For many surgical centers, procedure packs are a great way to maximize efficiency. Instead of handpicking items such as drapes and table set-ups off of the supply room shelves, everything you'll need for a case is prepackaged and ready to go. What can be better? But a pack that either has too little or too much of what you need can cancel out any economic and efficiency gains. I'm going to show you how to fine-tune your packs so that you get them just right.

Dealing with details of procedure packs might not seem like fun, but it can pay off. I've saved almost $100,000 by including reprocessed phaco tips in our packs. But more than that, procedure packs can save you time. I estimate that each pack saves 15 minutes that my staff would have taken to pick out the items individually. We do 13,000 cases a year in our 11 ORs. That comes out to 3,250 hours or 62.5 hours a week that we save - that's a full-time person-and-a-half.

Manage by walking around
How do you know if your procedure packs need some work? One way is to stand in on some surgeries. Take note of items from the pack that aren't used. Every supply that's not used from a surgery pack is costing you money. One of my greatest challenges is determining surgeons' preferences. Their preferences often change, and if you don't keep up with them, it can cost you money. For example, you might observe a surgeon throwing away a pack of suture that costs $20.

If you're going to err in setting up your procedure packs, err on the side of smaller packs. If your surgeons are particular about the kind of suture they use, let them get it directly from your supply closet. As a general rule, if your surgeons use a supply in 85 percent of their cases, you should include that supply in your packs.

A good start to the fine-tuning process is to enlist the help of your staff in reviewing the details of your current packs. Get the nurses who coordinate your specialties involved, of course, but also ask the rest of your center's employees to help out by letting you know what they regularly see going in the trash. You can post the lists of each procedure pack in the employee lounge or some other accessible area. Make it clear you'd like to hear everyone's idea on what could be added or omitted.

Specialty coordinators can also take this time to review pack contents with surgeons and each other. Sometimes the coordinator of one specialty can give valuable information for another specialty's surgery pack. One specialty coordinator might notice that several other procedures at your center can use the same three-quarter drape. You can then order those three-quarter drapes in bulk, and get volume discounts.

You can find surgical packs for a variety of procedures. Most vendors prepare standard packs that offer table set-ups, bowls and drapes that are generally the same throughout the industry.

When your needs differ from a standard pack's contents, you can design customized procedure packs to meet your needs. You can have a customized pack for each specialty but be careful what you put in. The production of custom packs run in 90-day supply batches. This means that if you make a mistake, you'll have to live with it since about a three-month supply of packs is already in the pipeline. Avoiding these mistakes will save time and money later.

Free help from vendors
After you've gathered input from your people, it's great to get an outside set of eyes to look at your operation. Your vendors can provide some great outside views - for free.

Vendors can also provide a clinical specialist who has many years of OR experience to observe your procedures. He'll usually review cases in your OR for three days or four days, and then will submit an analysis of his observations.

This is a great opportunity to catch the additional items that you've been leaving out of your procedure packs. For example, we found that we were pulling prep separately in a few of our procedures and were able to gain additional savings by incorporating a single-step prep agent into our packs.

Standardization, volume discounts and other money-savers
Once you determine what's in and what's out, you can find ways to be more efficient and save money.

For example, vendors will prepare X-ray-detectable sponges with different folds: 4 inches by 4 inches, 4 inches by 8 inches or 4 inches by 16 inches. You probably can realize volume discounts by standardizing all your packs to one vendor's sponge in the same one-fold format.

It can also be effective to include non-sterile product in your custom packs. Pack-content documentation may list these items with an "NS" at the end of a product description. These NS products, which include items such as prep trays, gowns and drapes, don't need to be sterilized before they go into procedure packs because vendors sterilize the packs on the pallet.

Here's an example: Sterile high-flow insufflation tubing we use for most minimally invasive procedures costs $18 or more for the sterile version. Substituting the non-sterile version in our packs runs $10 or $11. Outpatient centers that have high volumes of these procedures can really experience significant savings by identifying items like this and incorporating them into their packs.

You can find similar savings by using reprocessed surgical equipment. In fact, that was how I saved the $100,000 I told you about. Phaco tips often cost $70 new. If you're reprocessing at your center and do cataracts, you can incorporate reprocessed phaco tips into your customized procedure packs at a cost of $15 each. Based on volume, that could be a good chunk of money. We do almost 1,800 cataracts a year. That's a potential savings of $99,000.

Managing inventory
Luckily, the managing of procedure packs has come of age digitally. Most vendors now provide you with Web access to software that helps manage your inventory. This software typically gives you access to product pricing as well as inventory that may be in production.

You can use the software to track changes to pack contents and determine estimated delivery dates. In addition to the vendor software, your distributor should be able to keep you up to date with information on your current inventory of each of your procedure packs.

Closely managing these levels is crucial for staff satisfaction. Your staff will quickly rely on the efficiencies obtained through procedure packs. When a pack is out of inventory and your staff has to pick contents piece by piece, turnover time will increase and no one will be happy.

When surgeons join or leave your OR, you should review the contents of their procedure packs. Many packs are designed to meet the needs of one or two surgeons. When the surgeon leaves, you may gain additional cost savings with a small redesign of your pack.

Remember to allow lead time; you have a three-month supply of their packs in your inventory pipeline. Routine review of pack contents will help ensure cost containment and unit efficiency through custom pack design.