The Source | July 9, 2019

Advice from the Field

If I could offer one piece of advice to anyone starting out I would say learn why you are doing things the way you are being taught to do them. Knowing the reasoning behind your functions makes you a more valuable tech. 

Ryan, NY

CS Supervisor

How to Use Data to Support Your Hospital’s Revenue Cycle

Author: J. Vincent Sanchez (CRCST), Client Manager

The business side of healthcare is no cup of tea. With regulatory shifts, changes to the world of insurance, and natural disasters bringing challenges to all sides of the industry, managing hospital revenue cycles is only getting more difficult and more complicated.

The Correlating Cost

Hospitals exist to effectively care for patients, but their ability to consistently do so is limited if they’re running at a financial deficit. 

Unfortunately, that seems to be the direction that many hospitals are going. According to Healthcare Finance News, “hospital operating margins plummeted from roughly 3.5 percent to a record low of 1.6 percent” between 2015 and 2017. In a paper published in September 2016, the Congressional Budget Office predicted that, if hospitals do not improve their productivity, 60 percent of U.S. hospitals will be operating at a deficit by 2025. 

It’s crucial for revenue cycles to be managed—and managed well—and there are a variety of ideas about how data and artificial intelligence can be used to bolster those management efforts. But what does any of that have to do with the Sterile Processing Department?

Reprocessing instruments in one central department have been shown to be vastly more effective than distributing the reprocessing work across an entire facility. Well-run SPDs improve patient safety and satisfaction, while also building up the facility’s reputation and simplifying the lives of medical professionals. However, inefficiencies in the SPD can contribute to the shrinking margins on the business side of the healthcare organization. If mistakes happen frequently, if instruments need to be reprocessed multiple times due to shoddy work, the costs of running the SPD add up and negatively impact the hospital’s bottom line.

This is where department data comes in.

Hospitals collect a wealth of information, and SPDs are no exception. Your department may collect data on every step of the sterilization process that each instrument goes through.  You may measure the productivity of your team—maybe even down to specific team members. 

All of these data points have some sort of correlating cost. The missing or damaged instrument has a dollar value. The second round of cleaning for the returned inventory requires time, energy, and personnel, all of which amount to a monetary cost. Every wasted or well-spent hour in the SPD has an expense. And because you have the data, you can use it to make sure the dollar values are heading in the right direction.

Here are a few tips for using data in the SPD to positively impact the revenue cycle:

Determine Instrumentation Needs

Recent historical case data can easily show you what types of procedures are the most common. Maybe ski season sees an uptick in ACL surgeries. Maybe summer brings more heart operations. Maybe different times of day call for more of a certain instrument. Looking at the data of past cases can help you prepare for the future, in terms of both stocking additional instrumentation and scheduling additional staff.

Prevent Patient Safety Events

According to the World Health Organization, an average of 8.7 percent of hospital patients have healthcare-associated infections—and one of the most common types is surgical site infections. SPDs exist to make sure no infections happen as a result of contaminated instruments, but sometimes, bacteria still get through. By carefully analyzing the data around patient safety events (times when a patient’s health has been compromised in some way), you can discover factors that might have contributed to those events and use that knowledge to develop strategies to prevent future incidents. Any findings should be shared with all SPD staff so everyone is on the same page about ways they may have contributed to past incidents and how to avoid doing so in the future.

Spread the Word

If an instrument has been improperly reprocessed, it might be tempting to hide the mistake and pretend everything’s fine. But not only does that have ethical (and potentially legal) implications, but it also keeps patients who are at risk in a precarious place. “Prompt reporting of improperly reprocessed instruments is … essential to determining whether any patients are at risk from contaminated instruments used during their treatment,” says the Emergency Care Research Institute. If your healthcare organization isn’t keeping track of what particular instruments are being used on which specific patients, that’s the first step to being able to properly respond to the knowledge that an instrument wasn’t reprocessed correctly. The faulty reprocessing should be reported and the patient on whom the instrument was used should be notified so that they know about their risk of infection.

Maintenance

Pairing proper reprocessing procedures with accurate maintenance tracking at the instrument level increases your inventory management database effectiveness.  And as we’ve learned, clean data translates to better cost savings and, most importantly, increased patient safety standards.  

