INSIDE THE CURRENT ISSUE
Hospitalizations for medication conditions on the rise
among Americans ages 45 and older
The number of hospital admissions among Americans ages 45 and older
for medication and drug-related conditions doubled between 1997 and
2008, according to a new report released by HHSâ€™ Agency for Healthcare
Research and Quality. Medication and drug-related conditions include
effects of both prescription and over-the-counter medications as well as
Hospital admissions among those 45 years and older were driven by
growth in discharges for three types of medication and drug-related
conditions â€“ drug-induced delirium; "poisoning" or overdose by codeine,
meperidine and other opiate-based pain medicines; and withdrawal from
narcotic or non-narcotic drugs.
Admissions for all medication and drug-related conditions grew by
117% â€“ from 30,100 to 65,400 â€“ for 45-to 64-year-olds between 1997 and
2008. The rate of admissions for people ages 65 to 84 closely followed,
growing by 96%, and for people ages 85 and older, the rate grew by 87%.
By comparison, the number of hospital admissions for these conditions
among adults ages 18 to 44 declined slightly by 11%.
The new AHRQ report also shows that Medicare and Medicaid were
responsible for 57% of the $1.1 billion cost to hospitals in 2008 for
treating patients with medication and drug-related conditions, private
insurance covered 24%, and the uninsured accounted for 14%. The
remaining 5% of hospital costs for treating these conditions were borne
by other sources such as TRICARE.
Pneumonia is misdiagnosed on patient readmissions
Patients were misdiagnosed with pneumonia at an alarming rate when
they were readmitted to the hospital shortly after a previous
hospitalization for the same illness leading to overuse of antibiotics
and increased healthcare costs, according to two Henry Ford Hospital
companion studies. Pneumonia ranks second to congestive heart failure as
the reason for readmission within 30 days of a previous hospitalization.
Researchers found that 72% of patients were misdiagnosed with
pneumonia upon readmission to the same hospital; 72% of the misdiagnoses
occurred in the Emergency Department; fewer than 33% of patients had any
outpatient follow-up care prior to their readmission.
Researchers found that 92 of the 127 patients were misdiagnosed with
healthcare associated pneumonia using CDC/National Healthcare Safety
Network criteria. Healthcare associated pneumonia is a newly recognized
form of pneumonia in patients who had recent close contact with a
healthcare system, either through a hospital, outpatient dialysis
center, nursing home or long-term care facility. The classification was
added with the shift from hospital-based care to home-based care. This
also points to the importance of using X-ray for ruling out pneumonia.
Surgical suite storage needs strategic touch
by Susan Cantrell, ELS
the supply storage area of your operating room resemble something that could
be profiled on the cable television show "Hoarders"? If OR staff canâ€™t, at a
glance, look at their inventory and see what they need when they need it,
theyâ€™re about to face some tense situations with supply chain management.
The OR comes with its own
challenges. Storage space and inventory management are two prime problems.
Eric Schuldt, vice president of sales and marketing,
LogiQuip LLC, talked to
Healthcare Purchasing News
about difficulties that can arise concerning storage
for OR supplies. "Some of the biggest challenges include maximizing the use
of valuable OR space for supply storage; providing supply organization that
eliminates wasted time by the OR staff looking for particular inventory
items; maintaining appropriate par levels without having hoarding, stock
outs, or product obsolescence; having storage products that enhance good
infection-prevention practices by eliminating dust, dirt, and debris traps;
and providing appropriate storage for instrument containers and wrapped
OR clean core using wall-mounted PAR WALL by LogiQuip
Limited space dedicated for OR supply storage coupled
with ever-growing technology add to the troubles, noted Dave Salus, group
manager, clinical products and medication management,
Corporation: "Technology is evolving, types of procedures are expanding, and
the supplies required to keep up with both are growing. Storage is typically
the last space planned, forcing many OR supervisors and materials managers
to work with what they have."
Keys to quality
What are the keys to a successful supply-storage
improvement project? Salus offered a comprehensive overview: "Proper
planning is key, including having a good understanding of what supplies are
critical to support the OR. Workflow space should also be flexible enough to
grow and be reconfigured to meet future plans."
To manage processes and inventory, healthcare facilities
are increasingly turning to tried-and-true techniques and philosophies, such
as LEAN management, gemba, the 5Sâ€™s, Six Sigma, and kanban.
