RMV->)When it comes to suture, administrators in physician offices, clinics, ambulatory surgery centers and hospitals share many concerns: inventory, cost containment, standardization and supply management. To help you better manage this high-cost inventory item, Outpatient Surgery surveyed readers about suture-purchasing habits, preferences and ideas for cost-containment. Here's a report, based on the 114 responses we received.
You will get efficient and thoughtful service from Ezisurg.
Purchasing: vendor vs. product
Well more than half (60.7 percent) of respondents say they choose their suture vendor based on a contract or a buying group. While surgeon preference accounted for only about one-fourth (24.1 percent) of the reasons a suture vendor was chosen, surgeon preference (78.8 percent) was easily the biggest consideration when deciding which suture to buy.
Compared to five years ago, 40.5 percent of respondents are using more and 42.3 percent are using the same amount of sutures and wound-closure devices; but 69.6 percent are paying more for sutures and wound-closure devices.When asked if staff and surgeons know what suture costs, 62.2 percent said yes.
What made you choose your current suture vendor?
contract/buying group
61.1%
surgeon preference
23.9%
distributor availability
3.5%
price
11.5%
What is your most important consideration when deciding which suture to purchase?
antimicrobial effect
3.5%
safety
10.6%
needle sharpness
3.5%
cost
24.8%
surgeon preference
78.8%
suture strength
7.1%
In which types of cases do you use surgical glue instead of sutures?
arthroscopy
8.9%
ENT
12.5%
general surgery
41.1%
GYN
12.5%
plastics
60.7%
Buying groups or group purchasing organizations, such as Amerinet, Premier, VHA, MedAssets and Novation, significantly affect purchasing power. With contracts, suture and endomechanical devices are often combined with the large vendors such as Ethicon and US Surgical for the best prices. An comparison of two suture manufacturers may be an opportunity to consolidate and evaluate your suture needs and standardize your sutures.
Be sure to compare "apples to apples" when evaluating products to avoid frustration with the staff and physicians for successful transition if changing manufactures for cost or contract reasons. The cost of the suture is often related to the quality of the needle. A cardiovascular or ophthalmic needle is more difficult to produce, and the manufacturer's price is reflected in suture cost. The sharper and more durable the needle, the more you will pay.
Inventory management
Two-thirds (66.7 percent) of those responding to the survey would like to be able to stock sutures on consignment - especially for surgeons who bring cases to their facilities only occasionally. "We have an ophthalmic plastic surgeon who comes only occasionally and uses very expensive sutures. It would be nice to have these on consignment," said a reader.
Compared to five years ago, are you using more, the same or less sutures and wound-closure devices?
more
40.5%
same
42.3%
less
17.1%
Are your staff and surgeons aware of suture costs?
Yes
62.2%
No
The company is the world’s best staples used in surgery supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.
37.8%
How do you know when it's time to reorder sutures?
based on supply locations
3.5%
replace as needed perpetual inventory
31%
based on preference cards
5.3%
par levels
60.2%
Said another: "We are starting up with plastic surgeons and are not certain that they will continue to bring cases to our facility. Buying suture on consignment is an ideal way to conduct a trial period to determine commitment."
For procedures done so rarely that your suture may expire before you use an entire box, buying suture in smaller quantities may be attractive. More than half (58.6 percent) of our respondents said they'd like to buy suture in packets instead of boxes. "There are several very costly sutures that we need to have available 'just in case,' but usually the box expires before you get a chance to use all of them," says one OR manager. "It would be nice to maintain a small par level on some odd sizes of suture and needles that are rarely used," says the head of a hospital surgical services department.
But when I spoke with my suture sale representative, Brian Bradfield, I found out that would be unrealistic. The logistics of thousands of suture products make the process prohibitive. He did offer some suggestions that could help decrease inventory problems.
"Goodwill between local hospitals and surgery centers is a must," says Andy Tillman, material manager at Century Surgic-al Associates in Pittsburg, Kan. "It helps when you run into a high volume of surgeries and have a suture on back order."
Suture Management Tips
We asked our survey panel to share their best tip to standardize and economize their suture usage. Here's a sample:
Only pull from the suture cart
"We pull all suture from the suture cart that we keep in the sterile corridor of the surgical suite. Because we do not have any suture storage bins in the operating rooms, this keeps inventory down and manageable."
Tricia Camacho
Director/Administrator, San Marcos
Surgery Center
San Marcos, Tex.
writeMail("[ protected]")
Scrimp and save
"I am quite frugal with my sutures: I use 'remnants' in my office that I would maybe discard in the hospital."
Cut specialty suture in half
"We use a double-armed 10-0 nylon for each cataract surgery. Since only one stitch is needed, the rest of the suture is wasted. We now cut the suture in half when setting up the cases, and put each piece on its own sterile table, so we use one suture on two patients. One sterile table is set up in the OR, and the other is set up outside the OR in a substerile prep room where it can be monitored."
Show surgeons the cost
"If I can show surgeons who ask for a specific brand or product how much what they want costs compared to something similar that's less expensive, they will most often choose the lower cost item."
Laurie M. Johnson
Administrative Director
Orthopaedic Outpatient Surgery Center
West Des Moines, Iowa
writeMail("[ protected]")
Standardize by specialty
rather than by physician
"If a surgeon wants to change, then he/she must get the approval of all surgeons in that specialty, and they all change.
