OR Excellence Awards – Financial Management: Living the Mission

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St. Mary’s Regional Medical Center uses cost savings to help care for the less fortunate in their community.


When grateful patients in Central Maine return home from St. Mary’s Regional Medical Center in Lewiston with a successful surgical outcome, the thank you cards they pen aren’t to the finance department. But maybe they should be. The mission of the 233-bed community hospital, part of Covenant Health, is to provide healing and care for everyone, including the vulnerable populations who are suffering the most. “Those values are ingrained into the culture of everyone here, not just the clinical staff,” says Perioperative Nurse Director Janice Nichols, MSN, RN, CNML. “Everyone is always on the lookout to reduce costs in any way possible, because we realize that is what’s needed to fulfill our mission to care for the poor.”

A series of cost-saving initiatives, some of them bottom-up ideas that originated with frontline staff, is expected to produce a total annualized savings at St. Mary’s and two nearby affiliated hospitals of more than $622,000 this year. Those initiatives, and those savings, have earned St. Mary’s the 2022 OR Excellence Award for Financial Management.

One project, going from three joint implant vendors to one, saved approximately $100,000 at St. Mary’s alone, says Shaun Gallant, MBA, the hospital’s perioperative business operations director. The initiative began as part of St. Mary’s protocol to discharge many of its total joints patients on the same day of their procedures. One of the surgeon’s, Boris Kovalenko, MD, was advocating for a robot to assist with the joint replacements, which provided an opportunity for St. Mary’s to get all their implants from that vendor as well.

“We wanted a robot and wanted to standardize implants,” explains Mr. Gallant. “We talked to each of the robot companies and explained that in return for the robot and less costly implants, they would get all of our volume.”

While getting a lower price on implants — the big-ticket item in joint replacement cases — was the main driver for savings, the consolidation also helped with efficiencies in the operating room and sterile processing department, which also saves money. Staff no longer need to be trained in how to deal with meeting three high-quality standards in the manufacturers’ instructions for use. Allowing staff to develop expertise with one implant and having to open only two trays compared to six has improved room turnover times and first case on-time starts. The sterile processing department is hitting their improved quality metrics goals as well, says Ms. Nichols.

The savings initiatives were not top-down ideas. For example, Jacen Saunders in the facility’s sterile processing department has been involved in streamlining instrument trays to improve efficiencies and came up with the idea to switch soaps, detergents and cleaners to save money. The facility’s leadership feels the reprocessing quality has improved because of the switch as well.

St. Mary’s hired Jennifer Wormwood as a full-time operating room technician who oversees the facility’s central core, and she prepares supplies for all the cases. “She’s phenomenal and absolutely knows everything about the instruments and disposables in the ORs,” says Ms. Nichols. She rotates all the stock, makes sure PAR levels are current and regularly brings forward cost-saving ideas. Recently, she noticed that the facility was keeping an expensive antibiotic irrigation solution on the shelves that hasn’t been used recently and has an analysis taking place to determine if it should be removed from the inventory.

We see the human impact of these savings all the time.
— Shaun Gallant, MBA

Longtime nurse Michele Grass, RN, updates all surgeon preference cards. She knows what’s on all of them, keeps them up do date and recommends removing, adding or substituting items based on cost. Ms. Grass is currently streamlining the cards because St. Mary’s will soon open a hybrid OR for vascular procedures, which requires ordering a significant amount of new instrumentation. As she was building new cards and reviewing the existing instrument trays for the new room, she noticed there were omni retractors on the list of new items that needed to be purchased. She recalled that the facility had some of them in storage, which will be used and save the facility about $20,000.

“We’ve thought about adding more people to help with some of these tasks, but we find that having one person do them works best,” says Ms. Nichols.

St. Mary’s is part of a group purchasing organization that also serves Covenant’s other acute care hospitals in the region. The GPO assists Covenant’s value analysis team for surgical services to improve performance and reduce costs. The team includes administrative staff, nurses, surgeons and other frontline clinical staff.

Covenant’s four main values are compassion, integrity, collaboration and excellence. Mr. Gallant says sound financial stewardship fits in nicely with the integrity component. “These aren’t just savings on a spreadsheet for somebody’s profit,” he says. “In this rural community, we see the human impact of these savings all the time.”

“It’s living the mission through identifying cost savings to have the resources to serve the poor in our community,” adds Ms. Nichols. OSM

Saving Money With Streamlined Trays
HONORABLE MENTION
TIME IS MONEY Trays with fewer instruments makes UNC Rex Central Sterilization Technician Sherril Barrett’s job easier and saves her facility money.  |  UNC Health

A UNC Health facility saved an estimated $530,000 after an instrument rationalization program discovered that more than 10,000 tools could be removed from 40 high-volume surgical trays. The instruments were aging, but rarely used, so they didn’t need to be replaced or repaired. Nearly 1,000 of the instruments removed from trays were repurposed and placed on pegboards and in a quarantine cart in case they were needed. The thinning of the trays also resulted in saving about 800 hours of staff time, which resulted in savings of an additional $10,000.

That kind of cost shaving has been particularly helpful during COVID-19, when labor costs are the number one expense for most healthcare facilities at which supply costs have increased as well. “Hospitals have to be more creative with finding ways of saving and repurposing,” says Gretchen Steelman, BSN, RN, CNOR, MBA, category manager for perioperative services at UNC Health. “Evaluating your instruments, not repurchasing what you don’t need and being able to repurpose things from one tray to another can save you a lot of money and time.”

An analytics program helped the facility identify which instruments in trays were used less — between 1% and 20% of the time — and could be removed. Nearly 20% of instruments from each tray were moved by the end of the project. The cloud-based technology was useful because that hard data was incongruous with some surgeon opinions about instruments they categorized as “must haves,” when in fact they were rarely used.

“If you reduce the number of instruments in a tray from 100 to 50, that saves time because it’s fewer instruments the OR team needs to count. There are at least three counts per procedure, so the time savings is significant,” says Ms. Steelman. “It’s also cuts down on assembly time and reprocessing costs in the sterile processing department because they don’t have to touch instruments that aren’t needed. This is especially true if you’ve taken out delicate specialty instruments that take a lot of time to reprocess.”

Time was also shaved from setting up back tables in the OR, and staff appreciates carrying the lighter right-sized trays in rotation to and from the OR and sterile processing department. 

Adam Taylor 

 
 

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