Medical supplies abstract
A method for integration of the institutional supply chain for
medical products utilizing a nested bill of materials on a care
event level of a clinical pathway for one or more medical procedures.
The medical supplies appropriate for use in a care event are expressed
as a bill of materials. Each item of medical supply is assigned
a unique identifier which includes at least identification of the
item itself, identification of the supplier of the item, and identification
of the care event with which the item is to be used. At a first
location a portion of the supplies are unitized and containerized.
This subassembly is transported to a second and remote location
where further of the supplies are unitized and containerized, using
the same container. Thereafter the unitized and containerized supplies
are transported to the end user thereof.
Medical supplies claims
What is claimed:
1. A method for integration of the institutional supply chain for
medical products utilizing a nested bill of materials on a care
event level of a clinical pathway for one or more medical procedures
comprising the steps of
expressing a list of medical supply items appropriate for use in
a care event as a bill of materials which is representative of at
least one care event along a clinical pathway for a medical procedure,
providing the information on said bill of materials to at least
a first and second supplier of the medical supply items listed on
said bill of materials,
at the location of a first supplier of at least a portion of the
medical supply items on said bill of materials, segregating from
an inventory of medical supply items one or more distinct medical
supply items as a first unit, each of said items being included
on said bill of materials, but the total number of the items withdrawn
being less than the total number of items on said bill of materials,
selecting a container having a void volume which is greater than
the volume required to contain said first unit of medical supply
items, depositing said first unit of medical supply items in said
container, and releasably closing said container,
transporting said container to a second supplier of at least a
portion of the medical supplies of the kind identified on said bill
of materials, said second supplier being located remotely of said
first supplier,
at the location of said remotely located second supplier, opening
said container, segregating from an inventory of medical supply
items one or more distinct medical supply items as a second unit,
each of said items being included on said bill of materials, but
the total number of the items withdrawn being less than the total
number of items on said bill of materials, opening said container,
depositing said second unit in said container, and releasably closing
said container,
transporting said container with said first and second units of
medical supplies contained therein to the site of said care event.
2. The method of claim 1 and including the step of including a
copy of said bill of materials in said container at the location
of said first supplier, which bill of materials continues with said
container to the site of said care event.
3. The method of claim 1 wherein said step of expressing the list
of medical supplies for a given care event as a bill of materials
includes associating with each item of medical supplies on the list
a unique identifier.
4. The method of claim 3 wherein said identifier further includes
a coded identification of the care event for which the medical supplies
are intended, and the supplier of each item of medical supply on
the list, thereby providing traceability of each of the items of
medical supplies.
5. The method of claim 3 wherein said identifier comprises alpha,
numeric or a combination of alpha and numeric characters.
6. The method of claim 1 and including the steps of transporting
said container with said first and second units of medical supplies
contained therein to a health care institution where that medical
procedure is intended to occur, prior to delivery of the container
to the site of said care event, opening said container at the health
care institution, adding additional medical supplies to said container,
releasably closing said container and thereafter delivering said
container with said medical supplies to an end-user of said medical
supplies.
Medical supplies description
FIELD OF INVENTION
This invention relates to the supply of medical supplies to patient
care institutions, and particularly to methods for the assembly,
transport and storage of disposable medical supplies.
BACKGROUND OF INVENTION
In the medical care industry, constant vigilance is maintained
over the cost of the care provided to patients, with particular
attention being given simultaneously to assuring the well-being
of the patient. One method currently being practiced by some health
care institutions, particularly hospitals, is centered around the
concept of clinical pathways. As used in this environment, the concept
attempts to bring to bear upon the care afforded a patient all those
resources of the institution which are dictated by the nature of
the patient's illness and which will provide the dictated care,
and result in the patient being restored to that state of health
that permits proper release from the institution after a minimum
length of stay. The use of the clinical pathway concept has been
demonstrated to reduce the length of stay in an institution of a
patient. It has further been demonstrated to reduce the overall
cost of the treatment of the patient while in the institution by
ensuring that no ill effect associated with the patient's stay in
the institution caused the patient to require more that a standard
regimen of treatment for a specific illness. For example, through
proper care, the patient is prevented from developing decubitus
ulcers which could require that the patient remain in the institution
for an extended period of time, just for treatment of the ulcers.
In health-care institutions employing the clinical pathway concept,
there is developed within the institution a protocol for the treatment
of a given illness, surgical procedure, or other regimen of medical
care to be provided to a patient (termed a "procedure").
This protocol lists the contribution of each institutional unit
(e.g. department) toward the treatment of the patient (termed a
"care event"), and the sequence in which each care event
is to occur. This protocol then becomes the "standard"
for the care to be provided for any patient entering the institution
and suffering from the particular illness (medical diagnosis) which
is addressed by the protocol.