â€¢ LEAN management focuses on reduction of waste,
inventory, and response time. Gemba and the 5Sâ€™s are tools of LEAN
â€¢ The Japanese word "gemba" can mean several things. One
definition is "the real place or the real thing." Itâ€™s based on the premise
that problem solvers should first strive to understand the problem by
immersing themselves in the work, at the location where the work is
performed, to get the real facts of the matter before determining a
â€¢ The 5Sâ€™s stand for sort, by clearing the work area; set
in order, by designating locations; shine, through cleanliness and workplace
appearance; standardize, with everyone doing things the same way; and
sustain, by ingraining the 5Sâ€™s into the culture. Goals of the 5Sâ€™s are
reduced set-up times; reduced cycle times; increased floor space; lower
safety incident/accident rate; less wasted labor; and better equipment
â€¢ The philosophy of Six Sigma is based on identifying and
fixing defects in the companyâ€™s processes, which lead to improved
operational performance. It emphasizes process cost reduction, cycle-time
improvement, less waste of materials, a better understanding of customer
requirements, increased customer satisfaction, and more reliable products
â€¢ Kanban is the Japanese word for "visible record," such
as a sign or card. Traditionally, kanban cards are stored in a container,
such as a bin, that holds the items. The worker holds up the card to
indicate he or she wishes to pull a product from a bin. The card also
provides information used for reordering the item. Itâ€™s a
materials-requirement planning technique, an inventory control system, for
tracking the flow of in-process materials through the operations of a
just-in-time production process.
Southwest Solutions Groupâ€™s pass-through cabinets allow restocking from
outside the OR, limiting exposure to contaminants.
LogiQuip, observed: "The application of LEAN
inventory-management techniques are gaining favor throughout the hospital
supply chain, including the organization and management of inventory items
used in the OR. Implementing LEAN tools, such as 5Sâ€™s and kanban pull
systems, is becoming increasingly frequent due to the numerous benefits that
can be obtained."
Stanley InnerSpace is another company that practices LEAN
management. Shannon Kennedy, director of marketing, emphasized the
importance of solutions reached by hands-on involvement rather than by just
talking out the problem by people who may not fully understand the
implications and complications. Kennedy believes that management buy-in is
important, along with gemba.
"LEAN storage and inventory-management consulting is what
we do every day," said Kennedy. "We donâ€™t walk into a suite and wonder, â€˜how
many more cabinets can fit in this room?â€™ Instead, we try to understand why
the department is bursting at the seams when they already have more than
enough storage units. The best way to save money is to maximize what you
already have. LEAN is a continual improvement process. Thereâ€™s no stopping
point, but there must be a starting point."
Very simply, explained Kennedy, "The Japanese word gemba
means â€˜go and see,â€™ and itâ€™s just one foundational element necessary for a
facility to embrace, at every level of the organization, when attempting to
apply LEAN in healthcare. Donâ€™t sit in a conference room and talk about how
to fix a problem; go to where the work is done and interview the front-line
staff. The clinical staff needs to be empowered to make changes."
After a Stanley InnerSpace 5S
Project. Items such as sutures, tapes, and Tegaderm have a defined
location with established par levels.
Kennedy underlined her point with an anecdote: "During a
LEAN consulting project, we were trying to understand why the OR staff had
to leave the suite to get supplies when there were two cabinets filled with
supplies already in the room. As we began to ask questions, it became
obvious that the department didnâ€™t have an effective process for keeping
cabinets organized. This hampered both item retrieval and restocking. The
cabinets were completely unorganized, items were just thrown in the trays,
and there was no consistency between rooms. The nurses admitted it was
easier to walk to the core than to look in the cabinets."
"We reconfigured the cabinets in one OR suite to test our
solution. Each item that needed to be in the room was given its own
location, each location was clearly labeled, and a par level was determined.
The department worked with the cabinets for 1 week to confirm they were
happy with the setup, and then the solution was applied to the remaining
suites. Now that everything is clearly labeled and easy to find, trips to
the core have been minimized, and the night staff has the ability to restock
the cabinets with confidence. Ultimately, the department is happy, because
they were able to solve an issue that had existed for over 3 years."
