Operating room supply chain: Pilot program yields real savings within two years

New guidebook examines key projects like how better surgical procedure cards can help staff stay on schedule with less stress and more efficiency

This is the first installment of a three-part series examining various aspects of OR supply chain improvement projects, based on the Ontario Hospital Association’s guidebook, Optimizing Your Perioperative Supply Chain: A Guide to Improvement Projects.

Variety is the spice of life, but it is not a quality you want in an OR supply chain. If anything, clinicians want something reliable and predictable. Old data systems, inaccurate procedure cards, ad hoc storage and a lack of product standardization, however, tend to not only to make life difficult for clinicians, they also drive up costs.

While perioperative departments in Ontario hospitals continue to deliver a high standard of care, there are a number of sub-optimal areas and the time and effort it would take to overhaul an entire supply chain system can be daunting.

But what if you could just do one part?

That’s the idea behind the Ontario Hospital Association’s (OHA) new guidebook Optimizing your Perioperative Supply Chain: A Guide to Improvement Projects, available on the association’s web site as a free download.

Based on hospital experience

The guidebook looks at limited surgical supply chain projects that can be undertaken individually or as part of a larger systemic review that will overhaul processes. The guidebook is based on the experiences of 14 hospitals that participated in a pilot project between 2007 and 2009 developing improvement strategies, and the benefits are there.

Participants improved everything from patient outcomes to departmental spending. In fact, after two years of project work, a third-party audit found that supply costs for these hospitals had dropped; there was a marked improvement in efficiency; and staff was reporting a more collaborative work environment.

What’s more, most of the program participants were realizing a return on investment within two years and could expect significant annual savings in the coming years.

Encouraged by these positive outcomes, the OHA developed a guidebook to help other hospitals work through their own improvement projects.

Working the fundamentals

The guidebook focuses primarily on the business processes of providing medical surgical products to the surgical suites and the operating room sterile core.

And while each hospital supply chain has unique characteristics and circumstances, all share a number of common fundamental elements.

Making improvements in these key areas can provide a starting point for any clinical supply chain optimization. And one of those key areas is improving procedure cards.

Good procedure cards a key step

Procedure card management, as the guide describes it, is the logical creation and reorganization, as well as the active monitoring and maintenance, of a standardized set of procedure documents.

Rather than being hard copy documents or actual Kardex file cards, procedure cards tend to exist mainly as part of a clinical services data system. Since many hospitals began automating procedure cards in the 1990s, clinicians have been adding to these documents but seldom are any completely optimized or reorganized.

As with any component of the clinical supply chain, a lack of structured, standardized processes can lead to inaccurate information that, over time, will cause inconsistencies and errors.

These in turn cost the supply chain both money and time. Procedure card management must have a policy to manage the content, approval and creation of procedure cards.

A well-managed procedure card program will support clinicians by reducing case times and turnover times. This helps to free up more time for patient care, which can improve staff and patient satisfaction.

Bluewater Health’s experience

A procedure card overhaul was one part of the improvement work undertaken by Bluewater Health, a pilot project participant in Sarnia.

During its project, Bluewater Health was also involved in the largest public sector redevelopment project in that community’s history, consolidating programs and services from its two sites in Sarnia to one as the hospital’s new state-of-the-art facilities opened in 2010.

With one site’s OR department using Kardex cards and the other site using computerized procedure cards, the first order of business was to create a clean item master file (a catalogue of the product information hospital employees need to manage frequently purchased goods and services) whose OR specific items had consistent and up-to-date descriptions. This would later be used to generate the new procedure cards.

“For the procedure cards,” says Anne Karnas, Bluewater Health’s MDR (medical device reprocessing) manager, “the goal was to have a card that identified supplies and instrumentation that was easily understood by both [MDR] and nursing.”

Starting with 1,200 procedure cards, their work brought the number down to 900.

To maintain control over the cards, they developed a change request form that a surgeon and charge nurse must complete and submit to the OR clerk. With the new system, the clerk also has the ability to make global changes, should an item location need to be updated, for example.

Where can you start?

Seeing frequent overstock, placing a high number of calls to MDR requesting additional items for a case cart, and experiencing too many clean returns are just a few indications that a hospital’s procedure cards may be due for review.

Building better procedure cards is one of the four foundational projects discussed in the OHA guidebook Optimizing your Perioperative Supply Chain.

To learn more about how to assess your procedure cards, review procedure codes, measure product usage rates, define what your new cards will require and manage an ongoing maintenance plan to sustain this change, visit www.oha.com and select ‘Supply Chain Strategies and Initiatives’ from the ‘Services’ tab.