Take for instance reposable instruments, such as the DaVinci robotic arms. By documenting usage at the instrument level, your team is aware of how many opportunities are left to use the instrument and when to place an order for more. Plus, when it comes to sending an instrument out for repair, instead of sending the entire container out you can simply send the instrument that needs service.  By automating maintenance and scanning at the instrument level, your inventory will begin to tell you when it needs maintenance instead of guessing and spending resources unjustly.  

Lean In: A Three-Part Series

In this series of three articles, Rachel Mandel, MD, MHA (OPS) and Marlin D. Minnis, Director of Strategic Initiatives will lay bare some of the common challenges that negatively impact the provision of quality SPD services and patient safety, as well as the benefits of Lean interventions in removing the barriers to process improvement.  We will not only discuss the obstacles themselves, but present them from the perspectives of SPD Leaders, OR Leaders, and Healthcare Senior Leadership.  This team approach is crucial to the success of any Lean engagement that will not only improve and streamline SPD but sustain those improvements over time.

Lean In: Financial Challenges

Author: Rachel Mandel, M.D., MHA

Although the primary mission of a hospital or healthcare provider is to care for patients, it becomes difficult to do if the business is not financially stable and is not able to maintain a margin, no matter how thin. It is the responsibility of the entire team to look for opportunities to more efficiently utilize resources to support the mission.  There is waste in healthcare that includes but is not limited to, time, energy, supplies and resources. An efficient and streamlined sterile processing department and operating room can produce quality outcomes while contributing to the financial health of the organization by eliminating waste. Waste comes in many forms to include duplication of work, unnecessary work, payment for services not required and other inefficiencies.  Dollars that aren’t wasted can be spent on supplies, resources, salaries and capacity building initiatives.

 

SPD Leadership

Excessive instrument repair cost When there isn’t a preventive instrument maintenance program in place based on utilization, instruments can be neglected or unnecessarily serviced.  Instruments and trays should be inspected and serviced based on the frequency of use or frequency of exposure to harsh elements or processes. It should not be driven by the repair company’s pre-scheduled visit and a need to justify that visit.  When hospitals drive the maintenance schedule based on utilization, they decrease costs associated with servicing underused sets. In one Lean case study, the annual cost of replacement instruments was decreased by $100,000 with effective inventory management.

 

Increased turnover of staff – Inefficient processes are a burden. Sterile processing is a busy, high risk and stressful environment on the best day.  When work is wasteful, problematic, or not meaningful, staff are not satisfied and more likely to quit. Every time a trained staff member leaves, the resources used to train that person are wasted, and additional funds are utilized to hire and train new staff if you can find them.

 

Re-shelving of unused sterile supplies – If surgeon preference cards are not accurate or non-existent, and schedules are not coordinated, confusion can ensue. It is a waste of time, space and expertise to have to sterilize and re-shelve supplies that are pulled for a case and then not used.  Sometimes your surgeons will ask for extra supplies, “just in case” because they have had the experience of not having what they have requested in the past, or there are too many unused instruments in a case cart.  This creates extra work at the front and back ends unnecessarily. This error and the subsequent delays it causes costs money, time and effort. This situation is a dissatisfier for staff.

 

CensiServe's Lean Consulting can assist you with evaluating your processes for the elimination of wasted time, resources and money. 

Perioperative Leadership

Increased OR downtime due to lack of instrument availability – There are few things that are greater surgeon dissatisfiers than having to wait for a surgery to be scheduled or begin due to instrument requirements.  Even worse is having to wait during surgery with a patient under anesthesia for an instrument to either be found or sterilized.  It is a waste of time for the entire team, and it is a patient safety issue.  Surgeons will find other facilities in which to operate if these events are common or repetitive.  There can be significant financial consequences from limited scheduling capacity or outmigration of surgeons.

Increased risk of hospital-acquired infections and associated penalties – Hospital-acquired infections and complications are tied to dollars in Pay for Performance reimbursement models supported by Medicare and commercial insurers. As healthcare continues to transform, more and more money will be linked to these performance metrics.  An SPD and the operating room must do everything it can to perform at the highest level and maintain standards that keep patients safe.  When that is accomplished, there can be financial awards that benefit the entire organization.

