OR material manager nets savings through outsourcing

Healthcare Purchasing News, June, 1999 by Carolyn Pye Sostrom

Carolyn Pye Sostrom is a Scottsdale, AZ-based correspondent.

In the summer of 1997, Cleveland, OH-based Hillcrest Hospital needed to replace several instruments for its busy laparoscopic operation, which could have required a considerable capital investment. To Elaine Fisher, operating room materials coordinator, it seemed like a good time for a change.

"We had few sets working," Fisher said. Ultimately, she turned to an outsourcing program to manage Hillcrest's laparoscopic instruments. As of April 1999, her facility has reaped close to $100,000 in savings.

Previously, Hillcrest spent a lot of money on disposable instruments because it didn't have an abundance of reusable instruments to cover its busy laparoscopic surgery practice, which averaged 125 cases per month. That's why Fisher turned to Allegiance Healthcare Corp.'s OpEX program.

With OpEX, Hillcrest pays a fee per tray used rather than purchasing the instruments outright. And it doesn't have to worry about instrument maintenance, repair and replacement. An Allegiance technician inspects and tests instruments after each case to ensure that the instruments are sharp, properly insulated and in working order. Because few people have extensive expertise for every different type of instrument, "it's worth it to outsource," Fisher said.

What pleased Fisher and the OR staff members about the outsourcing program they selected was that they could choose the instruments they wanted, rather than having the program do it for them. "The idea was initially met with a lot of resistance from staff," Fisher recalled. "They thought we had to use [one manufacturer's] instruments. They didn't think they could get what they wanted."

Fisher fostered teamwork by facilitating meetings between staff and OpEX. Prior to implementation, OpEX representatives viewed cases to see the instruments at work.

Hillcrest's surgical staff were already using standardized instrument sets for most laparoscopic surgeries, but though outsourcing the doctors can request a particular item and it's available, kept separate in a peel pack until needed, Fisher said. "If we want to try something new, we can see if we like it," she added.

After a 30-day trial, Hillcrest signed a three-year agreement with McGaw Park, IL-based Allegiance. Fisher noted that Hillcrest now turns cases over more smoothly and is able to offer a more uniform standard of care to patients. "With the amount of cases we have, we could never afford as many sets as OpEX can provide us," Fisher said. "Now, we can afford to have more sets on hand. There's always a fresh set ready to go."

Fisher credited outsourcing for helping generate substantial savings on disposable instruments. Although the hospital still uses disposable instruments in some cases, spending for those items plunged 86% in 1998, compared with 1996, according to Fisher. "It's enough to pay for the program," she added.

Outsourcing also helped address staff concerns about the condition of instruments. In the past, surgical staff had complained that scissors were never quite sharp enough, Fisher said. Hillcrest now uses scissors with replaceable inserts.

Hillcrest shared its strategy for outsourcing instrument management with its three sister hospitals in the Cleveland Clinic Health System. Each has implemented a similar program for different types of instruments and is finding that it can realize savings by avoiding repair costs and the purchase of new instruments.

Since Hillcrest began outsourcing laparoscopic instrument, Fisher has continuously monitored staff feedback. The overall reaction has been positive. "We've had very few complaints," she said. "We've had a great deal of satisfaction."