If you're among the growing number of surgical facilities lured by the clinical, logistic and financial benefits of procedure packs, you'll want to know how to use these pre-packed bundles of surgical supplies to their best advantage, especially on your high-volume procedures. To help you do that, we asked longtime users to share what's worked for them.

1 Save time. When you consider that the OR minute can be the most expensive minute in healthcare and that pulling supplies is a time-consuming process, it's not surprising that the time you'll save is the chief payoff. The speedier pull also contributes to time efficiency once the supplies are in the OR, adds Marlene Brunswick, RN, director of nursing at the Findlay Surgery Center in Findlay, Ohio.

Packs can also mean faster room turnover times and fewer delays between procedures, says Bev Swanson, RN, BSN, CNOR, director of nursing for North Platte Surgery Center in North Platte, Neb. "Time is money. If it can speed up the time it takes to turn over a room, it's well worthwhile."

2 Tidy the supply room. Shelving and managing inventory are more convenient as well. "With limited storage space, it is easier to store the packs," says Joann Forno, RNFA, BS, MPM, CNOR, nurse manager of surgical services for Garrett County Memorial Hospital in Oakland, Md. Supply counts take less time, too, since "there's a decreased inventory of single-wrap items required in the inventory," says Karen Gabbert, BSN, clinical director of the Surgery Center for Kansas in Wichita.

3 Help prevent infections. The packs also provide a measure of infection control, given that the supplies inside are opened and handled fewer times, says Judy Cutten, RN, of the Tulsa Spine Hospital in Tulsa, Okla. "There's less chance of contamination. The more you have to put on a back table, the more chance there is of contamination."

4 Lower costs. A pack's cost depends on the type of procedure it's assembled for, the number you order and the brands you select in the supply mix. "They're cost effective if you spend the time bidding them out and selecting brands closely," says Patrice Spera, RN, MS, CNOR, CRNFA, administrator of the Tampa Bay Surgery Center in Pinellas Park, Fla.

The bidding may be the easy part, as the selection of the pack's contents is a major organizational task in itself. "Procedure pack companies are highly competitive, so the cost is pretty easy to control," says Kevin Gilbert, BSN, director of surgical services at Wenatchee Valley Hospital, Wenatchee, Wash.

5 Customize for procedures. If you're a new surgical facility, it pays to watch each surgeon's supply use for your top procedures closely; but if you've already been hosting the procedures for a time, you may already know what gets pulled.

At the Glasgow Ambulatory Surgery Center in Newark, Del., administrators create packs for the most frequently done procedures - the five podiatry cases in a row they often see, for instance, or the 13 back-to-back hand surgeries.

"We make note of what the surgeons use for their procedures," says materials manager Linda MacGaffin, RN, BSN, CNOR. "Then we look at the common denominators in the supplies and add them to the pack."

Ms. Spera notes that the more you can match the pack to the procedure, the more efficient it will be. "You should use 90 percent to 95 percent of the stuff in your pack every time in order for it to be cost effective," she says.

A regularly scheduled review of your procedure packs' contents is critical to keeping the packs as efficient as possible. "There has to be a continuous audit of packs for integrity and changes," says Ms. Cutten. "Doctors change preferences, and packs take a considerable amount of time to turn around."

6 Work with reps. Let manufacturers' reps watch procedures or even, if the option is available, enlist a member of the manufacturer's clinical staff to work with your surgeons to better understand your facility's processes and protocols. Just remember to stand your budgetary ground.

"We make it real clear to our vendors what our goal is," says Ms. Swanson. "They're always wanting to throw in a little bit extra here and there, and that adds up. But they want your business, so they're pretty good about getting it the way you want it."

7 Get surgeons to agree. Standardizing the contents of your packs is a matter of getting near unanimous buy-in from your surgeons. Good luck. The payoff, though, is worth it: You can use the pack nearly any time a procedure is performed, regardless of which surgeon is performing it. What's more, you won't have to pull individual supplies for procedures you have packs for. It also sidesteps having to purchase two or more variations on the same procedure pack.

Ms. Swanson suggests communicating to your surgeons through the bottom line. "We are for-profit and have physician-owners, so part of what helps is, we do cost comparisons and put the data in front of them," she says. "What it costs for Dr. A to do a cataract procedure with a pack versus what it costs Dr. B. Because whatever supplies we don't have to use and still have a good outcome is money in our pocket."

8 Pull what you can't standardize. While standardization can add efficiency to surgical supplies, keep in mind that each physician and procedure is different. "You can't design a pack perfectly for every surgeon and every situation," says Mr. Gilbert, "so you end up with some extra towels or an unused gown occasionally."

He and others recommend leaving the supplies that can't be standardized, such as gloves and other personal choices, out of the pack and pulling them individually. After all, isn't it better to make a few extra supply pulls than to consistently waste items?

9 Trial instead of erring. Obtain prototype packs from vendors to trial in the OR before agreeing to a purchase or a regular contract. This lets staff make suggestions for improvement before the contents are locked in; once you place an order, it usually takes two months to three months before that stock is depleted and you begin receiving packs with any changes you make.

"During that time, you have to live with what you have," says Ms. Spera, adding that the long wait time for pack changes to arrive at a facility is the most frequently cited shortcoming of packs. "You just have to make the perfect pack the first time."

10 Open at the last minute. If a pack is opened but the case is cancelled, many unreusable supplies go to waste. If possible, use a pack's time-saving advantages to avoid disposing of unused items by setting up as close as possible to starting time. "We won't even open a pack until the patient's checked in and we know it's a definite go," says Ms. Spera.

Remember the big picture
Above all, keep in mind the aim of the efficiency that conveniently packaged surgical supplies provide: The less time you spend with supplies, the more time you have for patient care.