Surgery can generate 60 percent to 70 percent of a hospital's total revenues, and that's even though the average OR runs at only about two-thirds of its capacity. But when you fail to manage the supply chain well, the results are high costs and excessive waste, a low percentage of standardization among supplies and process that is unnecessarily labor-intensive.

Want proof? Take a look at these numbers.

• Procedure delays due to unavailable supplies add an average of 17 minutes downtime per case.
• When you consider that the average surgical facility has seven ORs, if you do even two cases a day in each OR, you're looking at about four hours of wasted time.
• One surgical case, on average, brings in a gross of $4,000.
• Say you could do one more case a day by eliminating that downtime, and five more per week; that would work out to about another 250 cases and $1 million per year.
• One extra case, per OR suite, per day, can generate an additional $7 million annually.

Supply management technology can help you reduce this downtime. Here's an overview of a few of your options.

1 Automated supply cabinets
These secure storage cabinets usually use either a push-button or bar-coding system for retrieving supplies. They can be installed in ORs, storage rooms or in pre- and post-op areas. As with the modules on automated drug carts, computers integrated into each cabinet let users log into the system, call up the patient name and check off the supplies and quantities needed. Staff can then take the number of gloves, scalpels, sutures and other supplies they've requested.

The computer system records the number of each supply used, which helps the materials manager know when to re-order and what par levels to set, and can alert the billing department to billable charges. Security is also increased, because only certain staff have access to supplies. In addition, staff often like the ease of use associated with automated supply cabinets - once they get used to them.

As with any technology, you might encounter some resistance to compliance, especially at the beginning. In addition, automated supply cabinets create a barrier between staff and supplies which, in a pinch, can pose workflow problems. They can also take up a lot of space and be expensive to maintain.

2 Open systems
This method for storing supplies generally consists of bar-code-based systems that use open shelving for supply storage. Because there is no barrier between staff and supplies, open-shelving is accessible; staff simply punch the number of each item they're taking as they point and shoot the bar-code scanner. Bar-code labels can be placed pretty much anywhere, which means this system for supply management fits in any place that supplies are stored - you don't need to set aside special areas, as you do with automated cabinets.

These factors result in a system that not only can fit well into your workflow, but also let you automate charging, reordering and supply tracking. However, for that to work, you have to ensure staff compliance; your supply management software won't count supplies if nurses and techs don't zap the bar-code each time. In addition, supplies are open to hoarding by staff, so security may be an issue.

3 Radiofrequency identification
In this kind of system, supplies and equipment are tagged with RFID chips, which transmit signals to receivers around the facility, which then feed the information into a computerized instrument-tracking system. For your surgical facility's purposes, you would probably want a closed system. That is, the tracked objects never leave, and data are stored in one place. There are two tag options: passive and active.

Passive tags do not contain a battery; the power is supplied by the receiver. When a passive tag encoungters radio waves from the reader, the chip within the tag forms a magnetic field. The tag draws power from it, energizing the circuits in the tag. The tag then sends the information encoded in the tag's memory. Passive tags can be used for a long time because they don't have batteries, are generally less expensive than active tags and are often smaller. However, they can only be read at short distances, so you have to consider the number of readers you place around your facility.

Active tags, on the other hand, have battery power or other sensors that can use electricity for power. They can be read from a long range - roughly 100 feet - and usually can store more data than passive tags. But they are larger, more expensive and cannot function without battery power, limiting their useful life.

RFID systems are beneficial because they require no action from staff, and ensure compliance with and accuracy of the system because potential human error is removed from the system: tracking is entirely automated. Thus security is increased while supply accessibility remains intact.

The major drawback is the cost of the initial capital outlay and the labor of having to apply tags to all supplies.

Weighty questions
Before you buy any of these systems, you have to weigh the benefits - automatic charge capture, inventory and expired products reduction, case-cost tracking and more - against your facility's needs. Ask yourself these questions to help determine which system is right for you:

• Is the system easier to use than the current one?
• Are you replacing one system with another that does the same thing or less?
• Is it going to continue to evolve?
• Is it really complete? Does it meet your goals?
• Will you need to change your processes, or is the software flexible enough to meet yours?
• Will you be able to transfer data from your current systems?
• Is it compatible with systems that will stay in place?