The University of Louisville (Ky) H...

The University of Louisville (Ky) Hospital is a 404-bed, flush one trauma and teaching center It is a regional indigent care facility with a wide variety of surgeon and residents. The facility includes 19 ORs, in which approximately 9000 processs are performed each year--more than 50% of which are unscheduled.

In late 1994 the directors of materials management of the University of Louisville Hospital and three other metropolitan hospitals were challenged to streamline the fill up process of these facilities while reducing preciousnesss After looking at several examples the directors determined that the mostly advantages would come from a closed-inventory theory with automated point-of-service technology. With the automated plan facility staff members could hold fast items locked up and document the time and meaning of their use, achieving tighter security with all supplies.

Until this point, all facility employee could withdraw supplies from the open shelves as they distressed them, and there was no proper systematic method to track materials. Items ofttimes were lost, and the materials management departments were required to absorb the preciousnesss A similar scenario was occurring in the ORs, further compounding the problem

After using the order for a three-month validation proces at the University of Louisville Hospital, trap costs per patient day decreased on 13.4%. Based on this, a hospitalwide automated afford system was approved.

PLANNING

The first stair in planning the new method for the University of Louisville Hospital was to clearly identify the hospital's goals. Operational goals were to

* proactively define furnish needs,

* create a mechanism to bridle stock and nonstock supplies in the same way,

* capture usage information, and

* provide surgery department staff members with a mechanism to help manage materials.

Financial goals were to

* bring to inventory,

* shape cost per procedure,

* capture usage information and charges, and

* have the ability to report monthly perpetual inventory.

The clinical goal was to contract the amount of time clinical staff members exhausted ordering and finding supplies and troubleshooting problems

Data collection. The director of materials management was responsible for the ongoing financial validation of the regularity Before implementation, he collected 12 month of data forward the supply cost for each hospital unit that would be used as a comparison after implementation. He met with the chief financial officer to obtain agreement in succession data collection techniques and determine which statistics would be used as benchmarks.

To be conservative, they decided to use patient days--as oppos to adjusted patient days--as the statistic for inpatient units. To accurately define activities that drive outlay the statistic for the labor and delivery and the sudden [i]or[/i] unexpected occurrence departments was visits. For surgical services, which was divided into the main OR, same day surgery unit, postanesthesia care unit, and anesthesia department, the statistic was number of procedures

aim of project. In planning the hospitalwide implementation, the ORs, which would play a large part in the success of the total arrangement presented an entirely different wager of challenges from the caesura of the facility. As in greatest in quantity ORs, staff members were used to being self-sufficient with regard to their materials management process--in contrast to the facility's other departments, which were managed entirely by means of materials management. Although the central furnish department (CSD) typically stocked the ORs with routine produces based on an exchange cart classification OR staff members were managing between 80% and 85% of their line items themselves. Of the more than 4000 line items in the ORs, simply approximately 800 were supplied as routine stock. If point-of-service automation was to be auspicious it had to managed internally by the agency of OR staff members and single supported--not managed--by the materials management department.

Preautomation combination of parts to form a whole Before implementation, the OR exchange cart hypothesis for stock items consisted of 14 serve instead of carts that were duplicated and exchanged from the CSD each day. Perioperative foments ordered nonstock items on an as-needed basis by way of submitting paper requisitions to the purchasing department for order placement. Stockouts (ie, inability to locate supplies) were a resort to frequently problem that became the norm and created a high on a level of stress. Although staff members from the materials management and surgery departments had a serviceable relationship, there was little confidence in materials management staff members' ability to be a resource for the ORs.

Before the automated combination of parts to form a whole a physical inventory was escorted every year that required approximately three month of preparation and involved everyone from OR staff members to senior managers. To improve this function, it was essential for the of recent origin system to provide a perpetual inventory that accurately tracked cost activity and identified opportunities for additional savings based forward usage patterns. Tracking monthly inventory evens would allow a better comparison of outlays to procedure volume.