The implementation of this methodology has confirmed that significant cost savings can be realised with minimal input.
One off costs for the reduction of stock held in the department resulted in €30,000 or a 25% stock reduction in line with other studies. It has proved that an experienced clinical nurse manager can determine how cost savings can be made.
The saving from the introduction of custom packs in the department was €140,000 with year on year savings in the region of €140,000 per year and this ensures a more efficient operating department performing more procedures for less. This increases the economies of scale per procedure.
Nursing labour savings of thirty minutes per case resulted from using custom packs mirroring Boyds (2004) experience with custom pack implementation. This is based on taking 15 minutes per case to collect all consumables and 15 minutes to open them. Taking cognisance that this is an average of minor and major cases it can take up to 1.5 hours to set up for some complex procedures if all elements are separate. This saving equates to €44,600 of nursing time.
This is a huge driver for the efficient use of trained perioperative nurses as it resulted in more expedient patient positioning and earlier surgical starts. The value of excess stock returned was difficult to capture due to the lack of traceability for some items but it is in the region of €40,000. The use of information systems needs to be vastly improved and would have led to better analysis of the materials database. Industry would not function without good information systems to manage their supply chain and in the future this will be led by GS1 barcoding technology.
The study found that staff involved in the Operating theatre supply chain need to be educated on SCM methods as supported by Davis (2005) and Patterson (2009b) who cite the importance of developing clinical champions in the perioperative supply chain. However, we must not forget that nurses/managers must perform their clinical work and be supported by fully functional ordering systems that don’t divert managers to manually order and then fill in computer database ordering. The implementation of this methodology in the perioperative setting is unique in Ireland. Crucially, the theatre department has driven the change from within, as it dealt with a real life issue which is apparent to no-one except perioperative nurses who work in this high cost area. There is a culture change in the department as staff now know the cost of the all supplies. This has empowered nurses to make decisions about which expensive supplies to open for each case, as in the past cost may not have been an issue. Nurses also appreciate the efficiency of custom packs, due to time pressure to set up for the next case immediately once the previous patient has left their theatre. Medical staff also make decisions based on value for money and decide which products they want to use.
The introduction of SCM as a method of saving money is crucial. Cost savings are a major result, as inventory reduction and the improved availability of standardized consumable products and instrumentation incur considerable savings (Park & Dickerson, 2009; Feistritzer & Keck, 2000).
A streamlined perioperative supply chain allows for increased efficiency for all staff. This showcases a framework for other theatres to follow in restructuring their supply chain; leading to a reduction in nursing time spent in preparation for surgery; scrub nurse preparation of instruments immediately prior to surgery and in the turnover of the theatre.
The time saved results in adding an additional major procedure to each operating list, thus increasing the hospitals efficiency and dealing with waiting lists. The savings described were achieved on a cost neutral basis with no extra human resources being required.