tube systems found in large hospitals. And while they’re pretty reliable — the systems run 24 hours a day, every day at 99%+ uptime — accidents happen.

Tube mishaps are timeless. “Medicine bottles are sometimes put into the tube without first being placed in a cylinder,” a 1945 article in Modern Hospital titled “A Little Prevention Means Less ‘Fixing’” recounted. “Once someone sent down a surgery cap without the aid of a cylinder that plugged the line; and another time an egg was sent down. The egg came down whole until it arrived in the tube room.”

I didn’t hear anything in my interviews about people shuttling raw eggs down the tubes, but that doesn’t mean the technicians I talked to don’t have to deal with other items not meant for tube distribution.

Tube troubleshooting is a big part of the job, and something technological advances have (sometimes) made easier. 

Before the turn of the century, someone would trigger a blower to move a canister from point A to point B via turning or pressing an electronic or magnetic switch. By the 2000s, technicians managed the systems on DOS, and these days, the latest systems run on programs that monitor every capsule in real-time (you can see them mapped out on a computer screen!). That level of control lets the tube team adjust traffic based on system demand, and a canister or carrier’s priority level.

“The majority of our work is tracking carriers,” said David Shramm, the hospital pneumatic tube senior technician at Michigan Medicine. Shramm and other technicians monitor each carrier via RFID tag, allowing them to tell users where their canister is if they can’t find it, and helping them retrieve it if something goes amiss. “We get some stuck carriers where people might not latch them properly or leave something sticking out and they get stuck,” added Shramm, “so we have to get those out of the system and deliver them.”

Unclogging tubes is also timeless. That 1945 Modern Hospital article griped how engineers fixing the tubes, “must follow the line, working in a space 3 feet high at the highest points and 1 foot high at the lowest.”

Pulling a tube apart looking for clogs doesn’t sound fun, no matter what century you’re in.

Which of these items, all of which should not be put into a hospital’s pneumatic tube system, have been put into the tubes with not-great results?

This is a trick question! All of these things have been put in tubes (inside or outside a canister) based on my reporting. Amazing!

Given this, it’s not surprising that user error causes most of the problems technicians face. A canister can become stuck, for example, if it’s too heavy. This happened one time at Michigan Medicine when someone put a hoodie in the system to send to a patient who changed floors. Another case at Penn involved a curious employee putting a bath towel directly into the tube, resulting in a major blockage. At least it wasn’t a raw egg!

Security is also a big thing with pneumatic systems, both tracking who receives and sends sensitive specimens, and also protecting the software itself from hacking. In the former case, staff members use their employee badge to access the tube system, which tracks who is sending what— an important chain of custody requirement for regulated pharmaceuticals. In the latter case, cybersecurity vulnerabilities are a concern, and were highlighted in 2021 as a weakness in a TransLogic system, something that the parent company, Swisslog Healthcare, has worked to address.

Overall, however, pneumatic tube systems are a reliable, pervasive part of healthcare. “We look at a pneumatic tube system kind of like a telephone,” explained Steve Dahl, an executive vice president at Pevco. “If you've ever picked up your phone… we all think it’s going to work.” Tubes, said Dahl, should be the same — a seamless process.

Frank Connelly, an assistant hospital director at Penn, agreed with Dahl’s assessment. “We treat [the tube system] no different than electricity, steam, water, gas. It's a utility,” he said. “Without that, you can't provide services to people that need it in a hospital.”

To see just how important they are, one just has to look at what Michigan Medicine had to do in 2024 when their system was down for five days for upgrades. In those five days, 60 “runners” took 2.6 million steps to get blood and other specimens where they needed to go. That comes out to 1,368 miles, roughly the equivalent of walking from Ann Arbor, Michigan, to Miami.

And even though the tubes are fun, they’ve thrived in healthcare because the efficiency they bring makes for happier patients. “You're nervous, you just got blood taken” Connelly explained. “How long is it going to be before I get my results back? Imagine if they had to wait all that extra time because you're not sending one person for every vial — they're going to wait a while until they get a basket full and then walk to the lab. Nowadays they fill up the tube and send it to the lab. And I think that helps patient care.”

It also might be a way to get a hoagie delivered quickly, but don’t quote me on that.

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