Bottom Line

Affording changes in wound drainage products

By Amy Herrin

Executing conversions effectively takes time and proper planning

Hospitals face an ever-increasing challenge in managing the link between financial budgeting and patient care, and operational efficiency is dependent upon continually strengthening that link. The monetary pressures that facilities face today must be managed while maintaining advancement in clinical capabilities.

General finance principals illustrate that an increase in purchase costs is related to the number of suppliers from which a hospital sources a given product. In turn, vendors are willing to offer additional discounts to obtain market share.

As a result, standardizing purchasing can yield savings. However, standardization across a product line can be difficult, particularly in the surgical area where the product preference of the doctors is paramount in many buying decisions.

On the other hand, if a category targeted for standardization is carefully selected, and clinicians are involved in the standardization process, successful results can be achieved.

One product category that has been successful as an area of focus for standardization is wound drainage. These products are used in a patient during surgery to allow fluids and air to flow out of the body during the surgical procedure so infections do not develop.

Drains, tubes, adaptors and reservoirs are generally included in this category. Wound drainage products present a conversion opportunity that may be less complex than other surgical product categories, so the potential for success is high if the effort is executed effectively.

Once a wound drainage category is targeted for conversion within a facility, it’s critical that appropriate planning and preparation is done at the outset of the project. 

Although the products are considered low-complexity, they are critical to patient safety. “If fluid does not drain properly, it can lead to complications,” says Myra Robinson, R.N., surgical portfolio executive at Novation, Irving, Texas. “Fluid retention heightens the risk of infection.”

There are various configurations of each product, and the different sizes and features ensure appropriate breadth and depth of product line is available to meet the specific needs of different surgeries. These products can be sold individually, or they can be sold in a kit in which all the wound drainage products needed for a particular case are packaged together.

At present time

Understanding a hospital’s current landscape of wound drainage product purchases is a key first step in the planning process. Hospitals should outline the product mix and use volume and quantify that for a certain time period.

It’s important to know the number of suppliers being used and to have detailed purchase information for each vendor. Knowing this information helps develop an understanding about how current share is distributed.

Materials managers can collect this information and use it to initiate discussions with the hospital’s clinical stakeholders.

Supply availability is a major component to consider when beginning a conversion initiative. Wound drainage products are used in many surgical cases, so it’s important that a facility be able to articulate its inventory needs to manufacturers.

In addition, manufacturers need to ensure that they have sufficient products to meet the the demands of a conversion.

Clinical task force

Clinician input is the key that drives conversion success, so this is the time to formulate a clinical review team to lead the wound drainage product conversion efforts.

This team should be composed of the product end-users (i.e., nurses and physicians/surgeons). The appropriate materials management staff should conduct a preliminary meeting to provide background on the conversion efforts, identify the goals of the initiative (i.e., reduce product quantities, or reduce cost per case) and set forth the time line and process for product review.

The clinical review team can take a look at the wound drainage product category and offer insight as to whether using one vendor’s products over another impacts clinical outcomes.

The product evaluation will allow the clinical review team to determine if certain drains, tubes or reservoirs can be considered functionally equivalent from one supplier to the next.

Product evaluation

The clinical review team should determine the relevant criteria that they will measure in their evaluation. Factors may include level of service, breadth and depth of product offering, savings availability on group purchasing contracts or incremental product benefit.

During this time, the team can engage in open dialogue, answer questions and formulate an evaluation strategy. The clinical review team should use their expertise to specify the most important elements that should drive wound drainage purchasing decisions.

These elements should be built into a ratings form for all members to use during the evaluation. This form will ensure consistency and documentation throughout the process.

Once the team is ready to evaluate products, it’s essential to begin contact with suppliers. The initial conversations  should outline the goals of the initiative and give specific instruction on how the evaluation will proceed and what information/products are needed.

Vendor participation is critical to a successful evaluation, so the up-front conversations will ensure they are aware of the intent and purpose of the initiative.

Vendors will identify product mix and cross-reference appropriate items to ensure that coverage is available. The clinical review team can evaluate those products in the operating room.

Appropriate vendor representatives should be available during the evaluation so that the reviewers can ask questions during the process. The vendor also should prepare a financial analysis of what the facility’s pricing would be and what the potential savings would be in the event of standardization, based on the products that were evaluated.

The information the materials management staff compiled on the current purchase mix within the facility should be used in conjunction with the supplier's analysis.

For vendors, the key to a successful evaluation is to speak about the use of the product with a clinician’s viewpoint in mind. It is helpful when a vendor employs a person who has prior experience using the product in a clinical setting so that he or she can answer questions from an end-user perspective.

As with any product evaluation, users will take into account the differences and similarities that exist between various products. Wound drainage products may not be as complex as other products used in the operating room, but there are elements to consider in an evaluation.

Specifically, ease of use is a significant factor for measuring the efficacy of wound drainage products, and that ease can be defined in several ways.

“Ease of opening, easy insertion and easy removal is the way I would explain what I expected when using those products,” says Robinson.

In a sterile procedure, products need to be used quickly, so it’s important that the package is simple to open. Furthermore, being able to insert a drain into a surgical opening without delay is critical.

In cases in which a trocar is used, the introducer must be sharp enough to easily puncture the tissue. In addition, the drain must be easy to remove so that a patient does not have to suffer unnecessary pain.

Making it work

The clinical review team should then meet and share feedback on the evaluations. This will open another round of discussions so that all parties can weigh the factors for decision-making.

Suppliers can be contacted after the evaluation, if needed, to clarify any questions and follow up with additional information.

Once the clinical review team has made a decision, it is imperative that those representatives communicate with the entire surgical community.

OR staff should be fully informed of the details behind the initiative, and they can rely on their peers who served on the clinical review team to ensure a smooth adoption.

The selected vendor should join efforts with the clinical review team to create a conversion plan. There will be a period of transition as old products are phased out and new products are introduced, so it’s important that a vendor maintains a high level of service, which includes being onsite, during this period.

Measuring success

After the work is completed, it is essential to highlight the positive result of the conversion. Annual savings figures, inventory reduction, and clinical outcomes are all data points that can be shared as part of the success. Hospital staff and suppliers also can offer feedback on the process of the outcome.

Some ways to measure such data within the scope of the actual product category include tracking inventory levels of kits and individual components and identifying if any lapses in supply occurred.

Clinicians also can comment on the packaging of the products and determine if the method of opening and delivery of the products to the sterile field was clinically acceptable.

This feedback can identify what worked well in the evaluation process and also what may be an area to improve upon for future projects. A hospital can continue to modify the process used for the wound drainage conversion and apply that protocol to other category evaluations.

Standardization is a familiar concept in supply chain management, but it is a concept that must be handled carefully in today’s hospital environment.

Wound drainage products present a viable conversion opportunity and, as with any standardization effort, involvement by the clinical stakeholders is the key to unlocking the process.  

Amy Herrin is a portfolio executive, surgical contracting, for Novation, Irving, Texas.

This article 1st appeared in the April 2008 issue of Materials Management Magazine.

To respond to this article, please click here.

Related Articles

Products that can help ensure proper wound management