Delivering Supply Chain Savings In Obstetrics

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Delivering Supply Chain SavingsIn Obstetrics

• June, 2006

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Presenters

• Deirdre McGuinness RN
• Senior Clinical Associate - Premier
• Sue Walters RN
• Clinical Project Manager Fairview Health System
• Don Mullins
• Director of Logistics Management - TriHealth

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Why Obstetrics?

• Not an obvious choice
• Not a lot of attention so far
• Low hanging fruit still available!

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Financials
There are 4.1 million births in the US each year
99 of them are in hospital settings

• Cost
• Labor cost 2,000
• Supply cost 200-250
• 40 of deliveries are funded by Medicaid

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Medicaid Reimbursement2005 average
1,679
DRG 373 - Vaginal Delivery
2,864
DRG 370 Cesarean Section
2,250
729
Normal Newborn
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Supply costs
Orthopedics
Cath Lab

• Lumbar spine hardware 4,100 - 7,500
• Hip implant 16,000

• Pacemaker and leads 5,769 each
• Implantable defibrillator 26,649 each

Obstetrics

• C-Section delivery pack 55-65

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Labor and Delivery
So how do you find supply savings in OB??
Its in the small stuff
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Areas of Focus

• Consumption
• Packs
• Kits
• IV supplies
• Etc
• Itemlevel detail

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• Hospital A switched from 5gm tube to 2.7 gm
  peelpack
• Savings 2,500 per year

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• Do you really need a 40-count needle counter for
  a c-section?

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Areas of Focus

• Utilization
• IUPCs
• Foley Caths
• Spiral Electrodes
• Breast Pumps
• Pads and Underpads

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Clinical Utilization
25 each
8 each
3 each
28 each
Foley Caths
Spiral Electrodes
Breast Pumps
IUPCs
8 41
5 - 59
0.3 2.9 per delivery
11 54
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Birthing this baby.
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First stage of labor

• Beginning Phase
• Mild contractions
• Decision is made to look at supply costs
• Get support team together

• Tips to help you through the beginning phase
• Your mood may become more serious as you focus on
  the hard work ahead

Tips courtesy of WebMD
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First stage of labor

• Active Phase
• Contractions increasing
• Questionnaire
• Purchase History
• Increasing dependence on support team

• Tips to help you through the active phase
• Try changing your position. You may want to try
  getting on your hands and knees
• Soak in a warm tub
• Continue practicing breathing and relaxation
  techniques

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First stage of labor

• Transition Phase
• Contractions strong 2-3 minutes apart
• Site visit
• Develop savings opportunity spreadsheet
• Encouragement from support team vital

• Tips to help you through the transition phase
• Focus on taking one contraction at a time
• Remember that each contraction brings you closer
  to holding your baby

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Second stage of labor (Delivery)

• A strong urge to push with contractions
• Present results and deliver savings opportunities
• Support team required at delivery

• Tips to help you through the second stage
• Take deep breaths in and out before and after
  each contraction
• Curl into the push as much as possible

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Third stage of labor

• Delivery of the afterbirth
• Implement savings opportunities
• WebMD says that this phase only lasts a short
  while but we disagree - Raising this child is a
  long term project

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Fairview Health Services
University of Minnesota Medical Center Fairview
Lakes Medical Center Fairview Northland Medical
Center Fairview Red Wing Medical Center Fairview
Ridges Hospital Fairview Southdale
Hospital Fairview University Medical Center -
Mesabi

23 Owned Primary Care Clinics 16 Specialty
Clinics 7 Urgent Care Clinics 5 Owned 13
Managed Senior Housing Facilities 23 Institute
for Athletic Medicine locations 5 Long-term Care
locations 26 Retail Pharmacies
Staffed Acute Beds 1172
18,492 Employees
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Participating Hospitals
2656 Births/Year
University of Minnesota - Riverside
Academic Teaching Hosp NICU
761 Births/Year
Lakes Medical Center
Community Hosp Level 1 Nursery
516 Births/Year
Northland Medical Center
Community Hosp Level 1 Nursery
Ridges Hospital
3775 Births/Year
Community Hosp Level II Nursery
Southdale Hospital
3392 Births/Year
Community Hosp Level II Nursery
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Fairview Health System

• Why do this project?
• High volume
• Quiet, under the radar, department
• DRG reimbursement

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Fairview Health System

• Biggest ahas
• All those little no-brainer things can add up to
  real savings
• IC catheters - 28,000
• Lubricant - 2,400
• Needle counters - 7,300
• Mesh panties - 4,850
• Chemical cold packs - 10,500
• Total opportunity identified
• 548,000

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Our Results
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Just Do It

