Wilmer surgical committee opens eyes with inclusive approach to sensible cost cutting
Asked to help cut operating room costs, Corazon Sarmiento, RN, and her team at Wilmer Ophthalmology took a surgical approach.
“We asked our finance guy, ‘What is the budget?’ ‘What does this number mean?’ We had him spell it all out so we were educated,” explains Sarmiento, operating room manager. “So much of this effort is about education.” Next, they used their eyes.
Each year, major U.S. hospitals collectively throw away at least $15 million worth of unused surgical supplies, according to a recent report by a Johns Hopkins research team. Part of the problem at Wilmer was the process. Standard operating procedure was for nurses and techs to open all surgical items so they’d be ready for doctors who might each have their own preferences. Once opened, used or not, sterile supplies needed to be disposed of to avoid spreading infections.
Also, too many instruments present meant that every so often one would go missing—“some of these instruments are very tiny,” Sarmiento explains–perhaps accidentally rolled up in a surgical disposable drape and tossed. Discarded items cost anywhere from $37 to $5,000, adding to a patient’s bill and nurses’ frustration. “We wanted to be fiscally responsible,” she says.
“It empowers nurses to say of an item that might be needed, ‘It will be available for you, but I won’t open it until you need it.’ ”
— Corazon Sarmiento, RNSo, about two years ago, Sarmiento helped form a committee of “everyone from junior nurses to senior nurses to NCIIIs to techs to finance to insurance people.” This finance committee charted items, priced them out, and made its recommendation: customized operating room packs.Sarmiento says that rather than persuasion, all the finance committee needed to win over the surgeons was presentation. “We put all the items on a spreadsheet. We had everything priced out and discussed this at our staff meetings, then we would post the costs. We’re not telling them not to use a particular piece of equipment. The doctors see this and say, ‘Oh, maybe I don’t really need to use this anymore.’ ”
The group is now working to bring the number of customized packs to two from four. “The key is including the nurses in the initiative. It empowers nurses to say of an item that might be needed, ‘It will be available for you, but I won’t open it until you need it.’ It’s about education: Now, the doctor might say, ‘I need this, but don’t open it yet.’”
Next for the committee: Look at the bigger equipment for the center. Sarmiento is a member of the supply chain group of the American Association of Eye & Ear Centers of Excellence, which can buy in bulk and get the best price. “We know what’s out there,” she says.
Illustration by Leonard Peng