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Collaboration is a key element to success in the provision of sustainable and integrated healthcare services. Among the many initiatives undertaken to improve service quality and reduce costs, collaboration among hospitals in Ontario has been difficult to achieve; however, voluntary collaboration is vital to achieving transformation of the magnitude envisioned by system leaders.
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There was a time when innovation in health care information technology meant being at the cutting edge of managerial systems. Hospitals made significant investments in financially oriented technology. In the past five years, the investment in clinical IT appears to have outstripped the investment in managerial systems, including enterprise resource planning aimed at improving the supply chain.
Find missing equipment fast with the indoor equivalent of the global positioning system. Billerica, MA-based PinPoint Co. is marketing a system to locate equipment, such as stretchers and wheelchairs, based on radio-frequency signals emitted from tags on the equipment. A New York hospital that has used the system says it could have a quick payback time.
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In May 1974, New York University Hospital began testing an experimental system using gravity for the slow-speed transport of laboratory specimens. This experiment demonstrated that the system was safe and easy to use. Consequently, in February 1975, a second station was installed adjacent to the intensive care unit to serve as a pilot for a multi-station system. The pilot was 42 m high. All routine laboratory specimens, except 24-hour urines, were transported inside closed transparent cylinders that descend at velocities between 50 and 100 cm/sec. Between April and October 1975, about 2,000 deliveries were made monthly, and each often carried only one or two tubes of blood or urine. At times, however, as many as 15 blood tubes or two body-fluid containers were handled. The overall operating reliability was greater than 98%. The mechanical performance of the new equipment was excellent. Novel design features guaranteed users at both stations immediate access for dispatching containers. Instrumentation was designed to detect all problems rapidly and to correct some automatically. In October 1975, New York University Hospital approved installation of a permanent slow-speed transport system to serve all patient-care areas.
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A prototype system for the slow-speed transport of specimens by gravity was installed in New York University Hospital in May 1974. Blood, urine, body fluids and other specimens, except for 24-hour urines, are transported inside cylindrical containers that descend at constant velocities between 60 and 120 cm/sec, depending on the weight of the contents. Containers could be dispatched at six-second intervals, and each could carry as many as 15 blood specimens. Experience with the system has demonstrated that slow-speed gravity transport is practical and safe. No specimen has been lost, damaged or broken. Performance was acceptable, but some design modifications were needed. In February 1975, the system was expanded to provide service to the Intensive Care and Coronary Care Units.
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A study was undertaken to determine whether or not the present extreme restrictions on the packaging of nitroglycerin tablets are indeed necessary when dispensing the newer stabilized tablets. Baseline tests were conducted on two molded and two compressed sublingual nitroglycerin tablets to determine weight variation, content uniformity, average potency and friability. Stability tests included: (1) use test designed to simulate patient use from a single bottle of 100 tablets over a one-month period; (2) an open plate study wherein tablets were exposed to the atmosphere for 100 days; (3) strip packaging of tablets using foil-foil or foil-cello systems; (4) placement of tablets in medication cups for a seven-day period; (5) repackaging 30-tablet batches in a variety of common prescription containers. All brands of tablets retained potency during normal use when dispensed and stored in their original containers. However, one brand was superior to all others when placed under stress conditions such as open plate exposure. These tablets also retained labeled potency when exposed in a medication cup for a seven-day period, or when repackaged in either foil-foil or foil-cello strips, or when dispensed in a number of ordinary prescription containers. The study indicated that this brand of nitroglycerin tablets might be handled like any other solid dosage form in hospital distribution systems without endangering patient care. However, exceptions to present packaging restrictions must be cleared with the Food and Drug Administration.
The development and implementation of a comprehensive unit dose distribution system for respiratory medications is described. Initially, an evaluation of carts and unit dose packaging materials for respiratory medications was conducted. Subsequent to the selection, a unit dose processing and packaging program was developed in accordance with the Respiratory Therapy Medical Director's Standard Treatment Orders. A 24-hour exchange system, separate but paralleling the already operational unit dose system, was implemented. The primary advantages attributed to the implementation of this system were 1) a decrease in potential respiratory medication order interpretation/transcription errors; 2) a decrease in the waste of medication solutions; 3) a decrease in potential preparation errors by the respiratory therapists; 4) standardization and accuracy of respiratory medication dosages; and 5) a more equitable method of charging patients.