Suzanne Alexander-Vaughn, product manager, perioperative
and supply solutions, Omnicell Inc., also encourages involving staff for
best results. "Active involvement of staff who will be using the product on
a daily basis is imperative. A clear delineation of goals from management is
also necessary. Understanding that there may be smaller steps required to
achieve the ultimate goal will allow for early successes on which a project
Alexander-Vaughn cited one of Omnicellâ€™s experiences with
a client: "Without having to manually count inventory or key in charges,
materials management staff at Patewood Memorial Hospital, in Greenville,
South Carolina, can now focus on picking and auditing cases, allowing the
clinical staff to focus on their respective areas of expertise. The hospital
has seen at least two full-time employees reallocated to different areas 2
to 3 days a week as a result of the improved efficiency. Geoff Hibbert, OR
manager at Patewood Memorial said: "Using Omnicellâ€™s OptiFlex SS, we have
weaned all scrub techs and nurses from picking cases. Materials distribution
staff does it now."
Southwest Solutions Group uses the quality-management
program Six Sigma along with kanban. David Myers, GAC LEED liaison and
healthcare division manager, explained how they apply Six Sigma and kanban:
"Southwest Solutions Group implements kanban and Six Sigma manufacturing
efficiency methodologies into surgery centers to improve their bottom line
and limit the exposure to infectious germs in their operating rooms.
Efficient surgery centers incorporate storage systems to maximize the use of
available space and enhance the productivity of personnel in three key
areas. These areas include storage inside the procedure room, supply storage
outside the procedure room, and surgical kit prep area."
There is so much help available to
maximize use of storage space in the OR and for managing inventory.
Healthcare Purchasing News
asked several vendors to describe their product and tell how it works to
help ORs improve their efficiency.
The MetroMax i high-density Top-Track maximizes space and increases
In this case, putting first things first means making
best use of the storage space allotted for the inventory. Salus talked about
what InterMetro Industries can do for clients: "Metroâ€™s consultative sales
team, equipped with planning tools and well-designed storage systems,
enables hospitals to make the most effective use of limited space for
managing inventory while enabling staff to work efficiently with ready
access to the supplies they need to provide quality care."
Metro offers a variety of solutions: the high-density
Top-Track converts wasted aisle space into storage units. For smaller areas,
there is the Starsys system, which has full-extension shelves to eliminate
wasted access space above supplies. SmartWall Plus offers hooks, baskets,
and shelves for versatile storage above equipment.
"As hospitals look for ways to contain costs and improve
efficiency, managing supply inventories is an important issue," said Salus.
"This was the case when not-for-profit healthcare system Union Hospital in
Terre Haute, Indiana, designed its Advanced Surgery Center with a long,
somewhat narrow, space devoted to the central core in the OR."
"Using CAD drawings of the planned area, Metro helped
build a storage system to maximize available space, using its MetroMax i
high-density Top-Track system, which increases the capacity of a given area
by up to 50%. The system met Union Hospitalâ€™s needs to move storage units
easily, even when stocked with heavy loads of up to 900 pounds, and to be
reconfigured easily as demands change."
"When Union Hospital opened its Center, it reached its
goal of storing 98% of supplies inside the central core. That success
enables surgical teams to access supplies more conveniently and enhances
flexibility to meet fast-changing medical challenges. In addition, it is
making a significant impact on the hospitalâ€™s bottom line by improving
efficiency, freeing up space otherwise used for storage, and eliminating
Southwest Solutions Group offers antimicrobial,
powder-coated steel or stainless-steel pass-through wall cabinets that can
be stocked from outside the operating room. "Pass-through cabinets allow
re-stocking from outside the OR even while a procedure is being conducted,"
said Myers. "Pass-through cabinets limit exposure to contaminants by
reducing intrusions into the operating room. If pass-through cabinets cannot
be incorporated, then nonâ€”pass-through cabinets can be used to create the
same function, except re-stocking occurs after each procedure."
Myers continued: "Storage of surgical supplies outside
the OR can be doubled, in most cases, with sliding or rolling high-density
â€“storage shelving units. These compact storage units typically support
several rooms and ensure critical supplies will be available when needed."
Southwest Solutions Group also offers automated
preparation of surgical kits with carousels. Myers described them:
"Horizontal carousels are powered spinning shelves that bring kit items to
the operator at a sterile pick station. Horizontal carousels use
inventory-management kitting software to increase operator productivity and
accuracy, and to manage stock counts of inventoried supplies. Horizontal
carousels use up to 80% less floor space compared to traditional shelving
with plastic bins."
