Inventory management of reusable surgical supplies

Integrated procurement and reprocessing planning for reusable medical devices with a limited shelf life

We present a new model formulation for a multiproduct dynamic order quantity problem with product returns and a reprocessing option. The optimization considers the limited shelf life of sterile medical devices as well as the capacity constraints of reprocessing and sterilization resources. The time-varying demand is known in advance and must be satisfied by purchasing new medical devices or by reprocessing used and expired devices. The objective is to determine a feasible procurement and reprocessing plan that minimizes the incurred costs. The problem is solved in a heuristic manner in two steps. First, we use a Dantzig-Wolfe reformulation of the underlying problem, and a column generation approach is applied to tighten the lower bound. In the next step, the obtained lower bound is transformed into a feasible solution using CPLEX. Our numerical results illustrate the high solution quality of this approach. The comparison with a simulation based on the first-come-first-served principle shows the advantage of integrated planning.

Application study of surgical instruments information management system in sports medicine specialty

The management of surgical instruments is related to the safety and efficiency of surgical operations, and a surgical instruments information management system (SIIMS) has been developed. The aim of the current study is to explore the application value of the SIIMS in sports medicine specialty. A set of self-developed SIIMS for sports medicine surgeries was applied to the study. The application value of the SIIMS was verified by comparing the safety and efficiency of instrument manipulation before and after its application, with instrument accidents, instrument repair rate, instrument scrap rate and instrument use efficiency as indicators. Through the application of the SIIMS, the incidence of surgical instrument accidents decreased from 3.7 times to 1.8 times (P = 0.02), the number of instrument repair decreased from 7.7 times to 2.9 times (P = 0.00), and the number of scrapped instruments decreased from 5.1 to 2.3 (P = 0.03), when referred to per thousand operations. Before and after the application of the SIIMS, the average instrument use efficiency was 74.0% ± 3.3% and 88.2% ± 4.4%, respectively, with statistically significant difference (P = 0.00). The application of the SIIMS in sports medicine specialty is helpful to the fine management of surgical instruments, improve surgical safety and instrument use efficiency.

A simple and practical approach to improving the cost effectiveness of surgical inventory management

Operating room inventories typically involve hundreds of surgical items. Managers require very high service levels since the cost of shortages can be excessive up to and including cancelling surgery. From our experience, many inventory managers rely on manual approaches and intuition to set inventory control parameters. Although there are classical theoretical methods available for deriving "optimal" inventory policies, these classical methods rely on assumptions that do not accurately represent typical operating room inventories. Using 5 years of data from a large Canadian hospital, we use simulation and a simple search heuristic to find the optimal (s, S) ordering policy and show that 1) current hospital methods dramatically underperform with respect to service level and 2) there are significant savings to be realised over the best available classical theoretical models. An example case testing potential lead time changes is discussed.

Examining reuse and replacement procedures for Ipas manual vacuum aspiration and cannulae in nine countries

OBJECTIVE

To determine how many times Ipas manual vacuum aspiration (MVA) instruments are reused, for what reasons, when the instruments are replaced and/or discarded, and what the barriers are to replacing them.

METHODS

We conducted a mixed-methods cross-sectional study of health care providers who provide MVA services and key stakeholders in the supply chain to understand reuse and replacement of Ipas MVA aspirators and cannulae. Qualitative interviews focused on procurement and replacement of Ipas MVA instruments.

RESULTS

The authors interviewed 352 health care providers from nine countries from 2019 to 2021. Providers reported reusing MVA instruments an average of 34.4 times (standard deviation, 45). The reuse averages ranged from one time (Democratic Republic of the Congo) to 500 times (India), with figures varying between providers within the same country. Instrument malfunctioning rather than a specific number of uses drove reuse and subsequent replacement. The decision to replace was most commonly made by the provider during use. Half of the providers said that they knew of no issues with the supply chain, and 85% said they were always able to replace Ipas MVA instruments when needed.

CONCLUSION

Tracking reuse of MVA instruments was uncommon at participating providers' health facilities. Providers' estimates revealed great variability in reuse frequency and tracking procedures.

Reducing Disposable Surgical Items: Decreasing Environmental Impact and Costs at a Children's Hospital, A Pilot Study

INTRODUCTION

United States landfill waste generated in the operating room (OR) is estimated to be three billion tons per year. The goal of this study was to analyze the environmental and fiscal impact of right-sizing surgical supplies at a medium-sized children's hospital using lean methodology to reduce physical waste generated in the operating room.

METHODS

A multidisciplinary task force was created to reduce waste in the OR of an academic children's hospital. A single-center case study, proof-of-concept, and scalability analysis of operative waste reduction was performed. Surgical packs were identified as a target. Pack utilization was monitored during an initial pilot analysis for 12 d then followed by a focused 3-week period, capturing all unused items by participating surgical services. Items discarded in more than 85% of cases were excluded in subsequent preformed packs.

RESULTS

Pilot review identified 46 items in 113 procedures for removal from surgical packs. Subsequent 3-week analysis focusing on two surgical services, and 359 procedures identified a potential $1,111.88 savings with elimination of minimally used items. Over 1 y, removal of all minimally used items from seven surgical services diverted two tons of plastic landfill waste, saved $27,503 in surgical pack acquisition-costs, and prevented the theoretical loss of $13,824 in wasted supplies. Additional purchasing analysis has resulted in another $70,000 of savings through supply chain streamlining. Application of this process nationally could prevent >6000 tons of waste in the United States per year.

