Supply chain management reduces OR turnaround
Supply chain management reduces OR turnaround
Pharmacy satellite saves time, improves care
When the management at the Evansville, IN-based Deaconess Hospital authorized staff to "make change happen in surgery," the farthest thing from their minds was a faint-hearted fix. "Benchmark the top 100 hospitals," management advised. It was an opportunity the surgical teams had coveted for more than a decade — a chance to place a pharmacy satellite in the surgical wing.
Within a year of the go-ahead the top, an interdepartmental QI team reversed persistent problems in patient care and reduced pharmaceutical costs associated with surgery.
Average response time for medication delivery to anesthesia staff dropped 87%, from 15 to two minutes. On the monetary side, Deaconess saves $32,000 annually through the improvements. (See graph, "Financial Payback on Initial Invest ment," p. 18.)
Joyce Thomas, PharmD, supervisor of clinical services for the pharmacy, notes that surgeons tout the satellite to colleagues in other departments, and due to physician requests, it now serves labor and delivery. All in all, the savings exceed original estimates by more than $140,000. (See "Cost Savings Comparison," p. 18.)
The advance of managed care into Deaconess’ service area erased all doubt that troubles caused by a surgical wing and pharmacy department a football-field distance apart begged for bold action. Among the problems:
• slow turnaround in the operating room (OR);
• delayed administration of antibiotics for surgical prophylaxis;
• inappropriate drug utilization;
• less-than-optimal formulary management.
The interdisciplinary team meetings vibrated with the exhilaration of stretching for the finest solutions it could imagine.
Thomas reiterates the importance of confidence from the top leadership: "They gave us the key and said, OK, do it.’" Everyone understood, however, that any changes had to pay their own way. "We stayed focused on our customers, and that kept us from getting discouraged." Customers in this case were the surgical support staff, anesthesiologists, nurses, and patients and their families.
Team meetings started in January 1996. Member-ship consisted of physicians from eight surgical specialties, as well as staffers from administration, finance, nursing, and pharmacy. The team strategy included the following actions:
• The team talked with representatives from St. Thomas Hospital in Nashville, TN, named in the top 100 hospitals.
• An extensive literature search brought the best of current pharmaceutical-surgical supply chain management practices.
• The team brainstormed dozens of solutions, pulling out workable elements until they created precisely what would work at Deaconess.
Rapid and continuous payoffs
Here are the highlights of changes and improvements since the new system launched on Aug. 5, 1996:
• The pharmacy satellite is housed beside the surgical wing. Pharmacists are present from 6 a.m. to 4:30 p.m., Monday through Friday.
• Standardized anesthesia trays draw from the drug formulary, eliminating floor stock of pharmaceuticals.
• Instead of nurses running back and forth for medication, the satellite staff deliver medications directly to the anesthesiologists in the OR suite. The same process is used with narcotics waste — physicians hand it directly to a pharmacist, removing the nurse from the go-between position.
"This project molded quality of patient care and financial elements into one process," Thomas explains. These results speak to both sides:
• The majority of patients receive their preoperative antibiotic prophylaxis at the optimum time prior to surgery.
• The medication charge capture system netted an 84% reduction in charge errors.
• The overall savings documented through pharmacist intervention at various points in the surgical process amount to more than $115,000.
• Clinical pharmacists share their expertise with the physicians, to the ultimate benefit of patients.
• Annual albumin costs decreased from $134,160 to $11,180, a 92% savings.
• More operations start on time. (For details, see graph, "% On-Time Surgery Start," p. 19.)
The surgery satellite inspired a continuous ripple of changes, one of which is a collaborative attitude among the anesthesiologists. They even invited Thomas to become member of the anesthesia team, and she now attends their monthly meetings.
"This networking saves a lot of money because the physicians talk to pharmacists about problems and we’re finding more appropriate drug utilization," she explains. In fact, she is even pulled aside occasionally by a physician who will ask her to tactfully discuss appropriate drug utilization with a doctor on one of the floors with less-than-desirable medication choices.
In April 1997, the Deaconess pharmacy satellite expanded its services to the labor and delivery department, with results replicating those in OR. For instance, nursing time related to medication delivery during cesareans dropped from 45 to 10 minutes, allowing nurses to spend 78% more time attending patients instead of fetching medications.
Team tending
Thomas credits a large part of the project’s success to strong team work. As team leader, she kept the cooperative spirit alive. If people missed meetings, she called and reminded them of their importance to the program’s success. The greatest challenge was developing consensus and consistent participation among the anesthesiologists.
The solution was regular attendance by the chief of anesthesiology — who has the most flexible schedule. It proved to be a fortuitous turn because he influenced buy-in by his colleagues. Thomas regularly shared developments with individual anesthesiologists and presented progress reports at their monthly meetings.
The team’s process and success have been inspirational. The staff constantly seek new services that pay for themselves while improving patient care. "Now at Deaconess, things get done through teams," Thomas adds. The external community has affirmed the pharmacy satellite project’s success as illustrated in these examples:
o In a local, all-industry competition, Deac -on ess won highest acclaim, the Evansville, IN, EQual Gold Award. Other contestants were from the energy, banking, and plastics fields, as well as one of Deaconess’ competitors. "It was a shining moment for me, as team leader," Thomas recalls.
"When we made our verbal presentation to the EQual judges, the team members told our story with no coaching from me. I didn’t have to say anything." Thomas says she’s certain that the team members’ enthusiasm and intimate knowledge of the project played a part in capturing the award.
o In the VHA 1998 Leadership Award competition, Deaconess won the Supply Chain Manage ment award for the hospital division. The facility was one of eight winners in four categories, among a field of 119 applicants. The other three categories are clinical effectiveness, organizational management, and community health. (VHA Inc. is a 1,600 member network of community-owned health care organizations based in Irving, TX.)
o As further affirmation from peers, Thomas reports, "Several hospitals have benchmarked us."
(For a different take on improving systemwide supply chain management, see related story, "U.S. poised to upgrade medical supply chains," below.)
Deaconess Hospital used the Top 100 rankings for 1996 to benchmark its pharmacy satellite project. To find the latest annual ratings, see: Morrissey J. All benchmarked out. Modern Health Care 1998; 28:38-46.
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