• Blood tubing
• Speculums
• IV Tubing
• IV Start Kits
• Beverages
• Cleaning wipes
• Witch Hazel pads
• Pack utilization review

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Next Steps

• Project Teams
• Unit Directors responsible for the just do
  its
• Staff engagement in product selection
• Clinical teams responsible for specific
  initiatives
• The Road Show
• IUPCs
• Fetal Monitoring Belts
• Spiral Electrodes
• Ultrasonic Gel
• Mesh Panties
• Umbilical Cord Clamps

82,000 Year
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TriHealth - at a Glancea partnership of Bethesda
and Good Samaritan Hospitals

• Good Samaritan Hospital (534 Beds)
• Busiest hospital in Cincinnati market
• Highest market share in Womens services
• Level III Nursery
• Teaching
• OB, Anesthesia, Surgery residents, Faculty
  practice
• High volume
• Cardiology, Orthopedic implants, OB

Good Samaritan Hospital
6225 Births/year
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TriHealth - at a Glancea partnership of Bethesda
and Good Samaritan Hospitals

• Bethesda North Hospital (273 Beds)
• Fastest growing hospital in the Cincinnati market
• Level III Trauma - 2nd busiest ED
• High volume
• Cardiology, Orthopedic implants, OB
• 2006 Solucient Top 100 Hospital

Bethesda North Hospital
4108 Births/year
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TriHealth - at a Glance

• Good Samaritan and Bethesda Hospitals are the two
  leading maternity hospitals in Greater
  Cincinnati.
• Delivering 10,500 of the approximately 28,000
  babies each year in an 8 county region.
• The two hospitals have a total of over 160
  obstetricians and gynecologists who use our
  facility,
• The system also has a large nurse midwifery
  practice.
• The TriHealth Ob/Gyn Residency education program
  is one of the largest in the nation with 32
  residents.
• In addition, the department supports a 3 year
  urogynecology fellowship program.

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TriHealth - at a Glance

• Good Samaritan
• Good Samaritan is a Level III maternity and
  neonatal center, and has the second largest
  gynecologic surgery program in the Greater
  Cincinnati area.
• The Level III NICU, which will soon have over 50
  beds, is known throughout the nation as a leader
  in high risk neonatal care, and routinely scores
  in the top percentile on the Vermont Oxford
  clinical benchmarking database.
• Bethesda North
• Bethesda North is a community, low-risk
  pregnancy, maternity center
• Level II Nursery

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Previous Engagements / Initiatives

• 2000 Suture / Endo mechanical Initiative
• 2001 Perioperative Process Improvement
• 2001Central Sterile Services Initiative
• 2001Restructuring of Logistics
• 2002 Installation Material Management / Accounts
  Payable Information System
• 2002 Orthopedic Supply Expense Reduction
  Initiative
• 2003 Supply Chain Management Business Plan
• 2003 Restructure of Purchasing Responsibilities

• 2003 Non-Labor Expense Reduction Engagement
• 2005 / 2006 Orthopedic Supply Expense Reduction
  Initiative
• 2005 / 2006 Supply Chain Initiative Pharmacy
• 2005 / 2006 Restructuring of the New Clinical
  Technology
• Committee 2005 Implementation of Point of Use
  System
• 2005 Implementation of WISDOM2
• 2006 Supply Chain Improvement Initiative - Labor
  Delivery
• 2000-2006 Hundreds of other Supply Chain
  initiatives smaller in nature.

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Labor and Delivery Project

• Project Kick-off
• March 2006
• Project Completed
• May 2006
• Project Results
• 600,000 in opportunity identified

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Our Results
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Preferences
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Next Steps

• Planning - Three major categories identified
• Physician Preference Items
• Physicians identified
• Supplies
• Drugs
• Practice Process Changes
• Non Physician Preference Items
• Assignments were given to Managers Staff in
  Labor Delivery, Purchasing and Logistics.
• Staff Preference Items
• Assignments were given to Managers Staff in
  Labor Delivery, Purchasing and Logistics.

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Next Steps

• Implementation
• Follow up meetings are being scheduled for
  results reporting
• Evaluations are being scheduled
• Prioritization of supplies and drugs initiatives
  (Degree of difficulty)
• CPI Committee
• Meetings being scheduled for review of
  recommendations
• Results Reporting
• Scorecard reported on a quarterly basis

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Lessons Learned

• Project champion needed
• Staff involvement is critical
• No-one knows the unvarnished truth of supply
  usage better than the nursing techs and
  assistants
• Check out the Missions Box if you want to see
  whats not being well utilized
• Watch whats going home at discharge
• Get as many people involved in the summit
  meeting as possible
• Bring product samples to the summit meeting

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Questions?