Business Advisor: It’s the Little Things That Count

There’s a lot to juggle at a busy health system with nine operating rooms in which an average of 50 surgical cases are performed each day. When it came to my attention that clinical and operational expenditures were high and didn’t align with our case volume, I decided to do a deep dive into the numbers to identify the issue. What I discovered ended up saving our facility thousands of dollars each month, without sacrificing patient or staff safety. 

It turns out we were spending more than $100,000 annually on instrument repairs and replacements, but I couldn’t initially identify why this number was so high. We also had an increasingly high rate of reported staff sharps injuries and near-miss events, averaging between five and 10 incidents each day.

After some more digging, I discovered the instrument care costs and staff injuries could be linked to the plastic decontamination instrument transportation covers our surgical team used while transporting contaminated tools to the sterile processing department. The covers cost between $6.50 and $7.50 each, depending on the size needed to cover the type and number of instruments used in specific cases. For example, the surgical team used as many as three large covers to transport soiled trays from joint replacement procedures. Using the disposable covers following the 40 to 50 cases a day our facility performed cost us over $3,000 a week.

Utilizing the covers wouldn’t be such an issue if they were non-penetrable, but instruments in the covered trays punctured the protective layer frequently during transport, which contributed to the high rate of staff injuries and near-miss events. At times during transport to sterile processing, the covers would even pop off the trays and instruments would fall to the floor, which increased the risks of broken or damaged tools and staff exposure to contaminated blood and bodily fluids.

I decided to test out the effectiveness of using back table drapes that are already included in our surgical packs to wrap and completely enclose decontaminated instruments and seal the packages with a biohazard sticker. Once the wrapped trays arrive in SPD, the single-use drapes can be thrown away.

Because these drapes were already a part of our surgical packs, we would not be increasing our expenses. By utilizing something we already had in stock, we increased our cost savings by $80,000 annually. We also reduced our annual instrument repair and replacement costs by $60,000, and our daily rate of near-miss events dropped to nearly zero.

That small change resulted in significant savings. It justified the constant effort we make to identify seemingly minor ways to trim expenses that can really add up. Here are a few other ways my facility is looking to save big:

• Selecting a needle size. We currently maintain par levels of two Veress needle sizes for use in minimally invasive procedures based on a patient’s BMI. Physicians’ preference cards list 120mm needles for patients with a BMI of <29 and 150mm needles for patients with a BMI >30 or bariatric patients. We decided it’s not necessary to carry both types of needles, as the 150mm size can be used on all patients. The cost effectiveness of removing the 120mm needles is currently being assessed.

• Consolidating irrigation fluids. We started purchasing and stocking smaller bottles of saline solution. It’s more cost effective in the long run to use two small bottles (500 ml) of solution rather than only half of a larger bottle (1,000 ml) and having to waste the leftover amount.

• Reviewing expiration dates. If we have extra supplies that will expire before they’re needed, we contact sister hospitals who could use the items and reappropriate the costs. If the items are not needed for clinical use, we contribute them to our hospital’s education department or to local medical schools, which find uses for expired items that would have ended up being thrown away. Medical students and residents therefore receive valuable hands-on training with actual surgical supplies.

Don’t ever think something is too small to make a substantial difference in your facility’s budget. If the numbers aren’t adding up, review the monthly spending reports to pinpoint where expenditures are too high. You might be surprised by what you find and use a little creative problem solving to fix the issue. OSM