Bar-code technology is sweeping across the surgical industry, these strange sequences of numbers and vertical scans popping up in some of the most unlikely places and producing uncanny results. Patient wristbands. Supplies. Instruments. Surgical sites. Syringes. All to better track and monitor your people, your places and your things. Who'd have thought that you could scan a bar code to

• access post-op instructions or dosage information by scanning a patient's wristband;
• reorder supplies and then keep those supplies safe and secure;
• be certain you're performing the right procedure on the right patient on the right site;
• be certain you're administering the right type and dose of anesthesia; and
• track check-in and discharge times by procedure, recovery times by procedure, and which surgeon performs procedures most efficiently?

Surgical facilities are slapping bar codes on just about anything that needs to be measured or tracked or counted. You can use the technology to increase case efficiency, improve patient safety and decrease supply expenses. If you aren't taking advantage of bar coding, here's advice on getting started. And if you already are, read on to ensure you're implementing the latest the technology offers.

Reduced supply costs
Recognizing the presence of bar-code technology these days is not as simple as looking for hand-held scanners and infrared beams. Just ask the surgical residents at the Medical University of South Carolina in Charleston. Automated supply cabinets were installed in the facility's surgery center to cut down on supplies being pilfered. The cabinets put an end to the nickel-and-dime thievery - and uncovered more than $200,000 in unused, billable supplies.

"I ran a report on our inventory and found a sizable amount of items weren't moving off our shelves," says Angela Czapala, RN, MHS, CNOR, the nurse manager of ambulatory surgery for MUHS. She discovered orthopedic plates, screws and grafts were collecting dust; all things, she says, "our surgeons of course had to have."

Ms. Czapala says the automated supply cabinets she installed in each of MUHS's seven ORs let her "see everything that's being used daily." She says knowing the exact amount of supplies used has increased the capture of billable charges, decreased outdated supplies and maximized accuracy in setting par levels.

Staff use computer modules at each cabinet to key into the system, call up the name of the patient about to be operated on and identify supplies needed for the case. They then highlight a specific supply, take the amount they need from the cabinet's shelf and push the system's "take" button a corresponding number of times. Let's say, for instance, one of your OR nurses needs a pair of extra large latex surgical gloves. She would key into the system, grab a pair of gloves and push the button on the shelf once.

The same push-button concept can be applied to larger supply items that won't fit in automated cabinets. "We found the clinical community wanted a tracking system that was completely hands-free," says Rob Sobie, vice president of marketing for supply automation, Cardinal Health Pyxis Products. These products offer the Just-In-Time remote Business Utilization Device (JITrBUD), a system comprised of individual buttons affixed next to supplies in facility storerooms.

Mr. Sobie says the Pyxis JITrBud scanning system runs about $8,900 for facilities that have a supply database in place. The cost jumps $30,000 to $40,000 if Pyxis has to establish a central supply database.

Ensuring the proper dose
A compelling application of bar-code technology in the surgical setting: You can use it to track and check anesthesia doses. Here's how one such system, developed by Docusys, works. Pharmacy units prepare syringes before surgery, creating bar-coded data carriers called Syringe Label Cradles (SLCs). Pharmacists assign each SLC - which resembles a bank ATM card - to a specific medication, place them in small plastic bags and ship the bags to the OR. Anesthesiologists then snap labeled syringes into corresponding SLCs when preparing their medication drawer for the day's surgical schedule.

During surgery, anesthesiologists slide the SLC along the rails of an electronic reader, dubbed DocuJect, and pause for 1.5 seconds when the syringe reaches the injection port. That delay activates DocuJect; the system reads the encoded SLC, identifies the contents of the syringe and instantly accesses patient and drug databases to confirm proper dose administration. A visual or audible warning alerts clinicians before an adverse drug or medication event could occur.

In addition to improving patient safety, the system captures anesthesia charges that might otherwise be missed, says Joseph Fontenot, MD, anesthesiologist at Providence Hospital in Mobile, Ala. He says Docusys automatically records the medications administered during surgery, creating a clear medical record of billable charges.

Docusys runs in concert with existing anesthesia information software and generally costs between $20,000 and $30,000 per OR, says the company.

Preventing the wrong surgery
Of all the adverse events in healthcare, none will land your facility in the courtroom or on the front page faster than a wrong-site, -surgery or -person mishap. AMTSystems designed Surgichip to prevent such errors. Surgichip is a 2-inch by 1-inch label containing up to 256 bits of information, storing the essentials of a medical record: patient name, sex and birth date; operating surgeon; procedure date and type; and the surgical site.