Schuldt, LogiQuip, described some of the products they
offer: "LogiQuipâ€™s LogiCell product line is available as built-in
stainless-steel cabinetry or as a mobile cart line. Protected, easily
accessible, well-organized, high-density storage is the result. Wasted space
associated with flat-shelf â€“storage cabinetry is eliminated.
Procedure-specific supply carts can be created that also include general
supplies used frequently in OR procedures. Staff time, especially the
circulating nurseâ€™s, looking for supplies is greatly reduced."
"For storage in areas such as OR clean cores," continued
Schuldt, "LogiQuipâ€™s PAR WALL and PAR STOR provide open or drawer-type
storage systems with wire baskets that are configurable to accommodate
different SKU physical sizes and par levels. Each product line provides for
exceptional supply storage compression along with superb supply organization
and identification. Specialized storage products for suture, IV solutions,
and mechanical-instrument storage are available, in addition to
high-density, floor-mounted track systems for traditional wire shelving.
Specialized LogiCell carts can be used for implant storage to better
organize, identify, and control the different types and brands of implants.
Wrap instrument sets should not be stacked onto each other and should be
stored on shelving that wonâ€™t tear the wrap. LogiCell provides storage for
both instrument containers and wrapped instrument packs that accommodate the
unique storage needs of both."
Marc G. Higgins, director, materials management, St.
Josephâ€™s Hospital, Eureka, CA, described the impact that LogiQuipâ€™s systems
had on them: "Converting our supply areas to LogiQuipâ€™s systems has had a
profound impact on supply chainâ€™s ability to support clinical operations at
our facilities. We had older rooms that were not designed as supply areas
and were a root cause of stock outs and frustration for materials-management
staff and our patient-care customers. LogiQuipâ€™s specialized systems allowed
us to significantly increase the storage capacity in these areas and reduce
stock outs in par inventory areas to a statistical anomaly. LogiQuip also
provided services such as onsite analysis and CAD drawings, and worked
closely with me to understand our needs. Our clinicians love the LogiQuip
systems, or at the very least the service improvements they helped us
After a Stanley InnerSpace 5S
Project. Items such as sutures, tapes, and Tegaderm have a defined
location with established par levels.
Maximizing use of space is important but it doesnâ€™t tell
the whole story. Management of inventory presents its own challenges.
Stanley InnerSpace offers a web-based inventory system. Kennedy explained:
"Inventory management continues to be a challenge in the OR. Knowing what to
order and when, and how and where to store supplies is something that
inventory coordinators must deal with each day. A web-based inventory system
like SpaceTRAX allows the department to apply the appropriate technology
solution â€“ barcode, RFID, or both â€“ without asking the clinical staff to
overhaul their current workflow. Unlike closed-cabinet solutions, you donâ€™t
need to remove existing cabinets and spend capital-equipment dollars to
start recognizing immediate savings."
Kennedy described the virtues of SpaceTRAX: "Stanley
InnerSpace inventory systems are designed to increase charge capture,
eliminate waste, and reduce manual labor involved with managing inventory.
With a user-friendly dashboard and a robust reporting engine, SpaceTRAX
provides visibility into inventory spend, par-level optimization, item
expirations, procedure cost by physician, and what should actually be on the
physician preference cards. With a better understanding of your on-hand
supplies, itâ€™s easier to reduce the overall storage footprint and simplify
the replenishment process."
Omnicell offers inventory-management software. Alexander
-Vaughn explained how it works: "Omnicellâ€™s OptiFlex SS software manages
products based on items on preference cards and provides visibility to what
is on the shelf at any point in time. Knowing what is at the hospital and
having a view to what is used on a regular basis, what is not moving, what
is expiring, and what may be needed for a scheduled case in the future are
all integral components. Bidirectional interfacing with clinical systems
allows data to be shared efficiently, and interfacing with other systems
means time spent keying data can be more effectively utilized."
"Management of implantables and other high-cost items remain a key challenge
for supply management in the OR. Maximizing the physical space available
with the appropriate level of supplies is also important. The Omnicell
Tissue Center solution excels at managing implants, and the associated
information needed to track them, and helps optimize inventory turns to
ensure appropriate items are available when needed. Omnicell also
understands different storage needs based on product type and can manage the
source of supply replenishment effectively for an OR."