Hospital OR Monitor

Accreditation Tips
Preparing for JCAHO's Tracer Survey
In a tracer survey, JCAHO surveyors trace the path of patients from pre-op to post-op, visiting each area a patient touches until they've audited a patient's entire surgical stay. Surveyors test staff they encounter along the way about facility policies and agency standards. How do you prepare for such a start-to-finish survey?

"Educate, educate, educate; the more everyone knows the better," says Peggy Abbott, assistant vice president for administrative services at Ouachita County Medical Center in Camden, Ark. Ms. Abbott started seven months before surveyors would arrive. Here's what worked for her.

• Walk the line. Make sure line employees - those who care for patients on a daily basis - are prepped and ready. "Staff that aren't in leadership positions might freeze when a surveyor approaches them," says Ms. Abbott. "Talking to line employees broke the ice about the process."
• Brand an icon. Ms. Abbott emblazoned her memos, letterhead and intra-departmental envelopes with a red phone. Her staff soon realized what the icon meant: this is an important JCAHO document and a must read. As the date of the survey approached, she printed the red phone on orange paper - a color the hospital's CEO had established as a facility high-alert signal. Ms. Abbott typed a one-line JCAHO tip or fact on the orange sheets and pasted them all over the hospital. Literally. She put them up on posts, bulletin boards, walls and even in bathroom stalls.
• Play games. Learning is so much more effective when it's fun. Ms. Abbott incorporated JCAHO-themed topics in crossword, word-match and jumble word puzzles that appeared in the hospital newsletter. Every employee who returned a completed puzzle received two free meal tickets to the hospital's cafeteria; Ms. Abbott then picked a winner out of the completed entries and awarded the employee a $10 prize.

She also made a habit of dropping in on departments for impromptu JCAHO quizzes. She'd ask individuals, or departments as a whole, 10 questions and would award small prizes - a soft drink, meal ticket or candy bar - to those who answered more than five correctly.

• Plan special meetings. The hospital's administration gathered all department heads in a high-end boardroom for two hours a day in the weeks leading up to the survey. "The room was a place our staff usually doesn't get to see, so that set the meetings apart as something special," says Ms. Abbott. "But more importantly, we saw the light come on in people's faces with respect to what a tracer survey really meant. With everyone together and communicating, the interlinking of our departments became apparent."
• Use JCAHO. Ms. Abbott signed up for JCAHO's Continuous Service Readiness Program (CSR) and found it to be a huge help. The rep assigned to her facility staged dummy tracer surveys and forwarded daily updates from other hospital administrators who were in the process of being surveyed. An annual membership costs $5,000; Ms. Abbott paid $1,170 per quarter and says it's worth every cent. "There wasn't a person in the organization who didn't know when the surveyors were coming and what they would be asking," she says.

- Daniel Cook

Mr. Cobb (writeMail("[email protected]")) is vice president of systems development for Surgical Information Systems in Alpharetta, Ga.

Improved Purchasing
Simple Ways to Trim Your Supply Costs
Hospitals around the U.S. throw away thousands of dollars each year on avoidable supply expenses. Here are some tips on improving your purchasing process.

• Eliminate monthly purchase orders. According to a 2003 study by the VHA, it cost a hospital between $70 and $140 to generate a single purchase order, depending on how automated its purchasing system is (the more man hours required to input data, the more expensive). Most facilities are also locked into long-term supply deals. You know, on average, the amount of supplies you need to perform your caseload on a monthly, and therefore annual basis. Instead of writing POs each month for supplies, write one large PO on an annual basis. If you spend $1.2 million annually on sutures - write a PO for that amount and have your supplier draw off that single PO on an incremental basis. By eliminating the need to write monthly POs, you can save your hospital a lot of unnecessary expense.
• Use a purchasing agent. Your hospital should have a purchasing agent dedicated to the OR environment. The most effective purchasing agents have a clinical background and understand the impact their buying decisions have on the bottom line. Let's say a hospital strikes a deal with a vendor on a facility-wide basis without measuring the clinical equivalency of the company's products against what's already being used in the OR. The staff may refuse the new supplies, causing the hospital to pay list price for items the OR teams will actually use. A purchasing agent located in the surgical department would eliminate this possibility.
• Build buying power. The biggest factor in reducing supply costs is establishing buying power with vendors, and there is no better way to flex your purchasing muscle than by adding volume to orders. If your facility is part of a large health system, work with the other OR directors within your system to combine the vendor contracts. It's very common for one hospital within a system to get a great price on supplies while its sister facility is getting fleeced - from the same vendor. Hospitals in the same health system should have one agreement across the institutions. So what do you do if you work at a small, individual hospital? Look for facilities in your area with specialty niches that require supplies similar to your caseload. Join forces and form your own buying group. Coordinating purchasing efforts with neighboring hospitals will empower even the smallest facility.
• Get tools on consignment. When you buy a car, do you pay extra for the key? Of course not. The same should hold true for surgical tools. If you use a tool for 200 cases a year, you should be provided that item on consignment instead of owning it. For instance, let's say the orthopedic surgeon at your facility does at least 200 hand implants a year. You have to pay for the cost of the plate and screws for the implant, but why should you pay for the specific tools used to place the screws? Vendors of the implant will supply necessary tools at no cost, but most OR managers never think to make that request.

- Drew Cobb