World-Class Emergency Services

Supply chain has played an important part in the building of UC Health’s new emergency department. It will play an even bigger role when the facility opens this year.

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March 2023 – The Journal of Healthcare Contracting

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By Graham Garrison

Emergency services are a big part of UC Health’s legacy. The UC Department of Emergency Medicine is home to the first residency training program in the U.S., and the program celebrated its 50th anniversary in 2020. The department attracts top medical students from across the country to train in Cincinnati, and its faculty are national leaders in clinical teaching and research.

When UC Health got the greenlight to build a new facility for its emergency department from the ground up, leadership wanted the physical building to match their top tier ranking from a clinical perspective. To do that, they needed supply chain to play a key role.

The project was announced in October 2019. Ground was broken on the structures in late summer 2021, and completion is expected in late summer 2023, according to the IDN. The project includes:

• Expand the UC Medical Center Emergency Department (ED) onto a previously vacant lot adjacent to the hospital. The 41,000-square-foot addition will significantly improve capacity and patient flow, including reconfigured access for patient arrivals via ambulance and private vehicles.
• Renovate the existing 35,000-square-foot ED to provide additional emergency response ability and “surge” capacity for emergency and crisis situations.
• New construction of three additional floors above the new emergency department to accommodate an observation unit, a flexible ICU and a new 28-bed unit.
• New construction of a four-story surgical building that will expand surgical capacity at the hospital, adding eight new operating rooms as well as new waiting areas and pre-operative clinics.

During the design phase, UC Health leadership that included supply chain and clinicians took a few trips across the country to look at best-in-class emergency department set ups, including Mayo Clinic, to determine how they wanted to design their facility.

From a supply chain perspective, it was beneficial to be included early in the process, said Harold Dillow, assistant vice president of supply chain for UC Health. He has spent a lot of time with the emergency management service line people that represent College of Medicine, emergency management physicians, and then with UC Health’s own nursing administration that runs the ED to better understand what their expectations are for a best-in-class ED, and how the supply chain would service them. There are monthly meetings between supply chain, ED leadership that includes nursing and College of Medicine representatives, and a consultancy agency quarterbacking the process to talk about the progress of the project.

From theoretical to actual

UC Health’s current service model involves stocking a supply room in a couple of areas in the ED. Clinicians, nurses or technicians retrieve the supplies on their own. In the new ED, clinicians would like supply chain to provide everything they need at the point-of-use of where the care is being delivered, so the clinical person never has to leave patient care area or the “bedside”. It takes resources, more staff members and a new supply stocking strategy that UC Health’s team has been developing to be ready to roll out when the new ED is scheduled to open in July 2023. “It is fundamentally different than how we do it now,” Dillow said. “Now they retrieve supplies as opposed to us putting it at their fingertips.”

UC Health is developing an exchange cart process for the new ED. The concept is to always have supplies as close to full for the clinical team. Every single ED bay will have a cart stocked according to what the clinicians think would be the most used products at appropriate par levels. To stock the carts for the entire ED, supply chain will be allocated a large supply room in the middle of the space. The new ED is roughly the same number of rooms, but double the footprint.

“We have a lot of input on the design of the supply room because we want it to be big enough to not only have our inventory system hanging on the wall, but also space in the middle for the exchange carts to be restocked,” Dillow said. “We can take a full exchange cart, go to a room and grab one that’s been used and put the full one in. Theoretically there’s always plenty of supplies in every single room.”

Some parts of the process are already in place. For instance, last April, UC Health implemented a new point-of-use inventory management system that tracks supplies better and reorders with RFID technology. It’s a much more efficient way of reordering supplies, Dillow said. “So, setting up a best-in-class process and then layering on some technology we think is going to be a really awesome combination.”

Supply chain is working on a myriad of small details for the new ED, such as the routes they would use to stock rooms, and when they would do it, so they’re more offstage from the public. They’ve worked on where the carts are going to be staged in the rooms, and will eventually focus on the individual items the clinicians want in the carts.

“We’ve even gotten it down to what color handles should be on the carts, and the visual cue to let everyone know that a cart’s been used,” Dillow said. “Those are the granular types of decisions we’re figuring out so it can flow as smoothly as possible.”

Dillow said he’s excited to see the efficiencies gained from the new model. The estimated increased bedtime for clinicians alone was high enough to get a healthy FTE approval to build up the supply chain team in the ED for 24/7 across three shifts. “The goal is to have everybody practicing at the top of their license,” he said. “The nurses and physicians can be honed in on what they’re doing to help the patient as opposed to worrying about grabbing supplies. There’s going to be huge intangible cost savings, but more importantly real savings for the patient care time.”

Recent successes

The supply chain team has been quite busy over the last 12 months, and not just on the new ED rollout. Recent accomplishments include:

• Managed through the highest surge of pandemic and ongoing global supply disruptions while supporting clinical operations.