Prior to the present invention, the clinical pathway concept has
been applied internally of health care institutions, affecting only
those services which originate within the institution and which
are provided by the internal resources of the institution. No correlation
of the protocol to the cost of supplies is known to have been made
prior to the present invention. Yet, one of the major sources of
costs associated with the treatment of a patient in an institution
is the cost of the supplies which are consumed by the institution.
Because of this shortcoming of the clinical pathway concept, health
care institutions have failed to achieve significant cost savings
as respects the supplies used in the course of any given protocol.
This is especially true with regard to disposable medical supplies
which typically are supplied to the institution from outside sources.
U.S. Pat. No. 5,235,795 discloses a method for the delivery, storage,
transport and disposal of medical supplies to a health care institution
in which the ultimate cost to the institution of the medical supplies
is reduced by supplying disposable medical supplies direct from
a supplier in receptacles which may thereafter be used by the institution
in safely disposing of waste medical supplies. This method is dependent
upon the institution identifying the supplies needed and placing
an order for the same from a supplier. The usefulness of the method
therefore is limited by the institution's accuracy of ordering.
If the institution has inadequate facilities to determine its supply
needs, and as a consequence orders too little or too much of a given
supply item, this prior art system has no means for detecting this
shortcoming.
It is therefore an object of the present invention to provide a
method for the selection and delivery of medical supplies to a health-care
institution.
Other objects and advantages of the invention will be recognized
from the description provided herein, including the claims and drawings
in which:
FIG. 1 is a diagrammatic representation of a generic clinical pathway
as applied to a health-care institution;
FIG. 2 is a diagrammatic representation depicting various aspects
of one embodiment of the method of the present invention; and
FIG. 3 is a diagrammatic representation depicting other aspects
of one embodiment of the method of the present invention.
SUMMARY OF INVENTION
In accordance with the method of the present invention, the supply
needs of a health-care institution are integrated into a system
for the delivery of these supplies to the institution. The method
comprises a nested multi-level system in which the smallest element
of unitization in the system is termed a "unit". Units
are combined into supply bundles which are subassemblies to consumption
levels (i.e. care events) within a clinical pathway, and consumption
levels are subassemblies to a particular clinical pathway. In this
manner, the institution may follow an object-oriented, unitized
approach to supply consumption along with the clinical pathway.
The method of the present invention includes the steps of expressing
those items of medical supplies which a health care institution
requires for a given care event (consumption level) in a clinical
pathway for a given medical procedure, as a bill of materials, employing
identification codes (identifiers) which include at least an identification
of the care event with which the supply is to be used, an identification
of the supplier of the item of supply, and an identification of
the item itself. Employing the identification codes, a bill of materials
which is representative of those medical supplies identified for
a given care event within a clinical pathway, is prepared preferably
at a first location of medical supplies. At the first location,
at least a first portion of the medical supplies on the bill of
materials is unitized into a unit. One or more units may be prepared.
The unit or units are deposited in a container having a void volume
which is greater that the volume occupied by the unit. The container
with the unitized medical supplies therein is releasably closed
and thereafter transported to a remotely located second supplier
of at least a portion of the supplies listed on the bill of materials.
At the location of the second supplier which is remote from the
location of the first supplier, at least a second portion of the
medical supplies on the bill of materials is unitized. At the location
of the second supplier, the container is opened and the unit or
units of medical supplies provided by the second supplier are deposited
inside the container, the container is re-closed and transported
with the medical supplies contained therein to the location of an
end-user of the medical supplies. The end user of the containerized
medical supplies, commonly is a department in a care provider (e.g.
operating room of a hospital). In certain instances it may be desired
that the care provider also add medical supplies to the container.
In this case, the container with the unitized medical supplies from
the first and second supplier is releasably closed and shipped from
the second supplier to the care provider. This care provider thereupon
opens the container and adds to the container those medical supplies
which it can most advantageously supply. The container may then
be closed and either placed in inventory or transported to the end
user. The present method accommodates these steps of the procedure
in that the initial bill of materials lists thereon those medical
supplies which are to be added to the container by the care provider
prior to the container being forwarded to the end user. This method
provides advance notice to each tier of suppliers as to precisely
where and what products are to be required and it provides the means
by which each supplier can ensure the availability of its designated
medical supplies well in advance of the need therefor. Ordering
of medical supplies from a manufacturer and inventorying of the
supplies are both enhanced by the present method.
The unique identifiers employed in the present method serve multiple
purposes. These codes include identification of the supplier of
each item of medical supply, through multiple levels of supply within
the supply chain as necessary, thereby providing traceability of
the item to its source as is required by federal and other regulations
for the handling of medical supplies, particularly sterile medical
supplies. Further, each code includes identification of that care
event within the clinical pathway of the institution where the supply
item is to be used, thereby assuring that the particular supply
item is delivered to its intended point of use, so that the institution's
clinical pathway is not disrupted by reason of the item of supply
not being available at the time and place with the institution when
needed. First, This aspect of the method permits the institution
to order disposable medical supplies by procedure, as opposed to
the traditional ordering of individual items of medical supplies
for warehousing at the institution and withdrawing from the stock
of these supplies as needed. Second, this aspect of the method further
permits the institution to stock medical supplies on the basis of
historical information as to the number of given medical procedures
(care events) that are to be expected within a given time frame.
