RMV->)When it comes to suture, administrators in physician offices, clinics, ambulatory surgery centers and hospitals share many concerns: inventory, cost containment, standardization and supply management. To help you better manage this high-cost inventory item, Outpatient Surgery surveyed readers about suture-purchasing habits, preferences and ideas for cost-containment. Here's a report, based on the 114 responses we received.

Purchasing: vendor vs. product
Well more than half (60.7 percent) of respondents say they choose their suture vendor based on a contract or a buying group. While surgeon preference accounted for only about one-fourth (24.1 percent) of the reasons a suture vendor was chosen, surgeon preference (78.8 percent) was easily the biggest consideration when deciding which suture to buy.

Compared to five years ago, 40.5 percent of respondents are using more and 42.3 percent are using the same amount of sutures and wound-closure devices; but 69.6 percent are paying more for sutures and wound-closure devices.When asked if staff and surgeons know what suture costs, 62.2 percent said yes.

Buying groups or group purchasing organizations, such as Amerinet, Premier, VHA, MedAssets and Novation, significantly affect purchasing power. With contracts, suture and endomechanical devices are often combined with the large vendors such as Ethicon and US Surgical for the best prices. An comparison of two suture manufacturers may be an opportunity to consolidate and evaluate your suture needs and standardize your sutures.

Be sure to compare "apples to apples" when evaluating products to avoid frustration with the staff and physicians for successful transition if changing manufactures for cost or contract reasons. The cost of the suture is often related to the quality of the needle. A cardiovascular or ophthalmic needle is more difficult to produce, and the manufacturer's price is reflected in suture cost. The sharper and more durable the needle, the more you will pay.

Inventory management
Two-thirds (66.7 percent) of those responding to the survey would like to be able to stock sutures on consignment - especially for surgeons who bring cases to their facilities only occasionally. "We have an ophthalmic plastic surgeon who comes only occasionally and uses very expensive sutures. It would be nice to have these on consignment," said a reader.

Said another: "We are starting up with plastic surgeons and are not certain that they will continue to bring cases to our facility. Buying suture on consignment is an ideal way to conduct a trial period to determine commitment."

For procedures done so rarely that your suture may expire before you use an entire box, buying suture in smaller quantities may be attractive. More than half (58.6 percent) of our respondents said they'd like to buy suture in packets instead of boxes. "There are several very costly sutures that we need to have available 'just in case,' but usually the box expires before you get a chance to use all of them," says one OR manager. "It would be nice to maintain a small par level on some odd sizes of suture and needles that are rarely used," says the head of a hospital surgical services department.

But when I spoke with my suture sale representative, Brian Bradfield, I found out that would be unrealistic. The logistics of thousands of suture products make the process prohibitive. He did offer some suggestions that could help decrease inventory problems.

• For those slow-moving sutures that may be surgeon specific, purchase the smaller-quantity box of 12 versus 36.
• To watch how fast or slow a suture box is used, write the date on a bright-colored sticker on the suture box and watch for turnover time. Our computer inventory system tracks the date purchase order for each item and can also run reports of usage. This can help with par levels for reordering and help determine when a suture can be considered dead inventory and deleted from stock as well.
• With surgeons working in many sites, such as the local hospital and ambulatory centers, a good relationship between facilities can be critical when dealing with back orders or overstock.

"Goodwill between local hospitals and surgery centers is a must," says Andy Tillman, material manager at Century Surgic-al Associates in Pittsburg, Kan. "It helps when you run into a high volume of surgeries and have a suture on back order."

• Closely manage suture inventory to coordinate all these issues. In our center, a scrub technician is involved with ordering and closely monitors the suture cart. She is knowledgeable about suture, how rapidly it is used and works with the materials manager to keep a comfortable "just in time" inventory.
• If you can add case volume by bringing on an expensive, little-used suture, do it. Some-times, slow-moving inventory is the cost of doing business.

Packaging and reprocessing
Several readers asked about repackaging, reprocessing and reuse of unused suture. From the research I found, the manufacture of the suture couldn't stand behind the product if it has been reprocessed. Tracking the use of reprocessed suture is also a problem; when post-op problems arise, it makes it difficult to determine the cause.

Many readers remember sut-ure in multiple plastic packets: If the inside packet was unop-ened, it was still sterile. My sales representative noted that process had been changed years ago to decrease the environmental waste that was incurred by two plastic packages.

Economize your suture usage
When you emphasize speed or room turnover time, often suture and other supplies are opened quickly and wasted because they were not needed.

We've all dealt with a surgeon who expected all the sutures on his preference card on the table at the beginning of the procedure so he would not have to wait for the circulator to open it or get it from the suture supply area. If staff and surgeons communicate, staff can wait to open suture until the need has been determined.

We've also all probably worked with a scrub nurse who wanted to a full compliment of suture for the case for which she was scrubbing. She was under the mistaken impression that if you had to ask the surgeon what he wanted, you didn't know his routine. That's the past; no longer can we afford such behaviors. Surgeons and staff need to understand how critical it is to decrease waste and cost. Profit-sharing checks or extra equipment bought with the savings facilitates "buy in" from the staff and physicians.

Joyce Danels, RN, the director of surgery at the Twin Rivers Medical Center in Kennett, Mo., offers this tip: "You have to educate your staff and your surgeons on the cost, the utilization and the benefits of standardization of the most common suture used. We limit the initial amount of suture opened on a procedure. We have suture available in the room but it is not opened until requested. We keep the preference cards updated on a weekly/monthly basis. We have a central location for suture. A person is assigned to keep track of the suture. She does the ordering. She has her par levels set. Any surgeon wanting to trial a new suture knows to go to her."

Kecia Weimer, the OR manager for the Ambulatory Surgery Center of Burley, in Burley, Idaho, also notes: "Suture is not opened if there are any questions about what the surgeon will use in that particular case. It does not take that much time to have the circulator open suture once the surgeon has specified what he/she wants."

Ever-changing
Whatever your suture concerns, this ever-changing market will bring more innovations. Suture with an antibacterial coating is now available, and even more products will be available this year.