“Many in the industry experienced this the past few years, but it is worth recognizing our supply chain team’s extraordinary effort to deliver quality products in a timely manner with the odds stacked against them,” Dillow said. “While many items were procured via alternate sources or had to be converted, which resulted in clinicians having to use non-preferred product, we had great partnerships with the clinical team.”

• Reduced capital investment for instrument purchases to support the new surgical building. Supply chain and UC Health’s Perioperative Leadership Team partnered to calculate current instrument utilization and compare that to expanded case volumes to ensure only needed items were purchased.  
• Simultaneously implemented two technology systems. UC Health chose to perform an ERP conversion and MMIS/WMS conversion at the same time.

“I will say it was very difficult to implement two systems concurrently, but the team put forth an exhaustive effort to accomplish this goal,” Dillow said. “These new platforms enable us to gain efficiencies from automating processes that have traditionally been manual work. We intentionally refined and documented our manual processes so that we could layer on technology that would take us forward and not just be an expensive program built on inefficient, legacy processes.”

• Completed a GPO RFP. This was a large initiative that required strategic alignment across several departments (Finance, Supply Chain, Pharmacy) and included clinical partners.

“The result was UC Health selecting a GPO partner that most closely understood our needs as a health system that includes an AMC and community-based acute care hospitals and large ambulatory footprint. This will deliver the highest quality contracts and products, and largest savings opportunities for UC Health.”

Navigating conversations with physicians

Another major achievement was managing through an extreme staffing crisis in Sterile Processing Department (SPD) where a large portion of the staff was recruited away for agency staffing companies. This directly impacted SPD’s ability to meet instrument tray demand for OR cases, Dillow said.

As a result, the SPD tray backlog, which is an indicator of SPD’s throughput and ability to provide on-time service, soared from a historical average of 50 trays to approximately 500 trays. Supply chain and PLT met multiple times per week for several months to jointly address the issue. A shared staffing model was implemented as an interim countermeasure as well as OR capacity management to ensure all scheduled cases were cared for. These interventions, combined with a coordinated recruiting effort with HR, resulted in the tray backlog returning to under 50. 

“Over the last five to six years, supply chain has aligned and clinically integrated with our physician partners across all service lines,” said Dillow.

He said the springboard for this elevated engagement and alignment occurred because of their participation and involvement with the value analysis program and department specific product / implant standardization and savings initiatives related to:

• Ortho Trauma implants.
• Cardiology – CRM / DES.
• Ortho Total Joints
• ENT – Cochlear implants.
• Cardiovascular – Heart valves.
• Radiology – Peripheral vascular products.
• Ortho / Neuro spine implants. 

Building trust through transparency and partnership with aligning clinical quality needs and outcomes with cost efficiencies has been one key to success. No silo product decisions or changes without alignment of providers has been another key. Supply chain has also partnered with the chief medical officer to appoint a medical director for supply chain. “This has really helped navigate conversations with physicians and gain buy-in for service line product strategy.”

Adapting to new realities

Heading into 2023, supply disruptions and staffing availability remain challenges to address. “The pandemic largely focused on PPE items,” Dillow said. “Once those were secured, it was really about operationalizing the stocking strategy needed to support COVID care.”

But since then, global supply disruptions are affecting a much broader portfolio of products. “There’s almost no category that isn’t affected. Who would’ve thought crutches, of all things, would ever be an issue? That’s just one example of many.” 

Because of this, UC Health’s sourcing and procurement teams have experienced a 900% increase in backorders. “The constant management of alternate sourcing and related logistics is very time consuming, and quite frankly, frustrating for the team.”

Once you get the product, there is the additional worry of appropriate staffing levels needed to manage the inventory. In the case of SPD, its staffing needed to build case carts to support the OR. 

It’s hard to reflect on the last few years and not think about battle scars, Dillow said. However, the challenges presented during the pandemic and staffing crisis have silver linings. “We had to quickly adapt during those times to survive, and the key to surviving resulted in doing things differently.”

Although UC Health continually stress tests its processes to find improvement, those test scenarios simply didn’t include a once-in-a-century pandemic or having such a staffing deficit. So they adopted innovative ideas from their teams to create better processes and standardized those efforts where they made sense to carry on. “As a result, we have a better understanding of our end-to-end operations with process maps created because of the need to increase the speed of communication amongst supply chain teams, suppliers, and clinicians.”

UC Health also consolidated many reports and data sources that different supply chain leaders were using to manage the business. Now there is one source of truth that pulls together inventory levels, sourcing notes, and procurement information to make educated decisions based on a complete picture. “Lastly, we now have increased automation and data visibility that helps us be more proactive decision makers instead of always reacting and firefighting,” Dillow said.