Operating Room Supply Chain: Want OR efficiency? Learn to find best locations for supplies

Pilot study finds key supply chain projects like optimizing your OR inventory can reduce costs and improve staff satisfaction.

This is the second 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.

When the newly appointed inventory coordinator at St. Joseph’s Health Centre Toronto started taking stock of the hospital’s OR sterile core, his biggest surprise was the excess.

“There were a lot of items that were physically there that hadn’t been accounted for,” says Jonathan Laceda, explaining that they mostly came in through custom packs. But these sometimes-expired and often-unwanted items took up valuable real estate.

An imbalance like this is all it takes to throw off a delicately calibrated OR supply chain, and since medical-surgical supply expenditures can be as much as half of an acute care hospital’s operating room budget, it pays to have your system performing optimally. But cost savings are just one advantage.

What if clinicians could find what they needed when they needed it – every time?  How would that change things? These were questions the St. Joseph Health Centre’s team asked itself as one of the 14 sites participating in an Ontario Hospital Association pilot program to develop OR supply chain efficiencies.

Is undertaking an OR inventory project worth it?

In the guidebook developed as a result of the program, pilot sites reported that the typical benefits of an optimized OR inventory process tended to come in three forms:

The first was improved OR supply chain ‘customer service’ levels, which was simply a result of things like faster order cycle times, having supplies when and where they were needed, having less inventory on hand, and having less OR suite delays – all of which improved staff satisfaction.

The second was that clinical staff spent less time placing orders and replenishing supplies, which meant they could direct more attention to patient care, which again improved job satisfaction.

And the third was more administrative. Having improved medical-surgical supplies usage information helped to standardize supplies and equipment, lower supply costs and create more accurate procedure and surgical case costing.

What exactly is OR inventory optimization?

Optimizing your operating room inventory is essential to streamlining the movement of materials from the supply chain to their point of use.
A fully optimized operating room is one where an appropriate level of inventory is available when and where it is required to support ongoing clinical procedures and patient care. At the same time, it must ensure that the replenishment process is efficient and effective, which will in turn optimize your investment in inventory.

Where do you start?

Investigating your OR inventory involves reviewing both the physical locations used to store supplies (these include areas of the surgical suite, the OR sterile core and the medical device reprocessing (MDR) areas), and the location of the system(s) used to store the data, namely, the item master files.

As one of the pilot hospitals participating in the operating room supply chain project, St. Joseph’s Health Centre completed a number of improvements, but one of its strongest areas of success was in optimizing its inventory. Here’s an overview of what the team there did.

Learn what is actually there

Starting with a five-year usage report listing every item the OR had ordered in that time, the project team compared it to what was actually stored in the department.

They found almost 400 items that were not on the usage report. Many came from trials, and some were just leftover items from custom packs. There were also some instances of hoarding, recalls inventory coordinator Laceda, referring to caches of items stowed away in anticipation of future shortages.

With storage cleared of expired, redundant and cached supplies, the team set about finding the best place to locate items.  It used a blueprint of the space and mapped the path a clinician typically follows while supporting a procedure. This illustrated the problems of multiple stock locations for single items and the general confusion over where some things were stored.

Develop patient-centric storage

The system they devised also aimed to keep the clinician, as much as possible, in the OR with the patient rather than having to go in and out in search of supplies.

Interestingly, this was not much different from the model that existed for the department before the project, which called for closed, mobile cabinetry that would keep all emergency supplies in the OR.

“It just wasn’t supported,” says Laceda, who has since implemented a storekeeper position dedicated to replenishing items stored in the ORs.
Individual storage carts in the central core are now organized by either the storage of item types (dressings, anesthesia, IV’s) or by service (ENT, Gynaecology). These are used to supplement case carts and the dedicated OR theatre carts, such as the ones for anesthesia.

Improving OR inventory systems is one of the four foundational projects discussed in the OHA guidebook Optimizing your Perioperative Supply Chain.

Does your OR inventory need improvement?

The following service failures are often signs that an OR inventory optimization project may be warranted:

Customer service failures such as:
• Constant ‘stock outs’ of needed medical-surgical supplies;
• Surgical procedure delays due to medical-surgical supply issues; and
• Staff unable to locate medical-surgical supplies when required.

Process fragmentation such as:
• Variances in practices, responsibilities and accountabilities across the OR for supply replenishment;
• Lack of historical usage information to understand replenishment needs;
• Excessive clinical time spent on inventory replenishment;
• Multiple and redundant locations of OR inventory;
• Limited/no documentation for procedures and policies;
• Long training periods and high staff turnover;
• Visually disorganized and cluttered OR inventory storage; and
• No ability to manage non-stock or consignment inventories (i.e., not managed through PAR1 levels).

To learn more and to download a free copy of the guidebook, visit www.oha.com and select ‘Supply Chain Strategies and Initiatives’ from the ‘Services’ tab.

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