Savings
found with new instrument-handling program 
by
James M. Berklan 
The way Carol Vance sees it, the time had come to stop talking and start
doing.
The coordinator of surgery purchasing and supplies at St. Vincent Mercy
Medical Center in Toledo, OH, Vance now believes good money can be saved
through her new instrument-repair system.
"This
has been talked about for several years, but we never did it," said
Vance, a key figure at her 900-bed facility.
"It"
is intense inspection and rotation of instruments, which helps head
off major repairs and breakage.
"In
the long run, we expect to save money on repairs because we're keeping
things maintained. We'll be catching things before they're unrepairable,"
Vance said. "That's the name of the game right now: saving money."
Vance said the repair service was about one-fourth of the way through
the unit's instrument sets after five months of work. Costs, which generally
are expected to rise early in the process, were not noticeably higher,
she noted.
On-site
instrument repairs specialist Vince Agoston of Allegiance Corp., V.
Mueller, McGaw Park, IL, was the one who pollinated Vance's center with
the new inspect/repair routine. He said he regained the center's business
on the strength of a similar program he was part of at St. Vincent's
Hospital in Indianapolis.
In Indianapolis, Agoston billed St. Vincent less for on-site repairs
each of the last three years. He said that suits him - and the hospital,
of course - just fine.
"If
I stay consistent with the program, it gives me a basis for what I'll
be billing each year, versus an up-and-down, up-and-down pattern, like
it was for the last 16 years," Agoston said. "It's nice for these hospitals
to be able to say this is going to be my repair budget. Instead of huge
fluctuations, now it's leveled off."
30%
cost cut
Since it initiated an instrument repair rotation in 1997, St. Vincent-Indianapolis
has lowered onsite repair costs 30% overall. The yearly breakdown was
$52,424 for 1997, $40,115 (1998) and $36,820 (1999). One manager projected
a slight rise to about $38,000 in 2000, due primarily to a rise in patient
volume.
"The
fact that it did prove itself to be a cost savings to the hospital helps,"
Agoston said. "It brings to me an air of credibility. It kind of shuts
the others [repairers] out. I don't know if it's ever been studied like
this."
St. Vincent's director of surgery, Kelly McCarthy, said that the instrument
repair rotation - along with better care and handling, proper packaging
and maintaining tight par levels - have brought notable savings. Competitive
bidding also brought in lower service costs, she said.
"It
makes more sense to do the maintenance on the piece rather than wait
for something to go wrong or get a complaint about it," McCarthy said.
"I think things done in hospitals before were kind of, ÔIf it ain't
broke, don't fix it.'"
A veteran of numerous cost-reduction efforts at her hospital, McCarthy
said repairs had been overlooked.
"When
we talked about [savings] goals per month, it got harder and harder
to find anything, so you start looking in areas that weren't so supply
focused in expenses," McCarthy explained.
Scope savings
St.
Vincent-Indianapolis Instrument Room Materials Coordinator Becki Harter
gathered data over three years to show the program worked.
"It's
obvious but not easy," she said of the four-prong cost-reduction program.
"People have to take some sort of ownership over it. Anybody who has
somebody screaming about budgets - instrument specialists, central service
or sterile processing department managers - they'll do it."
She
said one key is rotating equipment regularly, not just when it's broken.
"The whole point is to reduce the number of extensive repairs. That's
the animal that costs a lot of money," she said.
Another point of emphasis is choosing an adequate storage/sterilization
management system, Harter said.
Ignoring the effect of new endoscopes, which are rotated into use regularly,
St. Vincent lowered its score repairs from $30,320 in 1997 to $8,100
in 1999. That equated to a 73% reduction before $8,300 worth of new
scope trays was factored in.
No
dust allowed
Harter
said that maintaining strict instrument par levels is another critical
part of the plan. Her hospital has as few as five extra sets of commonly
used items, she said.
"Most
hospitals have way more than that," she noted. "We've had five sales
in four years for instruments we don't use. I've traded excess for what
we need and bartered with other hospitals."
The par levels reduce the number of purchase orders - she usually does
just one a month - and also help keep sets from sitting on shelves or
gathering dust, she added.
"Depending
on what you have, trim back to no more than half your excess inventory.
Then wait six months and see what has dust on it still," she advised.
Clamps and retractors, for example, were some of the items that were
far too plentiful at her facility, she said.
Other advice: Form teams within the department to review inventory,
and make sure surgeons and operating room associates are part of the
winnowing process. Surgery director McCarthy said the hospital may be
ready to take instrument management to yet another level.
"The
next step currently being investigated is instrument repair training
for hospital staff and capital outlay to keep this work in-house," McCarthy
said. "This has been under investigation for several years, but the
environment is ripe to support this effort."
HPN
Click
here to browse a handbook
on how to deal with instrument cost management.
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