Controlling your suture inventory demands managing one of the most difficult and most valuable cost centers of your surgery center. We have all been hit with large price increases on suture. The fact is there is very little that we can do about it. However, we can minimize the price impact by using better just-in-time practices, and controlling the rotation of our stock. To accomplish this we will need to outperform previous purchase trends and control our suture stocking patterns. By targeting these areas we will be able to minimize the impact of higher suture prices.

We may not be able to drive down costs but we can drive down our suture purchases by making better procurement decisions to build a more efficient suture inventory. The following easy and colorful steps will create an inventory control plan that will ensure you buy only the suture you need, when you need it.

1. Color-code your suture spreadsheet
To establish an effective set of metrics for your facility, first look at your suture inventory from a historical perspective. All centers have suture inventory that is used and rotated efficiently. This go-to suture are the types and sizes most frequency used by your surgeons and replenished by your materials manager. Unfortunately, many centers also inherited start-up suture inventory, had their case mix change, or had physicians change their suture requests, leaving suture on the shelf until they expire.

You need to collect data before you can identify your current suture needs and design a management plan. Start by preparing a report of all the suture you purchased over the past 12 months, either via a review of your materials management information system or by asking your vendor. You may want to do both for a spot-check comparison. When you're satisfied that you know the type and amount of suture you purchased, enter the information in a spreadsheet format with columns for:

• Item description,
• Manufacturer reorder number,
• Units of measure,
• Number of boxes purchased per year,
• Annual suture costs,
• Number of boxes purchased each month,
• Suture grouping cost (leave blank for now), and
• Suture grouping percent (leave this blank, too).

Once you have your data in place, refer to the "number of boxes purchased per year" column and place the most purchased and highest rotating suture items at the top of the list. This line item organization will show you which suture you purchase most often.

For instance, let's assume your annual order for a specific suture is 12 boxes. Therefore, orders of 12 boxes or more per year are your most frequently used suture. Group these rows and shade them green, total the amounts you're spending on each suture type and mark this number in the "suture grouping cost" column. After that, divide the cost of the green rows by your annual suture costs and enter this number in the "suture group percent" column. That's the percentage of the total suture stock comprised of your most frequently used suture.

On your spreadsheet, green rows represent a "green-light" for ordering suture. Make sure these sutures are always on-hand, but also keep the quantities in stock to a minimum, this way you are controlling the largest part of your annual suture cost. To do this, set a par-level that is slightly higher than what you're currently ordering. You may want to give your suture distributor a stock request so they always have this type of suture on their shelves in order to deliver them to your facility on a just-in-time basis.

Now, group the next set of data. As you are grouping your data this time, you will need to include suture that you purchase at least 3 boxes of a year, but less than 12. Start in the "number of boxes purchased per year" column ( 3 -11, in this example) and focus on columns that represent orders placed infrequently. Calculate the annual cost and percentage for these rows like you did for the green group, and highlight the rows in orange. Staff should exercise caution before ordering this suture. You usually won't place these orders on a monthly basis and you won't have to order more until you're down to a quarter-box. Everything else on your list of suture — 2 orders and below, in my example — should be grouped and colored red. Here, red means "stop — this may be possible dead stock." This suture may have been ordered in error during the past year or are sutures that you almost never use.

2. Color-code your suture boxes
Now, tag or color code your physical suture stock. Buy green, orange, red and black adhesive dots at your local department store. Affix the green, orange and red dots to your suture boxes, matching the color to the corresponding color code on your suture spreadsheet. After you tag every box in your supply room with those three colors, stick a black dot on all remaining and unmarked suture boxes.

Boxes affixed with black dots are suture that you have not purchased in the past year. They are excluded from your plan and are likely out of your regular rotation. You should recognize them as either dead stock or necessary stock for procedures that are rarely performed. Don't reorder these boxes without first confirming they actually need replacing.

Next, tag the data in your materials management information system. Add a color code classifier designation to each suture description (for example, "G" for green, "O" for orange, "R" for red, "B" for black). This will give you a check-and-balance protocol when putting together an order. The color-coded classifier can also serve as an alert or an approval designation on your electronic requisition or purchase orders. The approver of the purchase order, in most cases your materials manager, can refer to the color codes to easily tell how necessary the purchase is before ordering.

You can expand this tracking system with another color for newly added sutures. This color — yellow, for example — represents suture that hasn't been in your inventory long enough to tell how often you purchase replacement boxes. When staff see a yellow sticker, they'll know they need to make note of the suture's usage. Avoid bumping a color from, say, green to orange, without factual purchase history. The purpose of this plan is to remain objective and to keep a clean, clear, organized, color-coded inventory. Both the color-coded dots placed on your suture inventory and the color code classifiers tagged in your materials management information system become effective management tools for your staff.

3. Get the staff's support
At this point, since you have the data and concrete knowledge of the type and number of suture in your storeroom, it's time to put your suture control plan into motion. Educate your staff and get them involved to make the process work. After all, they're going to be using the suture, they're at the front line of the supply chain and they're also the experts who can help you improve on the management process.

It is very important to review the metrics and purpose of the plan with your staff with an emphasis on the goals you wish to achieve. Elaborate on the decision-making process for orange-tagged suture and discuss the par levels for green-tagged boxes. Stress the importance of analyzing how you reorder suture that is either outside the plan or marked with a red dot. This is the beauty of the plan; it should spur conversations and in turn help you make better procurement decisions.

Maintaining this plan is practically effortless. All you have to do is assign a key individual (or a few persons if you're in a large facility) to tag new suture boxes as they are received into inventory. You should select another person or persons to tag the data in your materials management information system. These are both straightforward and non-decision making tasks that are easy to keep current. For reference, hang a printout of the color-coded stocking method next to your suture stock. Print another copy for the final approver of your procurement process so that the materials manager can use the metrics on the fly before submitting orders.

Most of the staff will understand the need to be cautious when ordering, but they may not understand why they have to rotate suture stock. Explain that storing unused suture and expired materials is like placing stacks of cash on supply room shelves.

Less is more over time
If you follow these steps, you'll have a tool to control your suture stock and a fully knowledgeable staff that can manage the plan efficiently. However, your suture control metrics must be analyzed on a routine basis, either on an annual or bi-annual basis to become an effective tool. Your suture inventory did not grow to its current size overnight and it will not shrink overnight, but trust me it will shrink. You can feel confident that, by implementing a suture control program, you will thin your suture inventory and gain the ability to trend, track and control the procurement process.