When evaluating trays and kits, is the sum of the parts worth it? - Operating Room

Finding the right balance between optimal use of pre-assembled medical kits and prudent budget-conscious austerity can pose a paradoxical dilemma for hospitals in an era of conflicting trends.

One school of thought argues that using a pre-packaged set of products for specific procedures can help ease the nursing shortage by trimming the time and effort needed to find the right products for a particular procedure, pick them off the shelves and organize the procedure trays individually.

Yet this idea appears incongruent with another trend dominating healthcare--the avoidance of expenditures management deems to be extravagant, which in the case of custom kits and trays is the perceived cost of convenience.

Mary Lou Schroeder, a consultant with Milwaukee-based Kowalski-Dickow Associates, has a couple suggestions to help hospitals determine whether they are getting the best value from custom procedure trays and other pre-packaged kits. The first is for hospitals to evaluate every procedure tray component to determine which items should be kept and which ones should be discarded.

"Conduct a cost-benefit analysis when deciding which kits to use," she advises. "Estimate how much it costs to reprocess items internally as opposed to having disposable items. Scrutinize every item in every kit and see what you can do without. Why include products in a kit that you already stock? Is the extra ten seconds it takes to grab something off the shelf worth the extra cost of having it in a kit?"

Another pragmatic step in kit utilization is to order procedure-specific packs for the OR and cath lab instead of packs based on physician preferences, Schroeder said.

"For every [laparoscopic cholesystectomy], there might be six or eight packs based on what each physician wants," she said. "Physician specific packs are not cost-effective."

Of course, getting physicians to standardize on products is easier said than done. But Schroeder maintains that getting them involved in the decision-making process goes a long way toward culling out redundant products.

"We're seeing physicians providing more input into the surgical budget, collaborating with non-physician staff--it's a group effort," she said. "Physicians understand that things are costing more. If lap choles are a high-volume procedure, they want to know how much it costs and it's very telling. Although there are still pockets of physicians who want their choice no matter what, their numbers are shrinking."

In return for eschewing personal brand preferences, materials managers could work out arrangements for physicians to still have some reasonable choices for procedure trays.

"It's a compromise," she said. "It depends on the contract, but perhaps they could have their choice of trocar inserted into the pack. Instead of being picked. It would have to be one that they're all reasonably happy with however."

Unwrapping the kits

From the vendor's perspective, they are at the customer's command when it comes to assembling custom procedure trays and kits. If there's any rigidity in the kit or tray design process, it almost always comes from the hospital, manufacturers say, though there are occasional exceptions.

"Decisions regarding which components should be included inside the custom tray are made based on usage--if the item is used by most every doctor on most every procedure then it is typically put inside the custom tray," said Judy Barkhurst, director of marketing for Powell, TN-based DeRoyal, a major tray manufacturer. "That said, the inclusion of a component inside a custom tray also depends upon its price and availability- whether or not it can be acquired and sterilized along with the other tray components."

Tray- and kit-making decisions usually involve a sales rep, the nurse in charge of the procedure, as well as a representative of materials management. But she added, "Each facility is different in who gets involved in the quoting of custom trays."

Even though tray designs vary from facility to facility, there are some common denominators, Barkhurst said, mentioning basic back table items like bowls, basins, cups, towels, suture bags, electro-surgical pencils, syringes, blades, needles and needle counter boxes.

"Many customers also like to include disposable drapes and gowns inside their trays as well as procedure-specific items such as suture, drains, punches, saw blades and ligaclips," she said.

That disposable drapes and gowns are staples of pre-assembled kits shouldn't come as a surprise to anyone with context on how the concept started. It was the demand for single-use drapes and gowns that launched the disposable kit trend back in the early 1980s, noted Mike Kelly, vice president of marketing and sales operations for Dublin, Ohio-based Cardinal Health.

"As customers began using more single-use drapes and gowns, they saw the opportunity to add products that would help them Streamline their operations," he said. "That demand turned into a $1 billion marketplace."

Cost vs. convenience

Custom procedure tray manufacturers are quick to defend and promote the system as more than a mere convenience. In fact, they are touting it as a valuable service that offers hospitals time, labor and storage efficiencies that contribute to their bottom line.

"Think of all the picking that goes into each procedure--not just sterile products, but the non-sterile items that are supplied," said Tom Pistella, president of Mundelein, IL-based Medline Industries' sterile procedural tray division. "Someone has to store, load and pick. If the goal is to make rooms run efficiently, having all the supplies ready when there is a trauma really helps."

In that sense, custom kits and trays represent something of a solution to healthcare's chronic nursing shortage, vendors say. Eliminating product handling chores from the nurses' workload means they can focus on what they are trained to do--caring for patients.

"If hospitals had excess labor, they wouldn't need [custom procedure trays]," Pistella said. "But that's not the case. Some hospitals use night shift nurses to pick products for the next day, but they can't always do it, which means the day nurses become very expensive product pickers."

Healthcare's labor scarcity has also contributed to free-standing surgery centers becoming major kit and tray users, Kelly added.

"They are a natural healthcare setting for procedure kits," he said. "These centers are extremely busy and they don't have a lot of people to staff them."

Tray purveyors also point out that using their logistics services maximizes product flow throughout the institution by reducing the number of product "touch points," within the facility and by turning storage rooms into "revenue-generating space." From that aspect, vendors essentially become part of a hospital's inventory management team.

"It requires considerable cooperation between the sales rep, the distributor and the healthcare facility to monitor usage patterns for each custom tray," Barkhurst noted. "Decisions must be made regarding [quantity] to ensure product supply. Additionally, due to the extreme variation inherent in managing raw materials and manufacturing custom products, maintaining consistent stock is a challenge and must be monitored continuously as well."

Web-based tracking

Manufacturers realize that hospital personnel want to have the ability to follow inventory status themselves as well. Currently, both Cardinal and DeRoyal offer Web-based tracking systems that allow materials managers, OR directors and department heads to keep tabs on utilization patterns from their own computers.

Although Cardinal and DeRoyal have been offering their respective versions of online kit tracking for a couple of years, hospital adoption and usage of their systems has grown dramatically over the past 18 months or so, both Kelly and Barkhurst say.

"From the customer's perspective, it's scary for them when they add more kits because they lose visibility of the products," Cardinal's Kelly said. "With our Pack Manager program, customers can see what products are in each kit, any changes that are made, prices and inventory status."

Similarly, DeRoyal's Optimizer program allows customers to view a list of custom procedure tray components and change the contents and quantities of each. It also has a function that lets users perform a "what if" scenario to determine the impact a deletion or addition would have on new or existing trays.

Not to be left out, Medline also recognizes the need for a Web-based program and plans to introduce it by late this year or early 2004. "We are making an investment in that," Pistella said. "We will provide an interactive program with a lot of functionality. It's the wave of the future."

COPYRIGHT 2003 Healthcare Purchasing News
COPYRIGHT 2003 Gale Group