Shopping for items in the operating room

You may have noticed that stores everywhere, and restaurants, too, are getting mobile — as in mobile technology.  In a store like Nordstrom, where thousands of items in many departments must be inventoried and managed, it saves a lot of time, personnel, and therefore money, at least for the store.  From last season’s belts to the spring’s platform shoes, it is in the system, on the iPod and available for anyone to see.

Now consider a hospital — my hospital, for example.  Same problem.  Many departments.  Many items.  In the operating room where I work, the options for suture are mind-boggling.  There’s the variety of sizes, colors and needles and types.  There’s absorbable suture and permanent, woven and monofilament, synthetic, natural or wire.  The needles come in assorted shapes and sharpness.

And that’s just the basics.

Then there are the catheters, staples and clips and all the other stuff we use on a daily basis.  The OR core is a little like the inside Home Depot, but  all the instruments are sterile. If you have had surgery yourself, you an imagine this.  Recalling the itemization of disposables and medications you may have seen on your bill, you might think that basic retail technology is standard at hospitals and that vendors would have bar-coded every conceivable item for hospitals years ago. You might expect that even as you yourself may be bar-coded when you check into a hospital, that everything pertaining to you and your care will be similarly digitally itemized.

But you would be wrong.  There is currently no uniform identification code for surgical items, just as there is no uniform terminology for basic equipment and supplies around the world.  That is part of what makes surgery so expensive. That and the fact that most of the equipment and the pertinent attachments are not inter-operable.  There is no USB for the electrocautery machine.  In former times we would re-sterilized metal instruments such as staple appliers; we now buy plastic single-use devices, along with all the packaging and use-by dates and storage costs.

It is a difficult and touchy topic, to discuss costs of surgical supplies.  Each surgeon has his or her favorite materials, known and trusted since training, or since a rep came through with a more competitive bid to the hospital’s buyers.  You might think that the surgeon doing your case had considered the relative cost of one or another stapler or clip compared to its benefit.  Wrong again.  Most surgeons have no clue what any suture, catheter or dressing costs or what might be an equivalent but less expensive substitutes.

And this is problematic, because while surgeons don’t buy the materials, they are, in every sense, the drivers of these costs.  Why don’t we know?  We are busy, but we do care.  Recently, teams of doctors and nurses have been researching how to bring down the costs of surgery while maintaining the best possible outcomes. Known as “value” or “quality” teams, these groups seek to bring the “lean” concept popularized by Toyota, to the OR.

But we have been blocked on a few points.  Supply vendors have, for many years, placed clauses in purchasing contracts that hospitals cannot release the true costs of supplies to doctors, patients or anyone else. Our hospital supply chain and inventory systems are broken, and our providers can’t get the information they need to change it.  That’s a problem.

Until we have an app for that, we as doctors and consumers can’t do what we want to do, which is to bring down the supply costs of surgical care in a real-time competitive marketplace.  With the costs of the same operation varying by a factor of three, even within a single hospital, the opportunities for cost savings are huge.  SnapTell or RedLaser in the OR?  Imagine!

Catherine deVries is a Professor of Surgery, University of Utah and President, IVUmed.
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