Can something as simple as a case cart help reduce supply-related costs, which in most surgical facilities account for 20 percent of case expenses? Facility managers we spoke to called case carts four-wheeled wonders. They improve space management, relieve clinical staff of inventory management duties, improve charging accuracy, reduce excess supplies and eliminate waste. But, they cautioned, they're only as good as the effort you put into them. Here are some top tips for maximizing your case carts, so you can minimize supply costs.

Separate supplies you may not use. Put all items that the surgical team may not use on separate "hold/do not open" shelves on your open case carts. Doing so means you'll spend less time opening unnecessary supplies before surgery. "In the past, we picked supplies and put them anywhere on the cart, and we would open every item in preparation for the case, whether we used it or not," says Jennifer Misajet, RN, BBA, CNOR, director of surgical services at the Greeley, Colo.-based North Colorado Medical Center. "Our open case carts made it appear as if we needed everything."

Document and evaluate all problems. Put an inspection sheet in every case cart so that your circulating nurses and scrub techs can document every variance that occurs during surgery - such as missing supplies, wrong items, multiple names for the same item, incorrectly labeled bins and misplaced items. Once a month, meet with your team to assess the problem areas and calculate the picking error. Share the data with materials management, all physicians and the OR staff, says Ms. Misajet. This, she says, helps everyone take responsibility for supplies and stay on top of changing supply needs. "Sometimes everything is picked correctly, but we discover that our pick list is outdated," she says.

Maurine Weis, director of surgery with Flower Hospital in Sylvania, Ohio, takes her own documentation system a step further by following through on problem areas at the end of every surgical day. "We document each supply variance, and at the end of every day a specially assigned coordinator follows through with the circulator and surgeons to determine the causes," she says. The coordinator also evaluates the problems in the context of historical errors and, armed with all of this information, determines if the issue is a fluke or requires action, like a change in preference cards and pick lists. "The essential thing is to make sure preference cards are accurate," advises Ms. Weis, "and this system helps us do that."

Make terminology consistent. One of the most common causes of case cart picking errors is inconsistent terminology. At the most basic level, compare the descriptions on your pick lists with the labels on your case cart bins, and update them to ensure that all terminology is consistent. In addition, suggests Ms. Weis, be cognizant that terminology problems result from a lack of knowledge. "There is no substitute for experience and education, because we'll always have OR personnel calling something a tomato and central supply calling it a to-mah-to," she says. To address this, says Ms. Weis, consider elevating the position of supply management if at all possible. "These personnel are typically underpaid and undervalued," she says. "In our hospital, we're lobbying to get an experienced surgical tech in our instrument room who knows that you can substitute a 14-inch Adson for a 14-inch Allis if needed."

Consider a delivery system. When you closely evaluate the hours spent picking and the dollars spent purchasing supplies, you may have a case for upgrading from traditional custom packs to more comprehensive delivery systems, if you don't use them already (see "Delivery Systems: Is One Right For You?"). These systems - which contain nearly every supply you'll use in one self-contained procedure-specific module - can save picking time and supply costs, because the suppliers can pass on savings from the sometimes heavily discounted bulk pricing they obtain. "We were able to make a compelling argument for these procedure-based modules, because we had two people doing nothing but picking as many as 60 individual items per case," says Ms. Misajet. "Now we get everything from drapes and gowns to anesthesia circuits to mops, trocars and sponges in one big procedure-specific box, and our inventory has declined substantially because we just have a few of each item on our shelves now, strictly for backup." Ms. Misajet says her facility's two picking techs have moved on to fill other functions in the instrument assembly and decontamination areas.

Involve and educate everyone. Get the materials management and OR personnel together in face-to-face meetings as a matter of routine. "We meet with materials management weekly and talk about issues like par levels, what to bring in on consignment, our variance reports and other things," says Ms. Weis. It's also essential, she says, to educate and cross-train materials management and OR personnel. "The materials management folks need to understand what it means when the pressure is on in the OR and instruments are not properly processed," she says. "They also need to know why it is important for case carts to be filled, relatively lightweight and in good working order." Conversely, she adds, the OR personnel need to respect the very big job that the materials management staff has to undertake, make every effort to communicate with them consistently and accurately, and to pack up dirty instruments carefully so accidents don't happen during unpacking, like dirty sharps falling on feet. "Safety issues don't disappear with case carts," she adds.