PRODUCTS & SERVICES
the use of standard packs in place of custom proce- dure trays when applica- ble because they typically cover more procedures and service lines and tend to be less expensive. “Consider using stan-
Lindsey Crea
dard packs for commodity items in combination with smaller custom pro- cedure trays,” Crea recommended. “For
example, a common manufacturer’s Custom Hip Tray contains 55 items. The same manufacturer also makes a Standard Basic Ortho Tray and a Standard Total Hip Tray. The Standard Basic Ortho Tray contains 22 of the same items as the Custom Tray, while the Standard Total Hip Tray contains 35 of the same items. A smaller custom tray can be used for the remaining items, or the items can be opened separately.
Strategies, tactics for custom procedure tray performance
What are some strategies and tactics for optimizing custom procedure trays? Several experts share their tips for success.
• Perform a waste audit to identify items that are frequently unused in packs. Involve staff members and surgeons familiar with the packs to participate in/contribute to the waste audit.
• Develop a pack contents review schedule to ensure that standard trays don’t exist to replace custom packs and that all items in the pack are still being used (i.e., practice hasn’t changed).
• Invoke cost guidelines. Minimize product cost mark-ups by scrutinizing all items that exceed $10 and packs that exceed $300.
• Use manufacturers that offer non-sterile products in their packs and eliminate sterile items. Sterile pack items are typically higher cost than non- sterile items. Vendors sterilize the packs after assembly, duplicating the sterilization process.
• Eliminate delivery systems, which are custom packs packaged with additional components. Manufacturers may require a minimum number of items that need to be included, which can contribute to increased waste. Also, all items in the delivery system are subject to an additional mark-up and items that aren’t used can be put into product inventory — ensure that these marked-up products aren’t supplying inventory for the service line. To prevent the use of delivery systems, update preference cards to include all needed products and assign staff to pull the items the day prior to surgery.
• Know your [custom procedure tray] lead time! If you’re looking to standardize or change your custom packs, it will be important to know how much remaining inventory of the custom pack you have left and just how long it will take for a custom pack change to take effect. – Mark Scagliarini, President, Blue.Point Supply Chain Solutions
• To incentivize standardization, consider offering bonuses/profit-sharing for highly standardized high performers. (Note, this may not be permis- sible in a non-profit facility setting. Check with your legal/ethics department.)
• Collect and present data related to the number and amount of delays and adversely affected
patient outcomes caused by a missing or incorrect supplies.
• When root cause analyses are performed on de- fects related to supplies and instruments, the root cause can often be traced to multiple brands/ vendors/types of the same supply or device. – Kim Blakey, Executive Director, Sterile
Processing Department, LeeSar Regional Service Center
The most optimized custom procedure trays need to be managed and reviewed regularly by clinical staff utilizing the kits. Too often a custom procedure tray program is well-built, but then not thoroughly and routinely reviewed, which typically results in waste and inefficiency creeping into the program. The following are some key data factors that im-
pact an optimized custom procedure tray program: • Surgical volume and mix, identification of how many high volume routine supply items are uti- lized for each procedure
• Comparison of frequency of use per component along with the relative cost of each component
• Accuracy of surgeon preference cards • Strict delineation between actual items used for each procedure versus items to “be available,” but not used every case. – Ned Turner, Senior Vice President of
Perioperative Services, Medline Industries Inc.
• An optimized custom procedure tray would be a tray built specifically for a case that makes the best use of the instrumentation needed. An optimized custom procedure tray would have no “what if’s” or “maybes” built into the tray.
• A team should review the content list of the instrument tray yearly, and when physicians retire or new physicians are hired. Surgical Instrument Tracking Systems offer great information on tray usage. Using information from both the OR and CSP perspective would give useful information about individual instrumentation. – Kimberly Davis, Manager, Central Sterile Processing, North Mississippi Health Services
54 October 2015 • HEALTHCARE PURCHASING NEWS •
www.hpnonline.com
Smaller custom trays will be lower cost and generally have less waste.” Aligning doctors within a service line and eliminating doctor-specific packs whenever possible generate improve- ments, too, according to Crea. “If one doctor needs a specific item, have it pulled for them separately,” she added. Consider establishing and maintaining a “supply usage rule” that only allows items used in 90 percent or more of pro- cedures to be included in the custom pack, Crea urged.
Finally, evaluate the quality of drapes and gowns inside packs by verifying that AAMI levels are appropriate for the pro- cedures for which they are used, accord- ing to Crea. “Using the correct AAMI level decreases the need for layering drapes and using a higher resistance level than needed increases costs unnecessarily,” she indicated. “Also, limit the quantity of drapes and gowns inside custom packs, as pulling these items separately allows for size variation. Evaluate if removing procedure-specific drapes from custom packs would allow the pack to be used for more procedures/service lines.” Williams cautioned against standard- izing a custom procedure tray to the point that you achieve the “lowest common denominator” of products inside the kit. “This results in a ‘skinny’ CPT,” she noted. “However, this practice simply transfers the variation from the custom procedure tray to the items pulled off the shelf, often resulting in increased acquisition cost as well as increased labor for picking cases. While this can hide the variation in the short term, the practice only masks the issue.”
Don’t forget about the resources your pack vendor provides, Manning urged. “We have partnered with Medline in this process, and they have been an invalu- able resource in facilitating optimizing our custom trays since the conversion to them two years ago,” she said. “Our local representative and the [vice president] for Medline’s Perioperative Consulting Services have remained intricately in- volved in this activity. There are also on- line tools available through our vendor to pull data and to do comparisons between packs that get to the component level. I use my local representative on a daily basis in communicating with OR staff and making sure he is readily available to address any concern or opportunity identified.” HPN
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