What are the top challenges vexing the OR and surgical suites?

“The lack of attention to accurately recording the waste and consumption of materials during a case is preventing hospitals from understanding what cases are actually costing them and is adding to the overall cost of a case as clinical staff does not know what supplies will actually be used in a case,” he indicated.

The “lack of integration, if not interconnectivity or interoperability, between preference card systems, Instrument tracking systems and surgical and patient information systems,” remains a key area of concern, according to Angela Carranza, CST, Lean Certified, Manager of Clinical Resources, Medline Industries.

Setting priorities to overcome top OR challenges in surgical suites

by Rick Dana Barlow

1. Too much clutter on floor, such as equipment, power cords, storage and tools in too small a space as square footage remains lacking. “Space is often at a premium in U.S. operating rooms (OR), and with the continued advancements in technology, these challenges will continue. This is one of the reasons that Draeger continues to evolve our solutions for our customers. For instance, in the OR, we are now offering ‘Care-Centered Workplaces,’ where we combine OR lights, OR booms, anesthesia monitors, anesthesia machines and IT systems under one solution. We’ve made similar advancements to our solutions in the NICU and ICU. While we may not be able to make an OR physically larger, Draeger believes our expertise in the OR from both a technology and professional services standpoint can help our customers achieve the workflow efficiency they desire.”

2. Lack of integration, if not interconnectivity or interoperability, between electronic imaging, surgical and patient information components. “There is a lot of opportunity to improve integration and interoperability in the OR with the goal of reducing integration costs, increasing patient safety, and improving clinical processes. There are some promising movements with IEEE 11073 SDC standards where many vendors are working together to assist our shared customers in realizing the benefits of interoperability.”

3. Turnover time remains too long due to cleaning, disinfecting and sterilizing room post-procedure. “With hospital acquired infections (HAI) impacting reimbursement rates, hospitals are looking to their vendor partners for assistance in limiting this financial risk. Vendors can help mitigate this risk by introducing a new or modified design, like what Draeger introduced with our Perseus A500 anesthesia device, which offers smoother surfaces and improved cable management for cleaning efficiency. Another strategy for vendors to help mitigate this risk is creating more flexible use of a device, as we did with the Infinity Acute Care System (IACS) patient monitor, where the same IACS monitor stays with the patient from the time they enter the hospital until they are discharged. Our Infinity M540 is utilized as a Pre-op, transport, OR, and PACU monitor. While different, these two strategies can aid hospitals with their infection control efforts.”

4. Restocking and inventory access remains problematic such that circulating nurses scramble to obtain what surgeons need – sometimes during procedures. “Scrambling for inventory can be a stressful experience, not just for the surgeons, but also for nurses, anesthesia techs, and the Biomed/HTM team. In addition, infection control risk may be introduced by exiting and re-entering the OR. We as vendors can help by standardizing our accessories and consumables across product lines. This is something Draeger introduced many years ago in order to simplify the ordering and use process.”

Angela Carranza, CST, Lean Certified, Manager of Clinical Resources, Medline Industries:

1. Other – Lack of integration between preference card systems, instrument-tracking systems and surgical and patient information systems. “Perioperative teams often each use a different operating system, but they usually aren’t integrated with one another. This lack of integration limits predictive ordering and each system impacts another. For example, if preference cards aren’t updated in all systems, it increases the risk of necessary supplies going unordered. In the perioperative setting – all systems need to flow in order for the OR business to be a success, so this means streamlined communication, ordering, activity from the supply docking area, sterile processing department and up to the OR suite(s).”

2. Physician preference items add to inventory and procedural costs. “Hospitals continue to experience an increase in operating expenses so understandably, leaders are focusing on cost savings initiative. Some physician preference items can be expensive, but I caution leaders to take a closer look at product substitutes and to conduct a process analysis before eliminating it.”

3. Turnover time remains too long due to OR setup and stocking. “Turnover time has been impacted by a triple threat of challenges, including the staffing shortage, supply chain challenges and process changes during the pandemic. Medline has seen an increase in customers coming to our clinical resource teams about OR turnover challenges they’re experiencing within their organization. Some procedures require a longer turnover time and we’re working with customers on how they can get their OR teams more efficient.”

4. Ineffective, poor or no relationship with Supply Chain to help with product evaluations, contracting, supplier relations, etc. “This is an area of opportunity we continue to see. Effective communication between supply chain and clinical partners and understanding each other’s needs is essential for achieving success and driving cultural changes that empower teams. We are seeing more value analysis teams pulling in a clinical team member help keep patient care at the forefront of their decision-making process.”

5. Inability to track product consumption/usage patterns for billing, budgeting, economic service line evaluation, etc. “ORs generate a lot of revenue for hospitals, but there’s a greater need for teams to understand total procedural costs. Utilizing a preference card system that’s integrated with all electronic systems can help teams understand true costs and provide recommendations for mitigating them.”

1. Inability to track product consumption/usage patterns for billing, budgeting, economic service line evaluation, etc. “Tracking demand is a foundational and fundamental requirement for a well-functioning supply chain. Without it, all we have is guesswork based on experience and judgment. Too often, there is a significant amount of revenue leakage as a result of not tracking product usage to each procedure. It can also lead to potential challenges with recall management if the product is not properly tracked to the procedure. Additionally, product standardization is minimized if there isn’t a clear understanding of product use and demand patterns.”

