Introduction by Scott Hardin, Director of Cardiovascular Services When it comes to caring for patients, Carol Humble, cath lab inventory manager at Memorial Health Care System in Chattanooga, Tenessee, knows what it takes. After 14 years of direct patient care as a registered nurse, Carol has turned her focus to managing the vast amount of inventory in Memorial’s cardiac cath, electrophysiology, and peripheral labs. As an RN turned inventory manager, Carol knows the importance of having the right products at the right time for the physician — leading to improved care for the patient. Some may say inventory is a boring topic, but some, like Carol, know the importance precision in numbers can have for patient safety. Not only does managing inventory impact hospital administration, it also affects the clinicians in the room caring for the patient. Supply tracking and control can be an overwhelming task, with the burden multiplied by the size and procedure volume. It takes dedication and an organized multi-tasker to grasp this momentous job. Carol loves what she does, which doesn’t mean her job is easy; we’ve often said she has the hardest job in the department. The abundance of products now available in a variety of sizes and with limited shelf life makes it difficult to be accurate with a manual system — even for a detail-oriented perfectionist. Memorial Health Care System has always had a progressive cardiology department, with one of the largest cath labs in the area, often supporting neighboring hospitals when needed. But when it came to inventory control, we didn’t feel we had the right tools for the job. With escalating product costs and limited resources to account for items used, we knew we needed to get tough on inventory control and management. In the winter of 2009, Scott Hardin, our cardiovascular service line director, embarked on a search to automate the entire product life cycle process of ordering, receiving, billing and recording patient records. To accomplish his goals of improving charge capture, reducing inventory costs and providing a higher level of care for patients, we turned to RFID (radio frequency identification) technology. With a 99.9997% accuracy rate of tracking products, inventory is now as exact as it can be. The system we chose accomplishes all we needed through a series of integrations with existing hospital systems. The labs now have a fully automated system, yielding benefits for patients, clinicians and hospital administrators. Having greater control and accuracy over inventory, I now have more opportunity to do patient care and not feel guilty if I need to take time off. Pre RFID at Memorial Memorial has 7 cath labs, two of which are in a connecting building, making it the largest cath lab program in the Chattanooga area. Keeping up with inventory was a daunting task with our procedure load. This was primarily due to inventory being located on different floors and, in some cases, different buildings. When items were needed for procedures, clinicians would use an intercom system to call and locate the desired product. Once the location was determined, the clinicians — including the nurses and techs already weighed down with lead for safety in the procedure room — were running down the stairs and out the door to retrieve them. Not only did this require they leave the procedure room, resulting in one less person available for patient care, the round trip could take up to 5 minutes or more. There were also multiple tasks, requiring staff to transcribe barcodes onto charts and double-check that products were properly recorded in a patient record and on the billing sheets. RFID arrives To the relief of many, we implemented an RFID inventory system (WaveMark, Inc., Littleton, MA) in the spring of 2009. Using RFID to track inventory and usage of individual items provides an accurate glimpse at any moment, of exactly where and how much of each item exists. This is accomplished by scanning each product’s bar-coded serial number as it is received. Using a desktop reader cabled to a computer, a passive 13.56 MHz ISO 15693-compliant RFID tag is read and attached to the product, linking that tag’s ID number with the bar-coded serial number and other information regarding the product, such as its type, size, expiration date and cost to a patient. Once items are identified in the system, they are stored in an RFID-enabled cabinet. The cabinets capture the tags’ unique ID number, forwarding them along with a time and date stamp approximately every 20 minutes to the software running on Wavemark’s secure, Internet-based server. An Ethernet connection and VPN access is all that is needed from our IT department. The products are stored in cabinets and storage areas located in various labs, and the captured information is available for viewing on the web-based dashboard via a series of reports, alerts and dynamic searches. As products are removed from the shelf, the status of those items automatically changes to “missing” in the system. When the item is used for a case, the nurse or tech waves the item’s RFID tag by an RFID reader, where the inventory level is decremented and the clinical documentation system is simultaneously updated. If the item’s status does not change from missing to “used for a patient” in a predetermined amount of time, the software generates an alert indicating the item is missing and not linked to a patient, prompting a timely search for the item. So far, we have installed 10 cabinets — six fitted with shelves, as well as four specifically designed for hanging products, such as catheters and wires, an important requirement for us. Integration with existing hospital systems To achieve improved usage tracking and billing accuracy, we became one of the first hospitals to take advantage of direct integration with Lawson for automated requisitioning and with Meditech B/AR for patient billing. The RFID reader, with a touch screen software interface and CPU with hospital LAN connection, is used in the control room to record supply usage in the clinical