CONCLUSIONS

Application of a simple iterative process to reduce waste in the OR can result in substantial waste diversion and cost savings. Broad adoption of such a process to reduce OR waste could greatly reduce the environmental impact of surgical care.

Inventory Optimization in the Perioperative Care Department Using Kotter's Change Model

BACKGROUND

Perioperative services have been scrutinized in the context of cost containment in health care, particularly in the procurement and reprocessing of surgical instruments. Although solutions such as surgical instrument inventory optimization (IO) have been proposed, there is a paucity of literature on how to implement this change. The purpose of this project was to describe the implementation of an IO using Kotter's Change Model (KCM).

METHODS

This study was conducted at a tertiary academic hospital across the four highest-volume surgical services. The IO was implemented using the steps outlined by KCM: (1) create coalition, (2) create vision for change, (3) establish urgency, (4) communicate the vision, (5) empower broad-based action, (6) generate short-term wins, (7) consolidate gains, and (8) anchor change. This process was evaluated using inventory metrics, operational efficiency metrics, and clinician satisfaction.

RESULTS

Total inventory was reduced by 37.7%, with an average tray size reduction of 18.0%. This led to a total reprocessing time savings of 1,333 hours per annum and labor cost savings of $39,995 per annum. Depreciation cost savings were $64,320 per annum. Case cancellation rate due to instrument-related errors decreased from 3.9% to 0.2%. The proportion of staff completely satisfied with the inventory was 1.7% pre-IO and 80.0% post-IO.

CONCLUSION

This is the first study to describe the successful implementation of KCM to facilitate change in the perioperative setting. This success contributes to the growing body of literature supporting KCM as a valuable change management tool in health care.

A preliminary study for selecting the appropriate AI-based forecasting model for hospital assets demand under disasters

Purpose

Hospitals recently search for more accurate forecasting systems, given the unpredictable demand and the increasing occurrence of disruptive incidents (mass casualty incidents, pandemics and natural disasters). Besides, the incorporation of automatic inventory and replenishment systems – that hospitals are undertaking – requires developed and accurate forecasting systems. Researchers propose different artificial intelligence (AI)-based forecasting models to predict hospital assets consumption (AC) for everyday activity case and prove that AI-based models generally outperform many forecasting models in this framework. The purpose of this paper is to identify the appropriate AI-based forecasting model(s) for predicting hospital AC under disruptive incidents to improve hospitals' response to disasters/pandemics situations.

Design/methodology/approach

The authors select the appropriate AI-based forecasting models according to the deduced criteria from hospitals' framework analysis under disruptive incidents. Artificial neural network (ANN), recurrent neural network (RNN), adaptive neuro-fuzzy inference system (ANFIS) and learning-FIS (FIS with learning algorithms) are generally compliant with the criteria among many AI-based forecasting methods. Therefore, the authors evaluate their accuracy to predict a university hospital AC under a burn mass casualty incident.

Findings

The ANFIS model is the most compliant with the extracted criteria (autonomous learning capability, fast response, real-time control and interpretability) and provides the best accuracy (the average accuracy is 98.46%) comparing to the other models.

Originality/value

This work contributes to developing accurate forecasting systems for hospitals under disruptive incidents to improve their response to disasters/pandemics situations.

Exploring risk pooling in hospitals to reduce demand and lead time uncertainty

Nearly every eighth German hospital faces an elevated risk of bankruptcy. An inappropriate use of inventory management practices is among the causes. Hospitals suffer from demand and lead time uncertainty, and the current COVID-19 pandemic worsened the plight. The popular business logistics concept of risk pooling has been shown to reduce these uncertainties in industry and trade, but has been neglected as a variability reduction method in healthcare operations research and practice. Based on a survey with 223 German hospitals, this study explores how ten risk pooling methods can be adapted and applied in the healthcare context to reduce economic losses while maintaining a given service level. The results suggest that in general risk pooling may improve the economic situation of hospitals and, in particular, inventory pooling, transshipments, and product substitution for medications and consumer goods are the most effective methods in the healthcare context, while form postponement may be unsuitable for hospitals due to the required efforts, delay in treatments, and liability issues. The application of risk pooling in healthcare requires willingness to exchange information and to cooperate, adequate IT infrastructure, compatibility, adherence to healthcare laws and regulations, and securing the immediate treatment of emergencies. Compared to manufacturing and trading companies, hospitals seem to currently neglect the variability reducing effect of risk pooling.

Inventory management of surgical supplies and sterile instruments in hospitals: a literature review

Operating rooms are considered a significant revenue source, as well as the main source of waste and cost, among the hospital's departments. Any cost savings in operating rooms will have a broad financial impact. Over the last decades, many researchers and practitioners have conducted studies to deal with the issue of managing surgical supplies and instruments, which are highly affected by surgeons' preferences. The purpose of this article is to present an up-to-date review of research in the field of inventory management of surgical supplies and instruments. We have analysed the literature in a systematic manner and organised the identified papers into two groups: the papers that were published by scientific researchers and developed optimisation techniques and the papers that were published by practitioners and reported their observations of the current issues in the operating room. We also identify the future research directions leading to operating room inventory cost reduction.