Right-Sizing Supplies with Automation: The Experience of Christus St. Frances Cabrini`s Cardiac Cath Lab

Our cath lab was not unlike many others I’ve seen. Our physicians and patients had the needed resources, but we knew operations could be improved. We spent too much time on activities we weren't trained for or didn't want to do. Most importantly, these activities did not directly improve patient care. As clinicians, patient care should be our top priority, yet administrative activities kept us busy. Managing inventory topped our list of wasteful activities. We stocked too much inventory. We ordered what physicians wanted without monitoring how long it stayed on the shelf. Consequently, some of it would be expired when we went to use it. If someone from finance asked me how much we spent on pacers last month, I'd have to scramble through paperwork. Reordering was based on eyeballing inventory; it was manual and time-consuming. We needed tools to help us keep the product on our shelves fresh and maintain the right inventory levels while also tracking usage more accurately. Eyeballing what we needed just wouldn't work anymore. We needed access to data. We looked at a number of options to help us simplify these tasks. First, we looked at our cath lab information system, but the inventory module was not sophisticated enough for us to get usable data. Then, we evaluated computerized cabinets that document usage and refill with a simple button press and bar code scanners linked to an inventory system. Our medical/surgical floors already had medication and supply dispensing devices with interfaces written to automate reorder through our materials system. The same vendor had a bar code scanning option, which provided flexibility down the road if we wanted to change our workflow. After an assessment with the vendor, we chose automated cabinets because we felt everyone would document usage more accurately. We soon learned the more accurately we worked with the system, the less we did manually. Automation isn’t automatic. We placed the cabinets in our procedure rooms and automated specialty storage room with wireless tags for products kept outside the cabinets. Now, when a button associated to a supply is pressed, it is documented against the patient and procedure, and the item is automatically reordered through the materials system real-time. We can get reports on the value of on-hand stock and supplies on consignment, product expiration and physician utilization. We can even automatically update the required inventory levels. Our last physical inventory matched the electronic inventory with a variance of just a few hundred dollars. By watching demand, we've updated the inventory level and decreased on-hand inventory by 60 percent. Our physical inventory was $310,000 when we started the project. During a ten-month period, we reduced our inventory to $142,000. We've come to trust the data and are confident we'll have the inventory we need on-hand. Some time ago we performed network upgrades, so the machines were turned off for a day. We went back to taking notes and using stickers. While this was hard on the technologists, we were surprised at the physicians’ reactions. They said they were uncomfortable without automation because they didn’t hear the expiration voice alerts they had come to trust. Before automation, the reorder and charge processes lacked ownership. Stickers were placed on a form with other notes and the pile was given to someone to decipher and put into the computer for order. Before automation, we ordered daily. The supply cabinet documents usage and helps us order only what we need. Now we order 1-2 times per week and have seen a dramatic drop in express shipments, reducing stress on the entire staff. By automating reorder and use documentation, we've probably reduced technologist time by 8-10 hours per week. Now that we have to login to the cabinets, we're held more accountable. This change has translated into a 5 percent reduction in our cost per procedure. Product freshness is always important in a cath lab. We use the expiration-dating tool to help verify we have fresh stock. Just before we installed our automated system, we found $60,000 in dead stock. Since the installation, this expense hasn’t been a problem. Our confidence level in the inventory data was recently solidified when our physical inventory matched the electronic record. This pays dividends with our CFO and helps us manage our expensive consignment. We no longer have discrepancies between the vendor inventory record and our on-hand quantity. This has helped reduce consignment levels and made the quarterly vendor inventory counts occur without surprises. There have been side benefits as well. Some staff members have commented that the cath lab is less cluttered and looks more high tech. They know where to find everything and the rooms feel bigger. Focusing on inventory management is important to keep our cath lab the healthiest in the region. Having the tools to do the job makes our focus that much more effective. A special thanks to Ann Montanio who was the leader in this process. Tonya McGlothlin can be contacted at tonya.mcglothlin@christushealth.org

* Former Cath Lab Manager Former Director of Materials Management