Using Surgichip enhances the traditional protocol of writing "yes" on the correct surgical site, says Todd Stewart, vice president of business development for AMTSystems, because that simple notation doesn't provide the OR team with the procedure's pertinent information. According to Mr. Stewart, Surgichip also documents the verification process at the point of care with time/date stamps that are recorded in the system.

Staff still need to follow proper pre-op verification protocol to ensure the technology is effective. Here's how Surgichip works.

• Scheduling. Staff create the tags, scan the bar-code and confirm the displayed information when patients call to schedule appointments.
• Pre-op. Pre-op staff scan the Surgichip using a mobile computer terminal or a PDA-style device. They confirm the surgery information with the patient and the patient's chart, affixing the chip to the surgical site with an adhesive patch. The interface with the patient is a critical aspect of Surgichip's success, says Mr. Stewart, because it is a "double-check that will help alert staff to a problem."
• OR timeout. The surgical team scans Surgichip during the OR timeout to make sure everyone is on the same page, says Mr. Stewart. The team verifies the procedure, site, side and patient ID for accuracy before the chip is removed.

Surgichip uses a facility's existing computer infrastructure, says Mr. Stewart. He says the cost of the technology ranges from $8 to $12 per case in the first year of implementation to cover the cost of software, a printer and a coder. After the start-up costs are covered, says Mr. Stewart, Surgichip runs between $3 and $5 per case.

Smoother patient flow
Jeff Blatz, vice president of development for Medicon, created a patient tracking system that measures just about anything: check-in and discharge times by procedure, recovery times by procedure, and which surgeon performs procedures most efficiently.

The system is also used to define and analyze specific time slices of the surgical schedule, so "you'll easily be able to tell when you're busiest," says Mr. Blatz.

Here's how the tracking system works. Patients receive bar-coded wristbands upon check-in; staff scan the wristbands as patients move from room to room; and the system automatically displays the patients' names in corresponding grids on LCD screens throughout the facility.

You can avoid potential bottlenecks because you can determine how many people are in pre-op holding rooms, ORs and the PACU by simply glancing at a display. The easily deciphered display also eliminates the need for constant phone chatter to determine patient locations, says Mr. Blatz.

Christine Rich, director of the business office for Parrish Medical Center in Titusville, Fla., reduced the average 30-minute pre-op wait at her facility by implementing the patient tracking system. She says the system cut the wait times in half and provides powerful patient-flow data. "I now know exactly where and why patient delays occur in our facility because they are documented in the system," she says.

Medicon's program runs on PC-based applications (Windows 2000 or later) and costs about $50,000, according to Mr. Blatz. He says you'll also need a PC and bar-code scanner ($140 each) at each location you wish to track patients, and a document scanner ($80 to $300) at the reception desk to input patients' identification materials.

Instrumental change
Facilities also keep watch on instrumentation usage. Donna McLaughlin, sterile processing manager for the Fort Sanders Regional Medical Center in Knoxville, Tenn., tracked surgical tray usage to reallocate $8,000 worth of instruments throughout her facility. Several members of the hospital's OR team told her many instrument sets were opened but unused during surgery. Ms. McLaughlin confirmed the report with a quick check of tracking data and consolidated the sets.

The result? Staff opened one set per case instead of four. "I put the extra instruments back into the inventory system, and other areas of the facility used the items instead of going out and buying more," says Ms. McLaughlin.

According to Ed Becker, president of Materials Management Microsystems, you implement such a system by scanning instrument sets at each phase of the processing cycle - the decontamination area, before being washed and when the set is reassembled after sterilization. "Bar coding systems count instrument usage," says Mr. Becker, "enabling facilities to determine when sets are due for preventative maintenance."

He says most outpatient centers can track instruments with one computer and one scanner at a cost of about $30,000.

Getting started
The benefits of bar coding - both to facility performance and patient safety - are compelling, but less than 2 percent of healthcare facilities use the technology, says the FDA. "Get started by printing wrist bands for patients as soon as they walk through the front door, even if the bar codes aren't yet activated in all areas of the surgical path," says Debbie Murphy of Zebra Technologies. "Simply creating the bands will let you eventually leverage them throughout the entire facility."

Installing the latest tracking devices also sends the right signal to those scanning the classifieds. Says Ms. McLaughlin: "I wouldn't even consider working at a facility if bar-code technology wasn't available."