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In This Issue:
Chip Bolman and Steve Senat of OR/CSS
On a recent Wednesday morning, an entire hallway in the Cardiac Surgery Operating Room suite was filled with surgical carts containing sterile supplies that surgeons use to perform Coronary Artery Bypass Graft, or CABG, surgeries.
But there were no CABG surgeries scheduled; rather, surgeons and nurses had carved time out of their schedules to review their carts and identify opportunities for cost-savings. The goal was simple, but that morning’s dialogue was spurred by a strong desire to improve efficiency and reduce costs wherever possible. At the heart of that desire is the instinct of care providers to do what is best for their patients.
“This has been a true team approach to managing costs appropriately,” said R. Morton “Chip” Bolman, III, MD, chief of Cardiac Surgery. “Care is expensive; we need to find ways to make it more affordable for our patients without compromising quality.”
The department has always made an effort to be as efficient and disciplined as possible, but now, it’s becoming ingrained in the way care providers look at every piece of equipment they use in each procedure they perform.
The assessment in the OR began with that morning’s goal to look at the supplies each surgeon uses for CABG procedures, as part of the strategic planning efforts in Care Redesign across Partners HealthCare.
Surgeons often use different supplies to perform the same procedure based on where they trained and individual preferences and techniques. Each surgeon has a preference card outlining specific instrumentation and supplies that should be included on his or her case cart for every procedure.
By laying out all of the supplies on each surgeon’s preference cards, the team examined the different items and their costs to identify opportunities for savings. They discovered that some surgeons used similar products manufactured by different companies. Costs can be better negotiated and potentially reduced when ordering all the supplies from one vendor. Surgeons also found ways to trim non-essential items from the carts.
“It opened up a real dialogue for people to talk about their procedures and preferences with others and think about the costs associated with them,” said Maureen Kelly, director of OR/CSS.
Carol Richard, RN, nurse in-charge of the Cardiac/Vascular and ORL Operating Rooms, agreed. “We know what things cost, and as a result, we can identify supplies we don’t really need,” she said. “This type of sharing has never happened before.”
Although this is the department’s first pass at generating cost-savings for supplies used for CABG surgeries, it is part of a plan to reduce overall expenses. About a year ago, the department studied the number of heart valve implants in stock and reduced it by more than $300,000. The CABG surgery project has so far yielded more than $125,000 in savings per year, or $100 per surgery.
And that’s just the beginning.
“We’re going to conduct this same process for all of the procedures we perform,” said Kelly. “We believe that we will see a similar opportunity for savings.”
Nurses in the Operating Room have also dedicated time between cases to look for ways to reduce costs. “Nurses have been going through the custom packs of surgical supplies and making decisions on what is no longer needed,” Richard said. “We’ve also been sorting through inventory on our shelves to identify supplies currently not being used and working with the manufacturers to return these items for credit.”
In addition, Cardiac Surgery instituted an improved process for the introduction of new devices and technology. Bolman reviews and approves all requests, and items are ordered on a trial basis to determine how often they are used before ultimately purchasing them.
Now, the team is evaluating a reusable warming blanket system. Traditionally, they have used disposable warming blankets to maintain patients’ temperatures during surgeries, but a reusable blanket system will save money and decrease waste. “It seems promising,” Richard said. “We are working with other surgical services to determine if it’s something they can use, too.”
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