Stacy Danahy, RN

Outpatient Surgery Magazine: What are your thoughts about the supply chain, especially on the ASC side of things — how it's been through the pandemic, where it stands now, and any lessons learned from the past couple years you’ll be applying going forward?

Ms. Danahy: The funny thing about it is, if I look at supply chain right now, we're in pretty good shape. The only major issues we're having at our centers are medications, and that's an example of the basic supply chain methods that everybody should keep in place and not take for granted.

Take, for instance, your crash cart and emergency medications. At an ASC, you're checking your crash cart monthly looking for outdates. You really should be looking two to three months out and flagging it and ordering it then. If you do, you're not running out, but if you're waiting until the month-of, you're not going to be able to get it due to back orders. So being on top of that, flagging it in advance, making sure you're doing your checks and ordering timely is key.

We're not having any issues with PPE. The medication issues, I don't think, are due to COVID. I think it's more recalls. That’s always been a pharmacy issue.

Which medications?

A lot of the crash cart drugs are typically on backorder. Fentanyl is one of those meds that's hit or miss. It seems like if you order three weeks out, you're okay, but if you wait to order it the week-of, and just keeping two weeks supply on hand like most centers do, all of a sudden the refill is three weeks out. So you need to be three weeks ahead of schedule on fentanyl.

In what other ways is the supply chain impacting your surgery centers?

Honestly, I was concerned with inflation and cost of living and supply chain and costs going up. But I was talking with one of my administrators, and she said, ‘We've actually started saving money. Our cost per case went down $100 on total knees.’ And I'm like, really?

Because of the back orders that happened during COVID, she said they worked through a few different suppliers and were able to find alternatives that ended up being less expensive, and that the docs were happy with. So they're actually saving money.

Where did that $100 savings come from, specifically?

Some of the sutures were on backorder. One surgeon was the only doc who was using pop off singles, and we couldn't get them, so he changed his practice. We were able to get him to change to a different suture, and able to get the supplies he needed to do the case. He just had to change a little bit of his technique. It was a huge cost savings — and it was because he couldn't get what he wanted.

We often hear that surgeons are loathe to change their practices, but it sounds like that surgeon was pretty openminded about it.

Actually, he wasn’t at first, but due to the pandemic and supply chain issues, we had no other alternatives. We said to him, “Hey, these are options, and this is all we have available. We can get this in on a regular basis. Are you willing to switch?’ And he said, ‘All right, if I have nothing else, I need to make the change.’ It was great. We actually ended up saving money instead of spending more.

We've heard from some administrators that the supply chain has stabilized, but that things are more expensive. It sounds like diversifying your suppliers is a good idea, though.

You need to shop a little more, diversify your suppliers, and also diversify some of your supplies. When things are on backorder, we're finding alternatives that ended up being less expensive. I would have assumed it would have been the opposite, but it’s not. It feels like we're spending more for bread, milk, everything else, so I’ve been surprised.

Overall: Stay true to the supply chain. If you allow it to get ahead of you, you'll fail.