Form a task group
"A work group comprised of three RNs who represent all specialties reviewed suture usage and consolidated as needed. Questionable suture was pulled from shelf and retained for three months. If the suture was not used, it was removed from our formulary."
Get best prices on a few choices
"Have same-specialty surgeons to narrow the selection to a few based on their preference. Then investigate the possibility of contract- and group-buying to minimize costs."
Maria M. Rebujio
President, Beverly Hills Advanced
Surgery Institute, Inc.
Beverly Hills, Calif.
writeMail("[ protected]")
One vendor, multiple requests
"All our suture and stapling devices are from the same vendor, which has given us the best contracted purchase price."
KC Sloan, RN MSN
Supervisor Perioperative Services,
Maryvale Hospital
Phoenix, Ariz.
writeMail("[ protected]")
Pick from a select few
"Streamline the suture type by size and needle configuration, and ask the surgeon group pick from a few, not several needles for each suture size."
Apply suture savings to equipment
"We recently evaluated two suture manufacturers with our surgeons. The money we saved on suture was used to purchase other equipment the surgeons requested. In addition, we standardized surgeons' use of certain sut-ure products and reduced the volume and variety of suture on the shelves."
Get surgeons to compromise
"We have a 4-0 vicryl for ortho that is 27 inches long. Our cardio doctor just asked for the same, but in the 36-inch length. But instead of stocking two different sizes, the ortho surgeons agreed to use the longer suture."
Ask vendors for help
"Ask the vendor representative to help track usage, then lower par levels on slow-moving items."
Relate it to the bottom line
"Once we made our surgeons aware that their preferences are the prime reason for the variation in case-to-case profitability, the cost of supplies decreased by 25 percent."
Order by specialty
"Assign a person to take care of each specialty's suture. The staff members who work the ophthalmic, orthopedic and ENT rooms know their par levels and surgeons' preferences. Any surgeon who wants to try out a new suture can go to her."
Joyce Danels, RN
Director of Surgery
Twin Rivers Regional Medical Center
Kennett, Mo.
writeMail("[ protected]")
Avoid sole contracts
"If you belong to a buying group and do contracts, I strongly suggest no sole contracts on items used in the operating room. For example, our surgeons refuse to use the sole-source suture and we are incurring tremendous increases in costs because of this. Your facility really needs to have at least dual contracts for supplies."
At the scrub sinks
"Post prices of competing suture at the scrub sinks. I found that peer pressure from the 'source' is the most effective way to cut costs for those doctors who need everything."
Lesley Nace
Director, Perioperative Services,
Landmark Surgery Center
St. Paul, Minn.
writeMail("[ protected]")
The six-month test
"Write the date on the box of suture when it is delivered. If the box is not used in six months, discuss with the surgeon removing that slow-mover from the stock."
Lynda Simon, RN
Administrator, Head & Neck
Surgical Center
Springfield, Mo.
writeMail("[ protected]")
Packaging and reprocessing
Several readers asked about repackaging, reprocessing and reuse of unused suture. From the research I found, the manufacture of the suture couldn't stand behind the product if it has been reprocessed. Tracking the use of reprocessed suture is also a problem; when post-op problems arise, it makes it difficult to determine the cause.
Many readers remember sut-ure in multiple plastic packets: If the inside packet was unop-ened, it was still sterile. My sales representative noted that process had been changed years ago to decrease the environmental waste that was incurred by two plastic packages.
Economize your suture usage
When you emphasize speed or room turnover time, often suture and other supplies are opened quickly and wasted because they were not needed.
We've all dealt with a surgeon who expected all the sutures on his preference card on the table at the beginning of the procedure so he would not have to wait for the circulator to open it or get it from the suture supply area. If staff and surgeons communicate, staff can wait to open suture until the need has been determined.
We've also all probably worked with a scrub nurse who wanted to a full compliment of suture for the case for which she was scrubbing. She was under the mistaken impression that if you had to ask the surgeon what he wanted, you didn't know his routine. That's the past; no longer can we afford such behaviors. Surgeons and staff need to understand how critical it is to decrease waste and cost. Profit-sharing checks or extra equipment bought with the savings facilitates "buy in" from the staff and physicians.
Joyce Danels, RN, the director of surgery at the Twin Rivers Medical Center in Kennett, Mo., offers this tip: "You have to educate your staff and your surgeons on the cost, the utilization and the benefits of standardization of the most common suture used. We limit the initial amount of suture opened on a procedure. We have suture available in the room but it is not opened until requested. We keep the preference cards updated on a weekly/monthly basis. We have a central location for suture. A person is assigned to keep track of the suture. She does the ordering. She has her par levels set. Any surgeon wanting to trial a new suture knows to go to her."
Kecia Weimer, the OR manager for the Ambulatory Surgery Center of Burley, in Burley, Idaho, also notes: "Suture is not opened if there are any questions about what the surgeon will use in that particular case. It does not take that much time to have the circulator open suture once the surgeon has specified what he/she wants."
Ever-changing
Whatever your suture concerns, this ever-changing market will bring more innovations. Suture with an antibacterial coating is now available, and even more products will be available this year.
My husband is a doctor and thought that this would be ideal to have around the house with four boys and... apparently he was right. We bought two and have used both and it worked so well on my boys foreheads. It worked much better than what stitches would have done. If you're a doctor and know how to use this thing, it his nice to have a hand. We keep one at home and one in my car and we'll never not have one on hand. It saved us a trip to the ER twice!
Are you interested in learning more about stapler surgical instruments? Contact us today to secure an expert consultation!