With hospital administrators constantly facing the dichotomy of controlling expenses and improving patient care, more and more healthcare facilities are adopting the use of procedure kits and standardization techniques to help drive these values. On top of that, increasing numbers of facilities are moving from basic kit and tray configurations to more complex procedure based solutions that help to reduce labor and inventory costs.

Cardinal Health has had success with its Procedure Based Delivery System (PBDS), said Derick Elliott, Director of Marketing for Presource (Cardinal’s brand name for its procedure based products). "What PBDS does is take the concept of kits and trays and expand it to cover the entire procedure, from pre-op and anesthesia, through the post-op clean-up. "It’s a much more comprehensive program. We map out a customer’s highest volume procedures and integrate the single-use products into a case cart that we call the Navigator Cart", noted Elliott.

Tom Pistella, President of Medline’s Sterile Procedural Trays division, sees an increased trend towards the use of the company’s Complete Delivery System (CDS), which he predicts will grow further as the nursing shortage continues. "We’re taking the custom tray to the next level by combining many other kits that would be involved in the procedure, and we’ve ‘supersized’ the kit into one large case per procedure," said Pistella of CDS, which combines all sterile and non-sterile supplies required for a specific procedure and puts them in one container. "We as a manufacturer are holding more of the inventory, and we deliver it more frequently," he adds. "What else happens is that the labor involved in setting up for a procedure goes way down. We provide more savings for the hospital in terms of labor and inventory reduction."

No doubt, disposable options in kit and tray configurations are expanding, but to take it even further, SRI/Surgical Express offers its ReadyCaseSM, which contains everything needed for each surgeon’s procedure, from reusable products to surgical instruments. The ReadyCase can include reusable gowns, drapes and basins, disposable custom packs, surgical instruments and physician preference items.

Technician tests instruments

SRI’s program had its origins in processing and sterilizing reusable gowns and linens. About two to three years ago, the program grew to include surgical instruments. Called AccuSet, SRI’s instrument processing program provides high-quality Aesculap surgical instruments on a per-procedure fee basis. Each day SRI picks up soiled items, decontaminates, cleans, sterilizes and packages the items according to FDA-audited processes, then delivers them back to the hospital the next day. Joe Largey, CEO of SRI, notes that because they are FDA mandated, SRI’s instrument trays are always clean, always on time, and always complete. The majority of AccuSet clients currently use the service for its difficult-to-clean laparoscopic instruments. Said Largey, "Our partner Aesculap has outstanding laparoscopic instruments that are modular, disassemble very well, and validate through the FDA." SRI can work on or off site and can provide any combination of outsourcing services. Rex Healthcare in NC, credits SRI with helping to grow its number of surgeries from about 20,000 to 30,000 in 2003.

Another trend across the nation is an emphasis on value analysis systems and programs. Consorta representatives said that several of its shareholders have organized value analysis teams to examine the contents of kits and trays and look at standardization, a trend they say is happening across the nation.

One such valuation product is pack management software. Pack Manager from Cardinal Health is an online decision tool that allows customers to track kits in the manufacturing process, plus uses video imaging to show the configurations and components within a given kit. Elliott says this Pack Manager feature can help in training new staff and in times of labor shortages. Through standardization reports, customers can look at a kit or grouping of kits and see what the common supply components are, what the variables are and what things they can do to standardize. Elliottt said Cardinal will introduce an enhanced version of Pack Manager at AORN which will have expanded "score carding" options and an improved user interface.

DeRoyal offers a version of pack management software called C.P.T. Optimizer in which customers can view a list of custom procedure tray components and view the impact of changes to the contents or quantities. Medline will unveil a new online management tool called Med-Pack this month.