BLESS THIS MESS Having a centralized supply area is key to good materials management so nurses and doctors can find what they need when they need it.

If your OR equipment closets are a mess and your nurses and techs have to hopscotch through dogpiles of boxes and bins to find the necessary surgical supplies, it's time for you to get organized so your staff can pick cases more efficiently. Fortunately, there are plenty of inventory systems available to help you increase your OR efficiency and on-time starts. From case carts to just-in-time custom packs, here are some of the ways to get a grip on your inventory.

• Case carts. Case carts were the go-to system for 51% of the 64 surgical facility managers we surveyed, with another 5% saying they are considering making the switch. Users say they love the efficiency and convenience of picking supplies from a central location and transporting them to the OR on the wheeled carts. 'The cart flows through materials management to sterile processing and then to the OR,' says one manager. 'One cart eases the process.'

Choosing a cart, though, isn't as simple as picking something with some shelves and wheels. Users are split between the use of open or closed carts, with 58% choosing open and 41% using closed. While closed carts can be heavier, more expensive and harder to clean, users say they like that they can be used to transport both clean and dirty instruments if the carts are traveling the same route to and from the sterile processing department.

• Custom packs. Another option — which some facilities couple with a case cart system — is just-in-time custom packs. About two-thirds of the facilities we surveyed use custom packs.

Mary Radke, RN, BSN, ASC manager of the Dakota Eye Surgery Center in Bismark, N.D., says it works like this: Her center talks with its vendor to create custom packs that include all of the supplies needed for its most common procedures. The center orders the packs depending on its caseload, and the packs are delivered at the start of each week. If an extra is needed mid-week, they can have them shipped overnight. 'We do not have a lot of space for all of the supplies, and this is cost-efficient,' says Ms. Radke 'When we put the bid out for the packs, we priced what it would cost us to have the separate items, and then worked with suppliers to get what we needed at a lower price-per-case.'

Respondents say they love the convenience of the kits. 'Faster set-up, less waste, standardization for staff, cost containment, decreased inventory and easier control of outdates,' are some of the benefits Annette Scagerko, RN, BSN, CNOR, OR program manager of the Westerville (Ohio) Surgery Center lists about her center's custom packs.

Others, though, say that they found just-in-time kits to be 'not very reliable and costly.' 'The ordering process is not ideal,' says one manager. 'There are frequent back orders.'

ASSEMBLY LINE LOGISTICS
Picking Supplies: Case Carts, Custom Packs & Center Core

Before its recent expansion, Elkhart (Ind.) General Hospital's assembly-line case cart system worked like this: Sterile processing techs hand-picked supplies for each case and placed them onto carts, which then worked their way to the OR, picking up additional supplies from unorganized storage areas along the way. When the hospital added 10 ORs, a hybrid OR and 3 endoscopy suites, Pamela Goddard-Dunfee, RN, MSA, CNOR, executive director of surgical and cardiovascular services, and her team refined the case cart system. Sterile processing techs still pick supplies needed for each case from the sterile processing storage area and load them onto the case carts, but a couple of key changes have made picking cases easier.

First, Elkhart added custom procedure packs for certain procedures. The custom packs, which include all necessary supplies for such common cases as a total hip repair or a general gynecology procedure, are housed on shelves in sterile processing. 'The techs just grab the labeled custom pack off the shelf, load it onto the cart and it's ready for surgery,' says Ms. Goddard-Dunfee. 'It's greatly streamlined our picking process.'

The hospital also updated its 'center core' area, where staff pick instruments, gloves, suture and other specialty items needed for the case that aren't included on that procedure's standard case cart. The center core is organized by specialty, with supplies kept in clearly labeled bins. 'We also ensured that our carts were small enough to move easily between the aisles, which makes picking the cases that much easier,' says Ms. Goddard-Dunfee.

Before the expansion, staff spent months organizing and standardizing the old center core and sterile processing storage areas. 'We created supply carts that were tagged with where exactly the materials should be placed to work with our assembly-line system,' she says.

They also built in some extra space between supplies in the center core to store new instruments and devices that come along for a particular specialty. 'We can group these new items with their correct cases instead of just placing them on a random shelf,' says Ms. Goddard-Dunfee.

Elkhart also ordered brand-new supply bins. Instead of using a color-coded system, popular in some facilities, they decided to use see-through, labeled bins to store inventory. 'That way, if there's ever a need for a new bin down the road, it's easy to add it in without worrying about matching with the color-coordinated system,' says Ms. Goddard-Dunfee. 'Plus, the bins let staff quickly see the supplies sitting on the shelf and if any inventory is getting too low.'

Once in the OR, if the surgeon needs more suture, an extra catheter or a new pair of gloves, Elkhart houses these soft goods in the ORs behind closed-door cabinets. 'This protects the items from contamination, and lets a nurse simply grab the extra items during a case,' says Ms. Goddard-Dunfee.

— Kendal Gapinski

• OR storage cabinets. Having a centralized supply area outside of the OR is essential. Only 15% say they keep all of their supplies and instruments in the OR themselves, while 63% say they keep few or no supplies in the OR. A lack of space in the OR and the risk of supplying several rooms with duplicate materials is the driving factor behind this decision, say several managers.

Elkart (Ind.) General Hospital, profiled in the story to the left, keeps some extra supplies in the ORs behind closed-door cabinets. And some note that their smaller specialty centers make storing supplies in the OR to be the most efficient option. 'We're an ophthalmic surgery center with 1 OR,' says Katie Guglietta, RN, clinical director for Snowden River Surgery Center in Ellicott City, Md., 'so it's very easy to maintain supplies in the OR.' OSM