Aesculap Service Systems Process optimization with Instrument Management Improved efficiency with instacount

Transcription

1 Aesculap Service Systems Process optimization with Instrument Management Improved efficiency with instacount Case study

2 More and more hospitals use Instrument Management Systems to standardize, document and optimize their sterile goods cycle. 2

3 instacount Contents 4 Preface 5 Cost savings with instruments 6 Reduction of damage, complaints and stock loss 7 Streamlined set structures 8 Improved utilization of sterilizer capacities 9 Improved efficiency of work processes 10 Compliance with legal and normative requirements 10 Changing profile of CSSD management 11 Cost and process optimization for the entire hospital 14 Efficiency analysis 3

4 Preface The optimization of existing processes is rapidly becoming a core task of hospital management. For the sterile supply cycle, guidelines and regulations are defining ever higher standards with validated procedures while, at the same time, hospitals are under enormous pressure to achieve efficiency gains, in Germany and other countries, for instance, by the utilization of diagnosis related reimbursement groups (DRG). Moreover, modern surgical techniques employ more innovative instruments, which in turn require more complex and cost intensive reprocessing procedures. Increasingly, hospitals use instrument management systems to standardize, document and optimize their sterile supply cycle. The question is: Has this really brought quantitative and qualitative advantages for the hospital? For this case study we selected a 400-bed, regular care hospital as a reference site. When Aesculap began to install the instacount PLUS instrument management system at this hospital in 2003, they found a typical CSSD 1 operation: Training and updating had been neglected and there was a lack of work instructions. Since records were kept manually, it was not possible to analyze them efficiently or reproducibly by appropriate computer software. There was no overview information about the quantity, condition and current location of sterile items. Reasonable utilization of the sterilizing machines to their actual capacity was out of the question. Instrument stock shrinkage was part of everyday reality, but could not be tackled, because of inadequate documentation. Far too many sterile items had to be kept in circulation to secure the availability of instruments for each operation, despite all the obstacles. Costs and cost drivers were unknown quantities, making the CSSD a black box, with costs growing out of control. on a causal basis. Additionally, the qualified processing procedure, which is also KTQ 2 certified, is offered to external customers, as a service complying with all statutory regulations for cleaning and disinfection. In case of any damage or complaint, CSSD management can easily trace back the entire process applied to the items in question. Moreover, CSSD was given the main responsibility for configuring the instrument sets. In consultation with the surgical departments, CSSD procures the correct instruments, which will also fit into the hospital s reprocessing concept. The excellent intercommunication developed within the hospital assures ready internal acceptance of regular set optimization measures, resulting in continual slimming down of the instrument stock and associated tied-up costs. In the following we present some specific examples of how instacount PLUS contributed to this turnaround at the reference hospital. 3 So the main task was to optimize existing processes, for the long term, and restructure them for improved efficiency. As it turned out, the CSSD management at our reference hospital showed that this turnaround in their operations can actually be achieved. Four exciting years have passed since instacount PLUS was installed, in which time the tasks as well as the status of CSSD management in the hospital have changed fundamentally. Now it is a totally transparent cost centre, with the costs of sterile reprocessing allocated 1 CSSD: Central Sterilization Department 2 KTQ: Cooperation of trancparency and quality in Healthcare sector 3 All figures based on 30 per STU, 24 per man-hour. 4

5 Cost savings with instruments Consistent set organization allows conclusions about ongoing processes. Data gathered over many years can be evaluated and compared. Even the small selection of analysis options selected for this study clearly demonstrates the optimization potential regarding all aspects of the existing instrument stock. For example, CSSD management compared the bipolar scissors usually sourced from two different manufacturers. The analysis showed that the repair needs of the bipolar scissors from manufacturer X had been 70% higher than those of the product from manufacturer Y. As a result, procurement switched to another manufacturer, achieving permanent savings in repair costs. 4,500 Saving in repair costs for bipolar scissors 23,200 Saving achieved by switching to single-use monopolar electrode systems Another investigation concerned the question whether the hospital should use a disposable monopolar electrode system or a reusable variant. Thanks to the data produced by instacount PLUS, CSSD management were able to achieve a cost saving of more than 23,000 for 2007 in this area alone. For the 4,328 deployments recorded in 2006, it was possible to determine, separately, the durability of the attachment electrode (10 uses before disposal), the electrode handle (30 uses) and the monopolar cable (50 uses). Based on price quotations, it was obviously more economical to work with the single-use monopolar electrode system, especially considering the reduced burden on sterile processing. Cost reduction through comparison, exemplified by electrodes Year Cost of use reprocessing cost = Total single use item = Saving x Number of uses 4,328 4,328 = Total saving 17,788 23,198 5

