In search of …
a single stocking location

Reducing touches and consolidating stock are two keystones of inventory management and productivity. These are the basis for a best practice centered on inventory: Having a single official stock location for each item in each inventory.

This is primarily an issue in departmental inventories — and especially the operating room (OR) inventory. In most large ORs there is a storeroom of sorts that houses the high-volume common items. Here you will find lap sponges, trocars, electrocautery pencils, IV solutions, Foley catheters, packs, gowns, gloves and many other items that are used in most of the suites. But there are many more products that are used in more specialized procedures. These are things like nasal trumpets used in ENT cases, perfusion catheters used in heart cases, iris retractors used in eye cases and shunts used in neurosurgery cases.

The common practice for these specialty items is to have some quantity of each stored in any room where a procedure might be performed. So while ENT procedures may typically only be done in one or two OR rooms, nasal trumpets may be stored in many rooms throughout the OR pavilion. This approach to storage has many unintended consequences, including:

• Overstocking. Far more of these specialty products may be on hand than are actually needed. When the normal stock is low it may be reordered even when many more might be found in other rooms. This is one of the reasons why many OR inventory turnover rates are abysmally low.
• Inability to find stock. If a product is not found in the room where a procedure is usually performed, a search committee must go out looking for it in other potential storage locations. Sometimes product is not ordered because it is assumed that more are in the other rooms and an emergency order must be placed, often at a premium cost.
• Loss through expiration. Stock in alternate rooms may expire if it is rarely accessed.
• Loss through obsolescence. When procedures change, unused stock may go to waste. Even if there is an effort to use up old stock before introducing the new product, these items in alternate rooms may be missed.
• Clutter and disorganization. With specialty products stored in many OR rooms, it is much harder to keep things in order and where they can be easily located. As a result, all products become harder to find, which impacts efficiency.

The solution is the best practice of a single location for all specialty items. The ideal approach is to store specialty items in a small storeroom adjacent to or near the primary rooms where they will be used. If a case is done in another room, these items can be picked as part of case set-up. Alternately, appropriate items can be stored in the OR room where those procedures are most frequently completed. Using this approach, no matter what the circumstance, staff knows exactly where to go to find the items they need.

Except for specialty rooms noted above, the OR rooms should only have very small amounts of common items that are either not normally part of the case cart or that frequently need to be added. Examples of the former might be surgeons gloves, wound vac drains or steri-strips. Examples of the latter might be lap sponges, a couple of extra surgeons’ gowns or irrigation solution.

One large hospital in the Midwest developed this best practice approach to streamlining surgical supplies. Their OR had 24 rooms and performed most types of surgery except organ transplant. To support these rooms there was a central core storeroom that had all the common goods, including the primary suture and endomechanical storage. They had smaller storerooms for their largest services: Heart, orthopedics, neurosurgery, urology and eye. One OR stored specialty ENT supplies, and another had robotic supplies. Some of their operating rooms had small amounts of suture, but the majority of sutures were located on suture "trees" that were refilled from the main storeroom and moved between operating rooms. The operating rooms themselves had very limited supplies of the extras and were all similarly equipped with some variation based on the service usually using it. Most of these rooms had less than $3,000 worth of supplies stored in them. This was clearly a best practice organization.

Departmental inventories are not the only places where a single location is desired. I see many central storerooms where there are multiple locations for a single item. This often occurs for one of two reasons: There is not enough space in the primary location for a full complement of the item or there is both a bulk and low-unit location for the item. In both cases this leads to double handling and more chance for error. If space in the primary location is the problem, it can be solved by reducing the maximum on-hand quantity or relocating the goods to a location with more available space. The second situation can be more difficult.

Please note that this concept is the same for any departmental inventory — not just OR inventory. Initiating a project to reduce multiple locations can be a challenging endeavor. But the end result is well worth the effort through reduced cost and better staff efficiency.

David S. Kaczmarek, FAHRMM, CMRP, is a senior director at Chicago-based Huron Healthcare. Kaczmarek has more than 30 years of experience in healthcare administration and supply chain, including director positions at several hospitals and systems. He can be reached via e-mail at dkaczmarek@huronconsultinggroup.com.