University Health Network
Transforming the OR supply chain through integration, analytics, and standardization
Authored and produced by CareFusion, August 2013
Through its implementation of the Pyxis™ automated pointof-use dispensing system from CareFusion (BD), UHN has radically improved its OR supply chain so that real-time supply data integrates seamlessly with UHN’s clinical charting system, while automatically reordering supplies as needed.
Operating rooms (ORs) can play a critical role in a health system’s financial viability, often functioning as a revenue generator—or in some cases, a drain. Given that 40 to 60 percent of an OR’s total spend comes from non-labor costs,1 the OR supply chain offers opportunities for efficiency improvements. Yet a 2014 Global Healthcare Exchange (GHX) survey2 of hospital senior executives indicated that OR supply chain deficiencies have slowed organizational decision-making and increased costs and inefficiency.
Today, a growing number of healthcare organizations are scrutinizing their OR supply chain processes more closely. University Health Network (UHN) in Toronto, Canada, is one health system that is already well ahead of that curve. Through its implementation of the Pyxis™ automated pointof- use dispensing system from CareFusion (BD), UHN has radically improved its OR supply chain so that real-time supply data integrates seamlessly with UHN’s clinical charting system, while automatically reordering supplies as needed.
To achieve that, the team knew that they needed to create a sustainable, long-term foundation. “We knew that the solution wasn’t about contracting to obtain cheaper items or looking for fast savings because that couldn’t bring about the long-term value benefits we were looking for,” says Scott McIntaggart, Senior Vice President and Executive Lead, Toronto General Hospital, UHN. “Ultimately, we wanted to move to sharing real-time surgeon procedure costs so that our surgeons could reduce variation in cost without compromising safety or quality of care.”
UHN’s OR Transformation Committee came up with four specific goals that would help create a supply chain technology-enabled environment:
UHN’s team hoped that once these goals were realized, their efforts to transform the OR supply chain would alert surgeons to supply item costs so that they would choose supplies wisely, provide data to identify cost savings opportunities and reduce waste, enable discussion about product standardization, and promote fiscal responsibility. “We are experiencing a cultural shift in healthcare in that a growing number of surgeons want to self-regulate their OR spending,” says Timothy D. Jackson, MD, MPH, FRCSC, Division of General Surgery, Toronto Western Hospital, UHN. “The right information will support the movement toward fiscal responsibility with UHN surgeons.”
The new process required financial approval, contract verification, item master additions, and finally, physical and electronic additions loaded to the Pyxis™ system by an OR Supply Chain Supervisor. With the inventory now controlled, the team moved to the final phase of streamlining the clinical workflow. The automation of the unique device identification (UDI) lot and serial number, product identifier (PI) to the clinical chart was a complex but essential ingredient in the solution. After experiencing a GPO system conversion and upgrades to the Pyxis and ORSOS systems, UHN completed the final implementation phase in March 2015. The completed solution provides electronic tracking of all OR inventory as well as automated re-ordering, clinical charting integration with UDI, PI and automated item master standardization for the entire system.
Focus on OR research and planning
This stage is critical to a successful, sustainable outcome.
Engage OR Clinical and business segments from the onset, and maintain ongoing support from senior leadership throughout the project.
Form a Steering Committee
Form a Steering Committee, and establish its voting members, before any decisions may be required.
Subject Matter Experts
Remember staff will have to balance their daily operations jobs in addition to a full-time project. Subject matter experts in each area are essential to the success of the project.
Build the appropriate inventory team to support the system and clinical staff.
Ensure IT is engaged from the start of the project. For UHN, considerable internal and external IT time was required for the final interface to the ORSOS clinical chart.
Item Master may be incomplete
Be aware the Item Master may be incomplete and cause considerable delays. You may need inventory staff support for manual and new automated processes—at UHN, the 60-character length at the Pyxis station was shorter than SAP and required a translation table.
Avoid System overload
Reduce the Item Master interface update from hourly to daily to reduce system overload issues.
Time and Resouce Planning
Plan enough time and resources for the Item Master cleanse and alignment to the clinical system.
Contract conversions will require more time for the Item Master to be updated and for the station to be rebuilt.
Stay focused on the project goals and the OR needs, when cross-discipline feedback is not aligned.
Celebrate milestones along the way and ensure the team feels valued for their transformational work.