6 Decrease in damage, complaints and stock loss instacount PLUS challenges and optimizes the work processes within the CSSD. For instance, the program issues warnings to prevent any damage which may occur during processing. Consequently, since instacount PLUS was introduced there have been no such cases of damage anymore. At the same time, the system specifies standard sets, thus reducing the incidence of complaints about incorrect set contents. The error rate has dropped by an impressive 72%. This also contributes to optimizing instrument usage in the operating rooms. It has become a very rare event that an operation is delayed because of a missing instrument. Any avoidable opening of additional sets was reduced to a minimum. Simply being able to document the circulation of instruments at the set level has reduced stock loss by 80%. The traceability of missing quantities in instacount PLUS plays a crucial role in this regard. Precise documentation has steadily led to more disciplined instrument handling especially when it comes to ward instruments, e.g. scissors, forceps and endoscopes. 900 Saving through avoiding processing damage 3,500 Saving through reducing the number of complaints 3,900 Saving through reducing instrument stock shrinkage Reduction in stock shrinkage for ward instruments, (in Euro) Year Number of instruments Value of instruments Reduction on previous year ,575 1, ,904 1, ,840 6

7 Streamlined set structures instacount PLUS enables the CSSD to optimize special types of sets in a limited time within the everyday routine of the surgical departments. Using an additional return tray, the used instruments are sorted from the unused ones and recorded separately when returned to the CSSD. In this way, the number of instruments in General Instruments Set II at the reference hospital was reduced from 98 to 28. Some of the redundant instruments were used to create a new General Instruments Set III, while the remainder formed the basis for a replacement reserve. The General Instrument sets were changed from 1.0 STU 1 to 0.5 STU, releasing 314 sterile units overall. This took a substantial load off the processing cycle and opened up more sterilizer capacity, meaning less capital remained tied up in instruments, more CSSD man-hours became available to cope with a higher number of sets, and additional purchases of washer/disinfectors and sterilizing machines could be delayed. A similar picture was seen regarding the Gastrointestinal sets: Optimized set contents with a reduction from 1.0 STU to 0.5 STU led to an annual reduction by 70 STU, overall. An example of the opposite effect is provided by the Arthroscopy sets. instacount PLUS revealed that the shaver was used in 77% of operations. Five Arthroscopy sets, each now equipped with its own shaver, will avoid future bottlenecks in knee operations and allow a tighter sequence of operations. Because the CSSD has demonstrated its ability to deliver a used set back to theatre, sterile and ready for use, within 3 hours without flash sterilization. At the same time, the additional 0.5 STU for packing a single shaver disappeared from the reprocessing schedule and was integrated in the existing 1.0 STU of the Arthroscopy set yielding the same effects as described above for General Instruments Set II, releasing 163 sterile units per year. 8,600 Saving through optimizing the General sets 6,700 Saving through optimizing the Arthroscopy sets 2,700 Saving through optimizing the Gastrointestinal sets 5,300 Saving through optimizing the Small General UCH sets The Small General UCH Set was also reorganized. The list price for the instruments removed from the six sets of this title amounts to a total of 5,300. Placing these instruments into replacement reserve stock also reduces the planned investment into such stock. 1 STU: Sterile unit (30 x 30 x 60 centimetres) 7

8 Improved utilization of sterilizer capacity instacount PLUS allows detailed planning and control of batch loading. With sufficient supplies in circulation, the overview of the stock situation guarantees constant availability, so that unplanned sterilization of small loads can be avoided. In this way the utilization of sterilizer capacities could be raised from 54.3% to 82.7% since ,700 Interest saved due to deferred investment for additional sterilizer capacity As an important side effect, the acquisition of an additional sterilizer, which had originally been planned and which would also have involved some building work, could be postponed from 2007 to The precise deferment period is based on the long-standing experience of CSSD management that the utilization of sterilizers without an instrument management system never exceeds 70% of full capacity. The standardized and transparent processes in and through instacount PLUS, on the other hand, allow the utilization rate to be increased to, and effectively managed at up to 90%. Utilization of sterilizer capacity % % % % 82.7% year 50,000 sterile unit 40,000 36,785 STU 30,000 28,785 STU Utilization at 90% Utilization at 70% 20,000 10, New sterilizer concept (new due date for replacement) year without savings with savings (realized with instacount ) 8