documentation system, as well as automatically assign charge codes for supplies to a Meditech account number. The integration with these existing hospital information systems has made a significant impact on our ability to accurately bill and replenish items. Early success with the technology has us elated about the possibilities of long-term cost savings ahead. We have experienced a host of savings opportunities, not the least of which is staff efficiency. Results from RFID implementation As the inventory manager, I greatly appreciated the immediate effect on my ability to do my job better now that I have accurate and timely information for making decisions and supporting physicians. Still a registered nurse and available for patient care when needed, I was also able to experience the improvement in working conditions for the clinical staff. The biggest benefit of the new system is allowing more time directed to patient care. We counted the footsteps from the main cath lab to the labs in the other building at 300 feet. With the clinical staff making 6 trips on average daily, a lot of time was spent retrieving supplies. With the implementation of the new system, it is now rare that we are making these trips. Clinical workflow improvements With the entire product life cycle process now automated, the clinical workflow has improved dramatically. Nurses no longer need to record supplies into multiple systems, saving valuable time and improving accuracy tenfold. The nurses and techs are thrilled with the ease and accuracy of recording supplies into the clinical documentation system — just a wave of the item by the reader, and the product barcode and serial/lot number are automatically associated with the patient, and the nurse never touched the keyboard. The physicians have even taken notice of the workflow improvements in the lab. I am able to swiftly make adjustments to inventory based on physician likes and dislikes, ensuring the procedure room in which they are working always has what they prefer. In our lab, procedure volume is going up, inventory costs are going down, while product mix has increased, providing more options for physicians and patients. In addition, I can easily establish par levels for ordering and can quickly make adjustments using the system tool to match usage patterns at the line-item level. Finally, replenishments are based on ordering against an accurate real-time count of what is on hand and what is on order against par level. To streamline the receiving process, once orders are placed, the system tracks their arrival and links the products to their incoming PO. We recently broke our record in “door-to-shelf” time (D2S). The amount of time to receive products, match against order, tag the items and store on RFID shelves took only 30 minutes for 172 products. With many items in the cath lab on consignment, the reconciliation tool for comparing consignment par levels with on-hand amounts provides real-time reconciliation reporting. A critical aspect of any inventory manager’s job is to make sure expired or recalled products are promptly removed. RFID has given me an eagle eye into expiration dates and I can now easily locate and remove items due to expire in a set amount of time. The fact that RFID is tracking each individual item, including its expiration date and lot/serial numbers, is a boon to patient safety. Financial and operating efficiencies While the patient care, safety and workflow benefits of the RFID system are what I appreciate most, the bottom-line savings are the icing on the cake for hospital administrators. After just a few months in use, the RFID system has yielded significant hard dollar savings. Now that inventory levels are being matched to usage, the amount of money tied up in inventory on hand, especially in the EP lab, where most inventory is owned, has been reduced by $300,000, allowing the opportunity to bring in a greater variety of products. With the integration of hospitals systems, information is properly captured and documented in the appropriate system. Scott Hardin, director of cardiovascular services, feels that real time billing and product tracking will save thousands of dollars. Tracking is as easy as waving the product by the point of care reader. Real-time expiration tracking has savings opportunities in the thousands of dollars in reducing product waste due to expirations. Real-time tracking alerts me to when a product has been removed, but has not been assigned to a patient. The RFID technology system informs me of the time and last-known location, enabling me to find the missing items before the day is over. Possibly the largest savings opportunity is the proper execution of bulk buys. Bulk buys are a real savings opportunity for cath labs, yet rarely get executed properly and typically end up costing us more in the long run. The RFID bulk buy analyzer reviews what products have been used in a certain timeframe, creates a proposed shopping list based on that product usage and then tracks each item in that bulk buy from arrival in the hospital to final disposition. Scott estimates it can save more than $300,000 in inventory costs now that historical data is readily available to execute a successful bulk buy. The efficiency of the inventory management system has allowed me and the team to refocus on other pressing responsibilities. This is a big win when the economic environment requires that we do more with the same resources. Conclusion We are excited about the long-term savings opportunities and we have already increased the number of RFID cabinets to track more products. Nurses are even asking that more products are tracked with RFID, which shows how much they appreciate the clinical ease of use and value that comes from a real-time inventory tracking solution. RFID is allowing nurses to spend more time doing what we love, patient care. Carol Humble can be contacted at Carol_Humble@memorial.org Scott Hardin can be contacted at Lawrence_HardinSr@memorial.org
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