Optimizing procedure trays: A lesson on eliminating waste, cutting costs in the OR

ASCs face unique challenges in the operating room that highlight the importance of an efficient materials management process.

Since ASCs have less space for inventory and their financial health relies on quick turnover time for procedures,they must implement and maintain efficient processes for ordering and storing products.              

During a webinar sponsored by Cardinal Health, Sue Champion, RN, BSN, MBA, CNOR, senior manager of Cardinal Health Presource Products and Services, discussed major sources of waste in ASCs and shared strategies for optimizing custom procedure trays to help lower costs in the OR.

Identifying waste and inefficiency

Clinicians often pull too many products for a procedure, which creates a large amount of waste and inefficiency in the OR, according to Ms. Champion. Since surgery centers are "daylight operations" that typically close their doors at 5 p.m., clinicians don't have the time to restock unused products after a full day in the OR. Surgery centers also don't want to pay nurses overtime for restocking the items after hours, she said.

Products that are opened for a procedure, but unused, must be thrown away. Based on her experience as a perioperative nurse, Ms. Champion estimates as many as 20 to 50 percent of products pulled go unused.

"Those are staggering numbers — and the cost can really add up," she said. For an average surgery center performing 5,000 procedures a year, just $50 of waste per case can equal $250,000 annually, according to Ms. Champion.

"Imagine what you could do with all that money if it were available to support patient care initiatives," she said.

Standardizing custom procedure trays

To support quality outcomes while reducing waste, controlling costs and improving workflows, ASCs should focus on optimizing custom procedure trays, according to Ms. Champion.

She said ASCs should create a template of tray components that include approved items on formulary or covered by a group purchasing contract, along with clinically and economically justifiable preference items.

"An important key to tray optimization is product standardization," she said. "It's critical to reducing costs and improving efficiency at the same time."

Thirty-four percent of ASCs already practice product standardization1, and the other 66 percent are working toward achieving standardization, said Ms. Champion.

From a supply chain perspective, standardization produces fewer stock keeping units (SKUs) to manage, so staff members can work more efficiently. For clinicians, standardization creates less clinical and supply variation, which helps to improve OR efficiency and allows physicians to perform more procedures in less time.

Using data analytics

"Without advanced data analytics, it's an overwhelming challenge to identify opportunities to standardize," said Ms. Champion, noting a single procedure pack can contain anywhere from 30 to 60products for each procedure tray, based on procedure packs offered by Cardinal Health Presource Products and Services.

Data analytics help surgery centers visualize variations in custom procedure trays and quickly identify standardization opportunities to reduce waste and save money, without affecting the quality of care, according to Ms. Champion.

ASCs can use data analytics to set inventory levels based on utilization history, instead of just "filling the space" on the shelf. ASCs can also harness the technology to replace pack components with cost effective, yet clinically equivalent items, and add off-the-shelf items to packs for greater efficiency.

To save money in a sustainable way, ASCs must analyze the cost of supplies used not only in procedure packs, but also items pulled from the shelf and added to the case. This figure represents the actual procedural cost and gives ASCs an accurate baseline of overall supply spend per procedure to help make more informed decisions about reducing costs and variation.

"You can't manage something if you can't measure it," said Ms. Champion. "Knowing and understanding your procedural baseline is the first step in managing supply spend to meet financial goals."

Getting clinicians on board

Clinicians are far more likely to embrace the optimization process if they work in an ASC where physicians are regularly involved with managing overall business results, according to Ms. Champion.

"ASCs should engage with physicians and make them part of the optimization process from day one," she said.

Nearly 40 percent of physicians are already engaged with supply cost management.1 ASCs should use advanced data analytics to further involve physicians in change management efforts, since many clinicians require hard data evidence to buy into standardization, said Ms. Champion.

She recalled a standardization project she conducted 10 years ago with an integrated delivery network.

"At that time, we worked with excel spreadsheets, pack samples and the anecdotal knowledge of the clinical staff to make decisions. It was very difficult to obtain utilization information for a cost impact. When we presented our recommendations to the surgeons, many were rejected because we could not convince the surgeons to change products based on our stories," said Ms. Champion.

She recently went back to the same IDN for a new standardization project and used data analytics to support her proposed changes.

"When the surgeons were able to see the metrics, the conversation moved from anecdotal statements to discussions around the financial implications to change," said Ms. Champion. "There were still rejections, but the overall outcome was much more positive and had a much higher financial impact. One surgeon looked at me and said, 'If you had done it this way the last time, we would have been more open to the changes!'"

Optimizing procedure trays creates numerous benefits for both surgery centers and their patients by reducing the variation that causes waste and inefficiency, while also improving clinician workflow and patient throughput, concludes Ms. Champion. The process will improve a surgery center's bottom line and help leaders be better prepared to meet future challenges, which is essential amid today's increasingly complex and uncertain healthcare environment.

To view a recording of the webinar, click here.

To download a copy of the webinar, click here.

1. 2011 Provista Report of ASC Survey Findings

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