Updated May 20, 2013.

The surgical suite is often in the spotlight for the two "C"'s of hospital operation and reputation: "Cost" and "Care".

Cost

Surgical procedures are key revenue generators that hospitals need to support their operating budgets. Supplies and equipment in surgery often account for a large percentage of the cost that eats away at the profit buried within that revenue. Some estimates put the cost of disposable supplies at around 20 percent of an operating room budget.

If that cost can be reduced, then that newly available revenue can be repurposed to either growth expenses or even kept as profit.

Care

There are also other costs, both hard and soft, that surgical staff can affect. Besides the cost of supplies, hard costs include salaries for staff. But what about quality care? The operating room is a common place for patients to pick-up what are known as healthcare acquired conditions (HACs). An HAC is a harmful condition that the patient acquires during their stay in the facility. In other words, the patient reports to the hospital for one condition, and while there, gets sick or injured in a new way as a result of the healthcare environment. There are also medical errors caused by staff in the surgery process that add cost, and obviously affect care in a negative way, for the patient.

Where Cost and Care Meet

Cost and care intersect when a patient suffers a healthcare acquired condition. The Centers for Medicare & Medicaid (CMS) have set in place a requirement now that healthcare institutions must pay for the care it takes to help a patient recover from an HAC developed while in their facility.

Private insurance companies have followed suit, so that now healthcare organizations cannot collect full reimbursement for secondary conditions acquired while in their care. As a result, the patient's care suffers, and so does the healthcare organization's bottom line. With revenue now reallocated to paying for the care associated with the HAC, which has been estimated to cost on average anywhere from $10,000 - $40,000 per patient, the OR staff of any hospital will always have a target on its back as an area of fiscal focus and healthcare quality improvement.

Healthcare Acquired Conditions, from CMS

1. Foreign Object Retained After Surgery

2. Air Embolism

3. Blood Incompatibility

4. Stage III and Stage IV Pressure Ulcers
5. Falls and Trauma

• Fractures
• Dislocations
• Intracranial Injuries
• Crushing Injuries
• Burns
• Electric Shock

6. Manifestations of Poor Glycemic Control

• Diabetic Ketoacidosis
• Nonketotic Hyperosmolar Coma
• Hypoglycemic Coma
• Secondary Diabetes with Ketoacidosis
• Secondary Diabetes with Hyperosmolarity

7. Catheter-Associated Urinary Tract Infection

8. Vascular Catheter-Associated Infection

9. Surgical Site Infection Following:

• Coronary Artery Bypass Graft (CABG) - Mediastinitis
• Bariatric Surgery
  • Laparoscopic Gastric Bypass
  • Gastroenterostomy
  • Laparoscopic Gastric Restrictive Surgery
• Orthopedic Procedures
  • Spine
  • Neck
  • Shoulder
  • Elbow

10. Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE)

• Total Knee Replacement
• Hip Replacement

How a Case Cart System Can Help

• Strict Inventory Control
• Efficient Use of Space
• Effective Time Management
• Economically Appropriate Use of Staff
• Infection Prevention
• Information Captured Accurately

Inventory Control

The case cart system should include the use of centralized materials management system. That is, carts are stocked in a central sterile processing area with supplies required in cart drawers for the specific case for which the cart is intended. Alternatively, when a cart is stocked in the surgical area, this type of decentralized storage system becomes difficult to keep track of par levels, redundancy ensues, and the clinical staff wastes valuable time that should be devoted to medical care.

• Less inventory needs to be in the surgical area
• Standardized pick lists can be used, discouraging costly custom items
• Wasteful supply hoarding reduced

Efficient Use of Space

Only supplies that are difficult to standardize will need to be in the surgical department. Therefore supplies are delivered to the OR and returned back to central services on the case carts. Thus a case cart system frees space in the surgical suite for the equipment use, and unimpeded staff circulation.

Effective Time Management

We've all heard the cliche that time is money, and in the OR, each minute is measured in the hundreds of dollars. Therefore, time management matters. Keep no one waiting. Swift and effective turnover of a room will increase the quantity of procedures an OR suite can perform each shift. More procedures, more revenue. The case carts can be re-stocked by central service staff while another case is taking place. Once the surgical team finishes a case, a new sterile case cart can be pushed into the room for the next case start start.

Economically Appropriate Use of Staff

The case cart system divides up the work of running an OR along its designed scope. Clinicians care for the patients, while materials management and central service staff work on the supplies. When clinicians are pulled from patient care in order to deal with supply storage, stocking, disposal, or re-processing, this is a glaring example of waste.

Infection Prevention

Hospital acquired infections are another example of costly mistakes that can happen while a patient is in surgery. A case cart system reduces traffic into and out of the OR, and airborne contamination is minimized. Clean carts go in, and soiled carts go out, at the end of a case. Also, carts leave central sterile with locks or tabs on the drawers to show they haven't been opened and tampered with, reassuring the surgical team that the supplies they are about to use are clean.

Information Captured Accurately

With a soiled cart parked in surgery to collect the used supplies, actual use can be counted, and invoicing, purchasing, and` replenishment becomes more accurate and responsive.