Restructure supplies around patient
Materials management program saves $15 million
An innovative stockless supply program and cross-trained work force has saved Stanford (CA) Health Services more than $15 million over four years and has enabled caregivers to spend less time with paperwork and more time with patients.
Nurses no longer run around the unit gathering supplies. Charges aren’t lost. Inventories aren’t overstocked. These processes are now completed with a few keystrokes on a computer. The information is instantly transmitted to the appropriate departments and, within minutes, a clerk from a satellite stock room on the unit arrives with the supplies.
"We’re here to support the [caregiver])," says Nick Gaich, director of materials management for Stanford Health Services. "We want to remove the administrative burden of supply management so they can provide more direct patient care."
Stanford launched the program as part of an overall effort to center care around the patient. By streamlining processes, clinicians spend less time in non-direct patient care activities and more time with patients. The redesign includes the creation of a new position called the service support assistant (SSA), who is cross-trained in housekeeping, patient transportation, and supply management. (See related story, p. 43.) This person is located on the unit and is part of the patient’s care team, providing materials management staff with a better understanding of the clinicians’ needs.
The program has saved $850,000 in labor costs, $13 million in supply contract reductions, and a one-time inventory reduction of $900,000. Gaich says the redesign paid for itself "several times over."
Stanford spent one year researching and designing its materials management program. It formed a committee composed of representatives from nursing, environmental and support services, materials management, human resource management, staff education, and housekeeping.
The team visited other hospitals, conducted literature reviews in search of ideas for its own model.
Based on its research, the team decided to set up a system of five satellite supply centers, called service centers, scattered throughout the hospital to serve 24 units. Each center stocks supplies only used by its units. The team chose the locations for the centers based on the facility’s existing layout and the ability for the SSAs to deliver the supplies within a three to five minute window of receiving the order.
When deciding on the computer system itself, the team researched the market for options and chose an off-the-shelf program by Enterprise Systems in Chicago.
"We didn’t want a customized system," Gaich says. "We wanted something that was flexible and could adapt as our needs changed."
Here’s how the new system works:
If a nurse needs to order supplies to change a dressing, he or she pulls up the unit’s screen on the computer. He or she selects the name of the patient who needs the supplies, then selects the procedure, in this case a dressing change. Preset keys allow the clinicians to order supplies based on a procedure, such as replenishing an IV line. All the supplies needed for this procedure are listed under this one key. Supplies can also be ordered individually. The order is transmitted to the service center and all the supplies needed for a dressing change are automatically printed out so the SSA can pull them. An alarm sounds in the service center to alert the SSA a new order is in. The SSA fills the order and delivers it within the desired time frame to the patient’s room or designated place.
Meanwhile, the computer has also sent the order to the billing department’s records and logged it under the patient’s name, subtracted the items from the inventory, and reordered more from the supplier. (See flowchart, above.)
The team chose different applications of the software based on each unit’s need. For example, to meet the demands of a critical care unit, the system is designed to automatically restock supplies as they are used. Instead of entering an order into the system, the critical care nurse scans the supplies’ bar code as she uses them, prompting a reorder to be sent to the supplier for restocking at the patient’s bedside.
An added feature of the system is its ability to track supplies by a variety of data, including patient population, diagnosis, episode of care, or physician. By monitoring this data, managers can spot variances in patient care plans or forecast supply needs based on patient population.
The team tracked the clinicians’ ordering habits to determine the hours of operation and staffing for the service centers. The research showed that orders picked up in the morning and tapered off at night. So, the center opens at 5 a.m. with one person. From 8 a.m. to 11:30 a.m., two people fill orders. From 11:30 a.m. to 1 a.m. when work slows, one person mans the center. The center is closed between 1 a.m. and 5 a.m., except for the center on the critical care unit which remains open 24 hours a day.
To accommodate clinicians during the closed hours, the center provides a box of supplies for emergencies. Also, before the night shift staff leave, they provide nurses with supplies they know they are going to need, such as an IV bag that needs to be changed at 3 a.m. according to the patient’s care plan.
[For more information, contact Nick Gaich, Stanford Health Services, 300 Pasteur Dr., Stanford, CA 94305. Telephone: (415) 725-4504.]
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