Outdated and orphaned PLs can have adverse impacts in financial areas such as supplies and labor, physician and employee dissatisfaction and operational inefficiencies. There can be a significant amount of items on PLs that do not get regularly used during the procedures. These unused just-in-case supplies require the efforts of several full-time equivalents (FTEs) per day to re-shelve. Additionally, this back-and-forth product flow represents sizeable opportunities for the sterile products to become shopworn, damaged or lost. Finally, this tidal volume of items requires that more supplies need to be carried to ensure that every case cart has the item, even if only one case (or no case) for that day actually uses it.

While the job of streamlining and maintaining a PL database can be daunting, there are many things that can be done to ensure success. Some of these include:

• Eliminate unnecessary or unused PLs: Reduce the number of PLs by weeding out duplicated PLs, physicians who no longer practice at the organization and (in some cases) surgeon-specific PLs for procedures they do not have privileges to perform. In some systems, it is not possible to delete the PL due to data integrity rules. In situations like this, consider renaming the PL to something clearly inactive (one organization put the prefix "ZZZ" before the inactive PL name so it sorted at the bottom of the list of PLs).

• Define a permanent change vs. a case-specific modification: Develop guidelines with key clinicians to decide how to recognize what should be a permanent edit to the PL. Include workflow to permit the charge nurse or service line lead to review and approve before committing to the edit.

• Develop a clearly defined PL markup process: The circulators and scrub techs would be trained to use either a special pen color (e.g., green) or a special code (e.g., "UPDATE") to differentiate updates from case-specific exceptions. In this process, exceptions could be noted in black or red so the person decrementing inventory or entering patient charges can act on those, and updates in green so the person responsible for PL edits can act on those update requests.

• Assign PL edits to a specific person: Create a role that would be responsible for receiving information from the circulators and scrub techs performing the cases. This information would then be passed by the service line leaders to get authorization to make the change to the PL. Finally, this process owner would then update the PL in the system according to the documentation.

• Consider creating kits for just-in-case supplies: An example I once observed concerned cholangiogram supplies in a large hospital system in the Northeast. Each lap chole PL had all of the supplies for a cholangiogram with a quantity of 1 EA just-in-case; however, the actual number of cholangiograms performed at this organization was fairly small. One solution would be to create a "cholangiogram kit" in the system, stock 1-2 kits in each core and remove the "just in case" cholangiogram supplies from the PLs. When the supplies are actually needed, the circulator can reach outside the suite, pick one up and charge the patient for it as a single item. This would reduce the amount of cholangiogram supplies that would need to be carried, and it would reduce the risk of the product getting damaged with repeated picking and shelving.

David Hermann is with Aspen Healthcare Metrics, a MedAssets company.(dhermann@aspenhealthcare.com).