1. Perioperative Enterprise: Re-Designing Ambulatory Surgery Center Supplies Replenishment
Presenter: David Bivens
Team Members
Materials: Lisa McMillian, Lauren Smoke, Patrice Jordan, Brodrick Thompson, Mary Murray
Supply Chain: Jim Ishikawa
IT: Wade Altman, Craig Owen, Keith Shook, Irvin Serra
Institution
The University of Texas MD Anderson Cancer Center

2. So What Kind of Project is This?
Focus: OR Supplies Management
Involves:
Physical setup of supplies storage
Path Supplies take to arrive in the OR
Supplies ordering process

3. Geographical Proximity of the Main and Ambulatory ORs
Main OR & Supplies Storage
Ambulatory Surgery Center & Supplies

4. Overview of Baseline Condition
2 Locations Performing Surgical Functions
Main OR
Supporting 29 OR Rooms plus the Ambulatory Surgery Center
Ambulatory Surgery Center (ASC)
6 OR Rooms
1 stock location
Supplier Ordering and Receiving in Main Only
Automated, receipts daily
Ambulatory Surgery Center orders from Main OR Stock
Manual ordering requisitions to Main OR daily

5. Geographical Proximity of the Main and Ambulatory ORs
Main OR & Supplies Storage
Ambulatory Surgery Center & Supplies

6. Catalyst For Starting the Project
Why did we start this project?
Logical 2nd Step of a project that separated the two electronic stock locations in our OR Management Software
Large quantities being returned to Main OR Stockroom
Some Items getting close to expiration
Backup staff from Main stockroom struggling with workflow demands unique to the ASC

7. Baseline Conditions: ASC Workflow
Only Generalized Work Processes
No Standard Way to Perform a Task
What is the effect?
Inconsistent service to the Operating Rooms
No documentation for consistent training
No “Best Method” from a quality and performance standpoint
No clearly defined pars
Result: Too Much and Too Little
$’s tied up, expired material, lots of expediting

8. Baseline VSM

9. Baseline Data Inventory Level The Opportunity?
Total Inventory on hand $ 322,500
This equates to a days on hand of….
>30 days = 620 SKUs,
>60 days = 546 SKUs, out of 1210 total items
>90 days = 504 SKUs
In Terms of Dollars
$ > 10 days = $186,830
$ >15 days = $118,979
$ >20 days = $51,128
The Opportunity?
Set a goal of 30% reduction in On-Hand Inventory
30% is 96,750, overall would be 225,750

10. Aim Statement
“To reduce the amount of supplies transferred from the main POE materials center to the ASC materials location by 50% by August 31, 2011”
Secondary Aim
“To reduce the inventory on hand in the ASC materials location by 30% by August 31,2011 through improved par management”

11. ASC Ishikawa Exercise

12. ASC Ishikawa Exercise

13. VSM Idea Sheet

14. VSM: Future State Plan

15. Project Timeline

16. PAR Analysis
Based on a combination of actual usage documented in the OR Case Record and staff review for validation.
PAR calculations:
If JIT: PAR = (Avg. Day) + (Highest Day)
Non-JIT: PAR = (5) x (Avg. Day)
Both were rounded up to next Order Unit, either each, box or case

17. Sample of PAR Analysis

18. New Stockroom Setup
Setup business rules for Low Usage/high value items
Main is source for these items
ASC can pull from Main and return to stock whatever not used
Cuts down on overall inventory levels
Reduces chance of expiring supplies

19. Barcode Scanning Replenishment
No more scrolling through each item or typing items and quantities
Just scan locations needing re-supply and type in quantity remaining

20. Job Guidance Sheet: New Process
Posted in the Work Area
Training Aid
As-Needed Quick Reference

21. Data Over Time: Revisiting the Aim Statement
“To reduce the amount of supplies transferred from the main POE materials center to the ASC materials location by 50% by August 31, 2011” So, using QI Analyst software an Individuals and Moving Range chart was created to monitor the progress.

22. IDT History Prior to Intervention
Nov. 10’: PAR Analysis
Mar. 10’: Baseline Physical Inventory
July 09’: First Data Available
Jan. 10’: Physical Inventory Setup
Special Note: Why did transfers increase in 2010 prior to implementation?
---Different person ordering
---Pushback from Main to return items
Low vol. excess items from unique procedures not returned so can’t offset IDT’s per month
Why is the $$s/case on the low side? Port-a-cath cases skew the overall, 1/3 to half of the overall volume

23. Intervention Timeline
Nov. 10’: PAR Analysis
July 09’: First Data Available
Mar. 10’: Baseline Physical Inventory
Jan. 10’: Physical Inventory Setup

24. Intervention Timeline
Nov. 10’: PAR Analysis
Feb.11’: Begin Direct Ordering/ Receiving at ASC
July 09’: First Data Available
Mar.11’: Start JIT handheld Ordering
Mar. 10’: Baseline Physical Inventory
Jan. 10’: Physical Inventory Setup
Aug. 11’: Follow-Up Physical Inventory

25. VSM: New Current State

26. Results – Primary Aim
71.5% Reduction in transfers from Main to ASC ($298/case to $85/case) through 8 Months of post implementation data available
(Feb. ‘11 through Sept. ’11).
Looking at the last 6 months to get beyond the learning curve, transfers have reduced by 79.9%, exceeding goal by 59.7%.
This translates to a labor savings of $47,376 annually

27. Chart of Total Transferred by Month
Go Live

28. Results – Secondary Aim
48% Reduction in on hand inventory.
This is a reduction from the baseline physical inventory of $322,534 to $169,220 recorded in the first post implementation annual inventory (Aug. 31, 2011).
The goal of a 30% reduction in on-hand inventory has been exceeded by 58%

29. Next Steps?
Explore Implementing bar code scanning replenishment in the main POE Materials location proved out at ASC.
Re-Allocate some of the staff hours gained by the project to case cart picking of instruments. This would free Sterile Processing staff to focus on improving instrument set turnaround time and quality.