9 Improved efficiency of work processes With instacount PLUS, computerized workstations produce upto-date set lists, supporting media data and automatic print-outs of production bar codes. The workflow is defined by the software, which helps to avoid user errors and inadvertent deviations from process rules. Measurements show that the processing time per sterile instrument set was reduced by 5 minutes and the time required for single wrap processing by 1.5 minutes compared to previous procedures. Additionally, all process steps are recorded for later documentation. Substantial savings were achieved especially with new members of staff, whose training needs were reduced to a minimum, thanks to the clear, visual instructions in instacount PLUS. The saving of 1,915 man-hours recorded for 2006, with12,480 sets and about 3,500 single wraps processed, does not even include these training hours. 46,000 Saving in manpower costs for routine work processes Clear set list management Clearly setlist management 9

10 Compliance with legal and normative requirements Directives for operators of medical products and RKI 1 guidelines stipulate the assurance of qualified patient care. One element in this is the prescription of standardized quality standards, forming the basis for safe and transparent processes. Such documentation by manual means would require considerable payroll resources. At least one additional administrator post would have to be budgeted for the tasks of cost unit accounting and manual documentation to compliance standard. However, since our reference hospital had already introduced some measures in this respect, even before the introduction of instacount PLUS, CSSD management valued the payroll saving at 20% of one clerical post. 6,400 Payroll saving through automatic documentation and consequent redundancy of manual clerical work Changing profile of CSSD management The remit of the CSSD management shifted from active participation in everyday work processes to predominantly administrative or executive tasks. With instacount PLUS, CSSD managers now have a tool at their disposal to properly position themselves within the hospital, based on objective facts and figures. The analytic capabilities of instacount PLUS provide a new basis for reform and reorganization of existing processes. Importantly, instacount PLUS evaluations are met with general acceptance, in contrast to manual documentation, which often struggled to secure credibility especially if some fault had to be attributed to parties or factors outside CSSD. Now it is the software that brings such deficiencies to light, and ensures objectivity within the hospital. 4,200 Saving due to capacities freed within CSSD management Activity profile of CSSD management in % % 10% Free capacity New tasks Administration of instacount Organisation % 30% 20% 10% Participation in work processes 20 30% 1 Robert Koch Institute 0 before instacount with instacount 10

11 Cost and process optimization for the entire hospital Using an instrument management system has various monetary and non-monetary optimization effects in the overall operation of the hospital. instacount PLUS provides important status information which allows the hospital to deal flexibly with unforeseen events, e.g. emergency operations or technical breakdowns. Which instrument sets are where at this particular moment, and how soon can they be ready for use in the O.R.? The complete transparency of the instrument cycle provided by instacount PLUS helps to ensure optimum utilization of all operating rooms. The productivity summary opposite shows the current status of a sample set (in this example the set has been released) and the processing time, i.e. how long the processing has taken from receipt of the set at the CSSD until its release. Instrument management also allows pinpointing the exact locations where instrument damage occurs. Avoiding such damage contributes to the efficiency of the entire hospital by minimizing repair and replacement costs. This is easily demonstrated at the example of an endoscopic optical system used in general surgery, trauma surgery and gynecology. instacount PLUS allocates each scope to a cost center. This means that, when repairs become necessary due to a reported damage event, it is quickly established which department is responsible for the event. Following a damage analysis, specific handling instructions for the delicate optical systems were issued by CSSD with striking success: While the use of the endoscopes increased by 23% overall between 2004 and 2006, the incidence of damage to these systems dropped by 35% over the same period, equivalent to a decrease in the damage rate by 47%. Lower rate of endoscopes damage despite higher rate of endoscopes use in % year One of many evaluation options in instacount: set productivity Increase in number of operations Decrease in optics damage 11

12 Cost and process optimization for the entire hospital In the past, ordering new products and organizing repair orders required much effort and involved considerable risks of errors and confusion. The purchasing department received handwritten ordering and repair information, which then had to be entered into the hospital s general information system for further processing. This duplication of data inputting alone caused additional work, and often resulted in mix-up between instruments, incorrect orders, incorrect allocation of costs or time-consuming phone contact between the purchasing department, the CSSD and the supplier. Today, more and more hospitals leave the handling of instrument purchases and repairs to where it actually belongs the CSSD. As instacount PLUS holds the complete database of all instruments used in the hospital, data acquisition tasks are reduced, as are the associated errors. In this way, over one fiscal year the reference hospital released 80 man-hours of work in purchasing for other activities. The evaluation showed 48 orders in that year, with 20 order positions on average at a payroll cost of 24 per manhour. 1,900 General hospital savings, e.g. in the purchasing department Purchase and repair orders then and now (manual versus computer-generated, left) 12