Hospital water supplies often contain Legionella spp. and represent a potential source of nosocomial infection, especially for immunocompromised patients or those in intensive care units. Therefore, pathogen-free water should be provided for such high-risk patients. Surveillance of splash water was performed in high-risk patient care areas at Berlin Charité-University Medicine (506 samples) and Medical School Hannover (767 samples) to investigate the ability to provide water that was free from Legionella spp. by the use of disposable, terminal tap water filter systems with non-impregnated, as well as impregnated, filters with prolonged usage intervals. Twenty (Berlin) and 32 (Hannover) water outlets were provided with disposable filters with a pore size of 0.2 microm. Testing of unfiltered tap water revealed growth of Legionella spp. in 53 of 210 (Berlin) and 30 of 32 (Hannover) samples. Non-impregnated, terminal, disposable water filters at taps used for high-risk patient care led to water free from Legionella spp. in 154 of 155 (99.4%) samples after three to four days and in 137 of 141 (97.2%) samples after six to seven days. When testing a new impregnated filter, 255 of 256 (99.6%) samples remained free from Legionella spp. after continuous use for seven days, as recommended by the manufacturers, and also after 10 days. Samples that were positive for Legionella spp. contained 1-4 cfu/mL. We believe that an impregnated filter system is suitable for the prevention of nosocomial Legionellosis in high-risk patient care areas.
With more than 80,000 beds in 172 hospitals, the United States Veterans Administration operates the largest, centrally directed health care system in the nation. Created in 1930 to coordinate all government activities concerning veterans, the VA provides health care to veterans who have service-related illnesses and injuries or those who are unable to obtain care through the usual channels. For a look at how the management of medical supplies at an individual VA hospital fits into the entire VA system, the Journal visited the Audie L. Murphy Memorial Veterans Hospital. The largest hospital in San Antonio's South Texas Medical complex with nearly 700 beds, Audie Murphy Hospital provides a full range of inpatient, ambulatory and rehabilitation services to veterans. The hospital is the core of an extensive outpatient network that accounts for more than 180,000 outpatient visits per year.
As the United States healthcare delivery system evolves, the alternate care site market is creating challenges and opportunities for materiel managers, groups and alliances. To be effective, an alliance or GPO must provide value. Many network integrators are setting up wellness and "telephone triage" programs to keep people from entering the continuum of care at all. Alternate care sites will face the same cost constraints presently being felt in many hospitals. GPOs and alliances will therefore have to provide value to these sites in ease of use, meaningful benefits, easy administration, and working with the network and distributors. Materiel managers can play an important role by developing product standardization among sites, rationalizing distribution to sites by using one or perhaps two distributors to serve all of the alternate site providers in the network, using group contracts to lower acquisition prices and providing greater services.
Although healthcare information systems are increasingly sophisticated, they are capable of burying some users beneath flurries of unneeded reports while failing to provide sorely needed data for others. Environmental issues and patient privacy concerns add to the need to conduct periodic audits that explore how computer reports are distributed, used, retained, and discarded in health-care organizations. The process begins by reviewing and updating a report distribution list, a master document that shows why and how reports are created and circulated.
The prescheduling of blood deliveries from regional blood centers can improve blood availability at all transfusion services while reducing outdating, delivery costs and inventories maintained at region blood centers. A procedure for determining optimal distribution policies that maintain the highest possible blood availability at transfusion services while holding the achievable outdating level to a small percentage of the total usage is described. The manner in which this plan is being implemented in Long Island, New York, is presented, as well as a discussion of some preliminary results.
Hospital mergers afford healthcare providers the chance to take advantage of economies of scale, integrate clinical, administrative and support functions, eliminate functional redundancies and redesign patient care delivery. This article explains how such advantages were realized, demonstrated through a hypothetical case based on information obtained from actual mergers. A corporate materiel management division was established, and centralized warehousing, product evaluation and purchasing instituted. Some management positions were eliminated or restructured and patient care services were closed, relocated, or opened among the various entities in the merger. Through these and other changes, the new healthcare system was about to realize about $1.7 million in one-time savings and expects savings in the seven digits over at least the next three years. The article concludes that as hospital mergers continue to increase, the position of corporate director of materiel management will evolve as the next logical career step for materiel management professionals.
PURPOSE: Aims to give an overview of the re-engineering of processes and structures at Gujarat Cancer Research Institute (GCRI), Ahmedabad. DESIGN/METHODOLOGY/APPROACH: A general review of the design, development and implementation of reengineered systems in order to address concerns about the existing systems. Findings GCRI is a comprehensive cancer care center with 550 beds and well equipped with modern diagnostic and treatment facilities. It serves about 200,000 outpatients and 16,000 inpatients annually. The approach to a better management of hospital supplies led to the design, development, and implementation of an IT-based reengineered and integrated purchase and inventory management system. The new system has given GCRI a saving of about 8 percent of its annual costs of purchases, and improved the availability of materials to the user departments. ORIGINALITY/VALUE: Shows that the savings obtained are used not only for buying more hospital supplies, but also to buy better quality of hospital supplies, and thereby satisfactorily address the GCRI responsibility towards meeting its social obligations for cancer care.