2. Bad/erroneous data and/or lack of product data standards cause/contribute to decision-making problems. “With the continued introduction of new products into the market, the supply chain and clinical teams will need to have ‘good’ product and market data to properly evaluate the potential benefit for their organization and patient population. As more specialized products are introduced, supply chain and clinical teams will need to further evaluate if the product specialization enhances patient care or creates the potential risk of using the product incorrectly and/or inappropriately.”

3. Ineffective, poor or no relationship with Supply Chain to help with product evaluations, contracting, supplier relations, etc. “Supply chain continues to take on a broader role with product evaluations, contracting and supplier relations through their integration of clinical team members into the decision-making progress. It is imperative to have a cross-functional team that supports all of the stakeholders to ensure decisions made are in the best interest of delivering patient care and financially for the organization.”

4. Product recalls cause delays due to lack of preparation. “Product recall management starts with a clear understanding on what is stocked throughout the hospital and having visibility of these products in real-time. Unfortunately, some hospitals and health systems are not well-equipped with the right tools, processes and resources to effectively manage recalled products. Without strong processes in place, hospitals and health systems are potentially putting their patients at risk.”

5. Restocking and inventory access remains problematic such that circulating nurses scramble to obtain what surgeons need – sometimes during procedures. “Creating a streamlined inventory deployment strategy starts with understanding what products are used where and how often throughout the operating rooms and procedural areas. Too often, the inventory deployment strategy is created based on each person’s experience and judgment and of course they are wrong most of the time. Hospitals and health systems will need to evaluate where best to store each product to minimize delays when retrieving products during a procedure. There is a balancing act between the cost of the product, critically to patient care and time to retrieve the product when it is needed.”

1. Restocking and inventory access remains problematic such that circulating nurses scramble to obtain what surgeons need – sometimes during procedures. “Preference cards moved from hand-written cards to databases without much increased sophistication to help truly improve the process. In most cases the items brought into a OR prior to the case are based on historical data, not updated frequently, instead utilizing real time information on what the physicians are using now to predict what will be needed tomorrow based on the case, complexity, and patient characteristics.”

2. Bad/erroneous data and/or lack of product data standards cause/contribute to decision-making problems. “As systems grow more complex and the number of products continue to increase, it is becoming increasingly important to invest in clean data and quality data standards that make sure that all items can be easily found, documented, and billed appropriately.”

3. Physician preference items add to inventory and procedural costs. “As new physician preference items come in, there is a more complex parallel effort that needs to be done to reduce (and hopefully remove) some of the items which are no longer being used as frequently.”

4. Inability to track product consumption/usage patterns for billing, budgeting, economic service line evaluation, etc. “Accurate tracking of consumption is important not just for the billing and budgeting but so that we can know more about what was used in the case and more accurately have the correct items in the room the next time that type of case occurs.”

5. Devices, instruments break down/malfunction due to improper maintenance, repair, service. “Just as it’s important to track the supplies and trays used in a case, accurate tracking of equipment and individual instruments used in cases would allow for more items to be proactively maintained instead of waiting for items to break in order for them to be fixed.”

1. Other – Incomplete patient information. “Surgeons are often making decisions on which supplies and/or equipment to use based on incomplete patient information. To make the best possible choices, surgeons need current information regarding the patient’s history, medical conditions (current and past), surgical history, patient-specific risks, functional status, etc. All of these are important in making appropriate equipment, supply, and surgical technique decisions.”

2. Lack of integration, if not interconnectivity or interoperability, between electronic imaging, surgical and patient information components. “Lack of integration results in incomplete patient information, and this contributes to suboptimal decision-making. When surgeons have easy access to MRIs, X-rays, CT scans, lab results, consult information and a detailed patient history at the time of surgery, they are more empowered to have successful outcomes.”

3. Bad/erroneous data and/or lack of product data standards cause/contribute to decision-making problems. “Surgeons are often required to make multiple, complex patient-care decisions on the fly at the time of surgery based on incomplete information. This deficit is often due to a lack of consistent, evidence-based data around the indications for certain supplies and/or equipment and also the long-term results associated with specific supply decisions.”

4. Ineffective, poor or no relationship with Supply Chain to help with product evaluations, contracting, supplier relations, etc. “In general, surgeons have a limited understanding about the entire supply chain process. They tend of focus on just getting the supplies and equipment that they think will work best for their patients without much regard for how it gets into their hands or how much things cost. Regular communication between supply chain leaders and surgeons would help both sides understand the other’s concerns and priorities and foster a more effective approach to supply and equipment acquisition and use.”

5. Physician preference items add to inventory and procedural costs. “All surgeons are highly motivated to get great results for their patients, and most have developed their preferences around supplies and equipment based on years (or decades) of trial and error. Because of this they tend to have strong biases about what works and what doesn’t, and what they want to use in the OR. This isn’t about physicians being stubborn — at the end of the day, the surgeons bear the ultimate responsibility for the results of the surgeries they perform. Effectively managing PPI requires establishing an ongoing relationship between supply chain and surgeons, so that both sides can understand the other’s goals and work together to achieve great patient care at a reasonable price.”