Need for an effective back-up sterile peel pack inventory – During any surgery case scissors and needle holders may not operate correctly. There may be a need for additional clamps, forceps or special retractors. In these instances, a well-positioned and properly stocked sterile peel pack inventory will fill this void eliminating the need to open large sets unnecessarily creating a higher demand on already limited resources.

Wasted resources constrain budgets and the ability to purchase new equipment – Any waste in a department or system that consumes funds that could be spent on other priority items needs to be eliminated.  Is there any OR in the country that couldn’t benefit from updating equipment, buying new technology or hiring more staff?  Budget money is tight and finite.  Avoidance of waste can help shift resources to things that are priorities.

CensiServe's Lean Consulting gives you the tools needed to restructure your department so that is more efficient and effective while decreasing waste and giving you the budgetary flexibility to put your resources towards the ongoing provision of quality patient care. 

C-Suite Leadership

Dependency on expensive travelers and turnover of well-trained staff As it is true throughout the hospital, travelers and agency staff are expensive. The maintenance of a team of well-trained permanent staff is overall less expensive and more reliable than a rotation of travelers through SPD.  A chaotic and stressful work environment encourages additional turnover.  When permanent staff are trained and engaged in a process that is focused on quality, efficiency and stakeholder satisfaction, the turnover and need for travelers will decrease. In one case study, a Lean initiative decreased the monthly cost for travelers from $71,104 to $39,744.

Increased use of expensive immediate use steam sterile processing – Urgent steam sterilization is expensive, disruptive to workflow and time-consuming. It is necessary on occasion but should not be used casually nor frequently to provide instruments to the operative field due to bioburden, breaks in sterility, to replace a broken instrument or to provide an instrument that was in use elsewhere due to uncoordinated scheduling. A high-reliability organization will not need to steam sterilize often, thus decreasing costs associated with the procedure.

Value-based penalties due to hospital-acquired infections High functioning sterile processing departments have a lower rate of surgical site infections which can be tied to both penalties and bonuses monitored through pay for performance programs. Quality sterile processing departments can impact these reimbursements, as well as the data and grades that are publicly reported that will most certainly be more of a focus in the future as full transparency becomes the norm.  

Shrinking market share – Competition for surgeons and surgery is becoming more intense. Surgeons will choose operating rooms that meet their needs, which includes having the right instruments that are sterile and safe for their patients when they need them.  If your sterile processing department has defects and errors in their processing that cannot be resolved, surgeons will go elsewhere.  Insurance companies will encourage their patients to go elsewhere when the data becomes public and if it reflects an ongoing challenge.

Malpractice liability – Instrument failure and instruments with bioburden increase the organization’s vulnerability and the risk that it will incur legal liability.  Poorly maintained instruments can contribute to patient harm, including those events where small pieces of instruments may break off and stay embedded in the patient.  The risk of litigation over sterilization errors is also potentially high. These SPD error cases can result in legal action which can put the hospital at significant monetary risk. As a recent example, a hospital in Colorado was sued for allegedly causing infections that were acquired due to breaches in surgical instrument sterilization procedures.

CensiServe's Lean Consulting can help teach your perioperative staff how to be financially mindful as they pursue the highest quality service.  

By identifying opportunities to eliminate waste, as well as improve staff and surgeon satisfaction, you can continue to contribute positively to the bottom line. Reach out to learn more about CensiServe's Lean Consulting.

CtUC 2019: Solutions Center

The Solutions Center at CtUC 2019 is great for anyone who needs to connect with their Client Manager. From discussing past, current, or upcoming projects to pulling up your live database – you and your Client Manager can walk through any report, module, or general inquiry you may have. It’s also a great time to follow-up on CtUC sessions you’ve attended and would like more information on.

We encourage you to schedule a time and date to meet with your Client Manager at CtUC 2019 now. Call or email your Client Manager today letting them know you are attending CtUC 2019 and would like to schedule time at the Solutions Center.

 

The Solutions Center at CtUC will be located next to the General Session Hall in the Gaylord Opryland Resort & Convention Center 

"I love reading IFUs"

...said no one

All it took was two crashes in the span of five months for Boeing 747 Max jets to be grounded around the globe. What will it take to ensure better regulations for sterilization documentation?

Click to hear from Jason Rawlings (CRCST), on the two things the FDA could be doing better to regulate IFUs.