Authored by the RAIN Alliance Healthcare Workgroup
Manual supply documentation in operating rooms is an age-old problem that still exists today in the healthcare system. Clinicians who are responsible for patient care are also asked to manually enter information about every supply used in a surgical case. With increased regulatory requirements, clinical documentation has become increasingly complex and burdensome on nursing staff. A common observation from this lengthy documentation practice is that data capture errors are common, and those errors can affect all areas of healthcare operations.
In a 2015 study on how to improve this process, DeRoyal and a large academic medical center discovered that if hospitals could make use of the trash from each surgical procedure, they would have volumes of accurate data at their fingertips. The team began to investigate ways to automate the capture of surgical trash and create meaningful insights from not-so-glamorous surgical trash. Implementing RAIN technology provided a solution for passive and accurate data capture at the point-of-care.
Let’s look at the wide range of benefits we’ve found using RAIN to gain knowledge from waste:
#1: Accurate Charge Capture
Charge capture is the first step and a key driver in maintaining a smooth revenue cycle. Yet when a survey administered to hospital personnel across the country asked about supply capture accuracy in healthcare facilities, 50% of respondents estimated that their supply usage capture rate was less than 80%. One reason for this is the reliance on clinicians to provide the documentation. Clinicians aren’t meant to be clinical “cashiers”, their primary focus should be on patient care. According to a survey by TechRepublic, clinicians often spend 56% of their time accessing and updating patient records, when they could be providing patient care. Using RAIN technology allows clinicians to focus on patient care by automating charge capture, eliminating human error, and simplifying data collection. This solution can be simplified by using smart, RFID-enabled point-of-use devices. In turn, manual and redundant documentation can be eliminated, reducing time spent finding the 1-3% of missing charges by reconcilers. RFID point-of-use solutions provide Operating Room trash visibility while capturing charges at a significantly higher accuracy rate of 99.8% with DeRoyal’s OSCAR solution. Operating Room trash is starting to sound exciting!
#2: Unique Device Identifier Tracking for Product to Patient Association
Details such as lot number, serial number, and expiration date for items used in an operating room often go untracked. This untracking is a result of the burdensome task for a clinician to manually identify these data elements and transpose the information into the Electronic Health Record (EHR). A study performed by DeRoyal found that manual supply documentation in the operating room can take anywhere from 10-30 minutes per case. Another survey given by DeRoyal found that many hospitals were bypassing the capture of any Unique Device Identifier (UDI) information entirely because of the time and effort required to properly do so. A lack of supply traceability can lead to patient safety challenges but a simple RAIN tag can accurately track these data elements providing time-savings, accuracy, and insights to healthcare providers. Systems integrations allow UDI information to be shared with EMRs creating more seamless pathways for connecting specific product usage back to a patient for patient safety and audit visibility. Additionally, capturing this information automatically minimizes time-consuming clinical intervention during a case allowing the clinician to focus the patient. When it comes to recalls and patient safety, clear visibility of specific products used on patients can be a gamechanger by providing details to hospitals so that providers can share the specifics with a patient. At one DeRoyal RFID client site patient safety was increased by automatically tracking UDI information via RFID and tracing that item to a patient saving about 1 hour per recall.
#3: Expiration Alerting
According to Diagnostic and Interventional Cardiology, as much as “7% to 10% of products likely expire on hospital shelves.” Even more disturbing, these products make their way to the Operating Room and, according to Becker’s Hospital Review, 24% of hospital workers have seen or heard of an expired product being used for patient care. These numbers are staggering when you think about the dollars and risks that can be associated with this practice. Managing product expiration tends to be a manual process with the supply chain spending hours computing inventory and marking products that are approaching expiration. As previously mentioned, a single RAIN tag houses pertinent UDI information, such as a product’s expiration date. Hardware and software solutions offered in the market can use the data in a RAIN tag to notify a clinician if an outdated product does make its way to the operating room ensuring that item is not used on a patient. Even better, this data element can be tracked and alerted throughout the supply chain ahead of arrival in the operating room. A supply chain manager now has visibility of any item approaching an outdate throughout their entire inventory and can proactively manage these products by getting them used ahead of expiration, returned and replaced by the vendor, or disposing of those items. Proactive expiration tracking allows supply chain managers to focus on more strategic objectives and ensures clinicians can focus on patient care and safety.
#4: Tracking Waste
Waste plays a big role in overspending that occurs on hospital operating room supplies. Operating room supplies represent one of the largest spend categories in healthcare – around 30-40% of a hospital’s overall supply spend. Managing this is challenging due to the sheer nature of the operating room. Healthcare systems often assume that the amount of healthcare waste is low instead of taking the time to track it. The reality is that hospitals may waste millions of dollars each year, largely due to a lack of visibility and the amount of manual effort it would take to determine. A study published in the Journal of Neurosurgery about waste in operating rooms at a healthcare facility found that about 13% of surgical costs were spent on unused or wasted supplies. This study showed that a hospital waste was measured up to $2.9M each year. This hospital may not be an anomaly and the results for other healthcare facilities could be much higher. According to an article by The Journal of Bone and Joint Surgery, anywhere from 20-30% of hospital waste is attributed to the operating room. Waste has an enormous effect on a facility’s bottom line but also creates inefficiencies in managing inventory, product returns, and obsolete inventory. Automation through RAIN technology at the point-of-use brings visibility into what is used during a surgical procedure versus what was opened and unused in the OR bringing clarity to wasteful practices. Surgical case usage details enlighten hospitals on trends that can be used to expose waste, reduce unused inventory, and save money.
#5: Physician Performance Cards > Physician Preference Cards
A critical factor in managing hospital room waste is ensuring accurate Physician Preference Cards. When created and managed consistently, a physician preference card can be a useful tool to ensure that the surgeon or doctor has the correct supplies for a procedure. Typically, managing physician preference cards is such a manual activity that results in infrequent review and management. Cards quickly become outdated due to supply changes, preference changes, and the difficulty of manually managing something so dynamic. In a survey administered by DeRoyal to hospital personnel across the country, 50% of respondents estimated that their physician preference cards were only 65-69% accurate and a whopping 0% of respondents said that they were more than 90% accurate. In another study written about in Becker’s Hospital Review, one hospital reported only using about 60% of the supplies pulled using physician preference cards. One way to improve this process is to incorporate technology to update ever-changing physician preference cards. RAIN technology that allows easier case usage tracking can be used in meaningful ways to create a physician “performance” card that is based on historical performance rather than “hunch” data. Using technology to maintain current standings on the Physician Preference Cards can create efficiencies throughout a healthcare facility including reducing waste.
Making Garbage Glamourous
Using RAIN technology and complementary point-of-use solutions can bring tremendous value to healthcare. There is a world where charge capture is as simple as throwing the item away in the trash – a simple task that requires little to no process change. Who would have thought so much value was hiding in the trash?
Learn more about RAIN in Healthcare and RAIN Alliance’s many workgroups today!