Key steps to standardizing surgical packs: 5 Qs with Cardinal Health's Carl Hall

For hospitals and health systems, product variation within surgical packs can lead to inefficiencies and excess spending.

However, health systems can ensure they are optimizing their procedural packs through a greater focus on standardization, explained Carl Hall, Vice President and General Manager for Presource® Products and Services at Dublin, Ohio-based Cardinal Health.

Mr. Hall, who focuses on delivering insight-driven kitting products and solutions to providers, has more than 12 years of experience building and commercializing medical products across the globe.

He spoke with Becker's Hospital Review about the pack standardization process and how it can help health systems generate savings, reduce variation, create new efficiencies and give clinicians more time to focus on patient care.

Editor's Note: Responses have been edited for length and clarity.

Question: What is the first step hospitals and health systems should take to standardize items inside surgical packs?

Carl Hall: The key to pack standardization is developing a product formulary. The process of creating a product formulary helps healthcare organizations identify similarities and differences within product categories, allowing them to begin the standardization process.

To establish a practical product formulary, healthcare organizations should first look at distribution purchase data, analyzing and standardizing individual products on the shelf. Analyzing those products first can help deliver new insights that will help hospitals and health systems begin to answer questions about where and how to standardize the components inside their surgical packs.

Q: Once product formularies are set, how should organizations determine the pack component categories to start standardizing?

CH: Once an organization has chosen one or two service lines to start with, they can deploy utilization analytics to identify which pack items to standardize within the various component categories. Component categories can be summarized in two different ways. The first way is by using the United Nations Standard Products and Services Code® (UNSPSC®), which is an efficient, accurate and flexible classification system that allows organizations to have complete visibility of spend. The second way is understanding how various component categories impact patient care by working with clinicians who have a deep understanding of these products.

Q: How important are physician procedure cards in the standardization process?

CH: Maintaining accurate procedure cards can be a challenge, especially with the constant flow of physicians entering and leaving the hospital or health system and procedures continually being added, modified or discontinued. However, once a component formulary is identified, hospitals and health systems should update and maintain their procedure cards. This will make it a lot easier to not only standardize packs, but also ensure they stay standardized.

Once the procedure cards are updated, hospitals and health systems can use them to build custom surgical packs. The goal is to include as many items as possible from the procedure card into each pack. That way, organizations will minimize the need to pull single sterile items off the shelf, which improves operating room staff efficiency when preparing the back table for a case.

Q: What are the most common causes of supply variation?

CH: It's important to dispel the myth that all supply variation is due to clinical preference. While it's true that some variation is the result of clinical or provider preference, such as choosing a push button or a rocker on a cautery pencil, there are other root causes, as well.

For example, as health systems continue to grow, adding hospitals and other care sites, formularies and pack programs are combined. This often results in increased variation as the volume of supplies grows. Other causes of variation include contractual constraints, such as volume discounts or rebates, which can drive product choice within packs. Similarly, equipment constraints can affect equipment choice. A good example of this is tubing that is designed to work with specific equipment. 

Clinical practice, of course, continues to be a key catalyst for variation. An example is variation in draping, based on how a procedure is performed. For example, a shoulder arthroscopy could be done in either a lateral or beach chair position, each requiring a different draping selection.

Q: Are there any other myths about pack standardization you'd like to tear down?

CH: Yes, there's a common misconception that pack standardization is simply "skinnying down" surgical kits via SKU rationalization. Nothing could be further from the truth. This is a data-driven process that yields new insights to improve clinical best practices. In fact, standardizing an organization's pack program can not only save money and create new efficiencies, but it can also give clinicians more time to focus on patient care.

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