13 Cost and process optimization for the entire hospital Each set can be allocated to flexible or fixed cost centers. Reprocessing, transport and other costs are then consigned to these cost centers each time the set circulates through the sterile supply cycle. The cost allocation is transferred into the general hospital information system via an interface, so that the finance department can allocate the costs according to their origin. In the reference hospital, the analysis in instacount PLUS showed that the cost distribution code previously used had been incorrect. As a result, the costs allocated to general surgery were reduced by 14% and all other departments, except for gynecology, had to absorb more costs. Finally, the CSSD can become a profit center by offering services to third-party clients outside the hospital. After one year, the reference hospital was using instacount PLUS not only to save costs. Setting up different clients with individual production statistics and cost allocations also enabled the CSSD to make their services quantifiable for third party clients at the touch of a button. After three years, the CSSD is now realizing 3% of its turnover in this way and aims to increase this share to 15-20%. As another option, the sterile items used in an operation can be allocated to the respective patient. In this way, with the appropriate interface, instacount PLUS can provide case-related cost allocation for DRGs and determine the efficiency, in cost terms, of each individual surgical procedure. Changed cost allocation to cost centers as a result of evaluations in instacount 6 3 4% 6% 4% Growing turnover from processing services for third parties sales to third parties clients 20, % 15, % General Surgery Trauma Surgery Gynecology Urology Other 10,000 5, , , , , year 13

14 Efficiency analysis In this efficiency analysis, only of the quantitative cost savings due to instacount PLUS are taken into account. Qualitative aspects (e.g. the improved status of the CSSD within the hospital) or new areas of profitable activity, such as the provision of services to third parties are excluded. The cost savings identified and described above emerged through a gradual process. Many capabilities in instacount PLUS could be deployed only after collecting the figures to be analyzed over an extended period of time. Thus savings were relatively minor at first, but accumulated over successive years. Return on investment 1.8 years Staff savings due to automatically documentation. Therefore a lower rate of manual expenses. With an initial, one-time net investment of 56,000 and an annual support budget of around 4,000, return on investment was achieved after only 1.8 years. Using instacount PLUS allowed a relatively small, 400-bed hospital to save almost 100,000 after the first three full years. For comparison with other institutions, this should be regarded as a conservative figure, because the reference hospital already had a well-managed sterile supply cycle before the introduction of instacount PLUS. 14

15 Efficiency analysis Cost saving in Euro Cost saving with instruments a) bipolar scissors b) monopolar electrode system 7,800 4,500 23, Processing damage Complaints 1,400 1,600 3,500 3, Minimised stock shrinkage 1,900 3,300 3,900 3, Replacement reserve for General Set III Processing General sets 6. Processing Gastrointestinal sets Replacement reserve 7. Processing Arthroscopy sets Investment 1,000 2,700 6,700 8,600 2,100 1,100 4,900 6, Replacement reserve Small General UCH Set 5, Interest, sterilizer investment 2, Efficiency of processes 11,700 23,400 46,000 46, Staff training 1, Free capacities for CSSD management 4,200 4,200 4, Compliance 6,400 6,400 6,400 6, Reduced workload, purchasing department 1,900 1,900 1,900 1,900 Total savings per year: 25,200 44,400 95, ,500 Grand total after 4 years: 285,000 2,700 6,700 15

16 A B. Braun Joint Venture INVITEC and instacount are either registered trademarks or trademarks of INVITEC GmbH & Co. KG in Germany and/or other countries. Microsoft and Windows are either registered trademarks or trademarks of Microsoft Corporation In the United States and/or other countries. All other names of companies, products and services are either registered trademarks or trademarks of the respective companies. The main product mark Aesculap and the product mark 'instacount' are registered marks of Aesculap AG. All rights reserved. Technical alterations are possible. This leaflet may be used for no other purposes than offering, buying and selling of our products. No part may be copied or reproduced in any form. In the case of misuse we retain the rights to recall our catalogues and pricelists and to take legal actions. Aesculap AG Am Aesculap-Platz Tuttlingen Germany Phone Fax Aesculap a B. Braun company. Brochure No. E /0.5/2