B. Still1, L. Christianson1, A. Langerman2 2University Of Chicago,Department Of Surgery,Chicago, IL, USA 1University Of Chicago,Pritzker School Of Medicine,Chicago, IL, USA
Introduction: Healthcare spending in the US in 2013 exceeded $3 trillion; it is projected to surpass $5 trillion by 2022. Attempts to curb this unsustainable growth are putting hospitals under increasing pressure to reduce their operating expenses. In the surgical setting, a key avoidable expense is wastage of disposable surgical items, which are often opened in preparation of a case but then go unused. Given that essentially all surgical procedures use disposable items, reducing wastage of these materials presents a promising target for reducing overall costs associated with the operating room. We report the application of Lean value stream mapping and cost heat mapping to identify targets for standardization of surgeon preference cards and streamlining of the item acquisition process.
Methods: an initial value stream map (VSM) of the acquisition, use, and disposal of surgical items was constructed based on preliminary observation in the operating room.
Stakeholders from multiple OR roles (surgeons, nurses, schedulers, central sterile processing personnel, surgical item reprocessing personnel, and operations managers) were subsequently interviewed; their feedback was used to modify the VSM. Key obstacles to the effective completion of the process outlined in the VSM were identified.
Data on disposable item cost and surgeon preference cards were then obtained from the Strategic Sourcing department and visualized using the novel technique of cost heat mapping, which visually highlights expensive disposable items and allows comparison of cost data across different surgeons.
Results: the completed VSM allowed identification of 18 major obstacles to effective acquisition and use of disposable surgical items. Potential interventions were generated for each obstacle and each intervention was evaluated on its feasibility and impact.
The cost heat maps allowed quick visual identification of high-cost disposable items and comparison of cost data across surgeons. The average cost difference between highest and lowest cost surgeons for the procedures analyzed was $955.18 (range $674.65 – $1245.96).
This information will be used to inform future efforts to standardize preference cards among all surgeons that perform the same procedure.
Conclusion: value stream mapping and cost heat mapping can be used to identify targets for standardization and streamlining of surgeon preference cards and the item acquisition process, reducing costs associated with wastage of disposable surgical items.