This capability permits the institution to stock standardized units
of supplies for statistically calculable demands for the supplies
and thereby reduce supply inventories.
DETAILED DESCRIPTION OF INVENTION
Referring to FIG. 1, a generic clinical pathway for a given medical
procedure within a health-care institution may include a series
of care events such as admission 10, patient work-up 12, pre-op
14, anesthesia 16, operating room 18, post-op 20, floor 22 and discharge
24. In accordance with the present invention, the disposable medical
supplies which the institution must obtain from a source outside
the institution, as well as any medical supplies that are to be
provided by the institution itself, and which are associated with
a given care event, are identified. Each identified item of supply
is assigned a unique code which identifies at least the item itself,
the source for the item and the care event with which the item is
to be used within the institution. Each code also may include identifiers
of the anticipated user of the supply, such as a surgeon's initials,
and other identifier information. Preferably, the federally promulgated
ICD-9 code (International Classification of Disease--9th Revision)
for a given medical procedure is used to identify the clinical pathway
with which the supply item is to be used.
The preferred code further includes an identifier for the location
within the clinical pathway, i.e. care event at which the bundle
of supplies is to be consumed, e.g. in the operating room. Accordingly,
the code comprises a nested multi-level system--the supply item
identification, bundle identification, supplier identification,
and care event identification.
A typical code, listing the levels of the code, for a supply item
is given below:
______________________________________ 90-aaaabbbcxxxxx Clinical
Pathway Level aaaa ICD-9 code (without decimal point) bbb Surgeon's
initials c product configuration code (guarantees unique number)
xxxxx not used (blank) 91-3333ffffggggg Consumption Point Level
eeee consumption point identifier code ffff protocol identification
code ggggg code used to guarantee a unique number 92-hhhiiiiiiixxx
Supply Bundle Level hhh supplier identifier code iiiiiii unique
serialezed identifier code xxx code used to guarantee a unique number
______________________________________
A typical bill of materials developed from the unique number and
coded supply items associated with the operating room level of the
clinical pathway for a laparoscopy cholestomectomy protocol (performed
by Dr. Jones) is given below:
______________________________________ PART DESCRIPTION QTY ______________________________________
90-0926JAJSO768 Dr. Jones Lap Choy Procedure 1 56-11208 TraceCart
Lid 1 56-11360 TraceCart Base, 30 Gallon 1 91-OPRRM4620768 Operating
Room Supply Bundle 1 92-DER3345380768 DeRoyal Supply Bundle for
OR 1 50-9783P Basic Endo Pack 1 28-0500 Probe, Irrig/Aspir w/Tubing
56-50315 Tape, Video VHS 120 71-1101 Suction Canister, 1500cc 1
92-OMI334580768 O & M Supply Bundle for OR 1 OMI1553522 Grounding
Pad, Hydrogel, REM I OMI1832354 Tray, Skin Prep 1 OMI1443872 Tray,
Foley 16Fr 5CC 1 OMI1883624 Cath, IV PL Unit 1 ______________________________________
Each identifier (identification code) may include alpha, numeric
or a combination of alpha and numeric characters. The maximum number
of characters in any given identifier is limited only by the data
handling system(s) available to the manufacturer, the distributor,
the institution, and the end-user. It will be recognized that the
entity which initiates a bill of materials must have access to full
information for each care event as will enable the entity to generate
the bill of materials. This includes information as to which medical
supplies and how many of each, are required by a given health care
provider for a given care event. It also requires that the initiator
of the bill of materials have in its database full information as
to the source and identification of each item of medical supplies
which is to be provided for a given care event.
In the present method, the identifiers associated with the medical
supplies intended for a given care event, within a clinical pathway,
are initially expressed as a bill of materials which is thereafter
used as the basis for collecting and unitizing the medical supplies.
A single bill of materials for a given supply bundle is used by
all providers of medical supplies that go to make up the supply
bundle.
With reference to FIGS. 2 and 3, in accordance with one embodiment
of the present method, a typical supply chain for products made,
delivered and eventually used in a medical care facility, such as
a hospital, which employs the clinical path concept in its patient
care functions, includes one or more manufacturers 30 and 32 of
one or more of the supply items used in one or more of the care
events 34, 36, 38 and 40 of a clinical path, indicated generally
by the numeral 42, and, optionally, is a distributor 44 of one or
more of the supply items used in one or more of the care events
of the clinical pathway. The supply chain is completed by the inclusion
of the medical care facility 46 itself. In certain instances, medical
supplies for a given care event may be supplied by the manufacturer
and by the hospital, or by the distributor and the hospital or by
all three, or even including multiple distributors or multiple manufacturers.
With further reference to FIGS. 2 and 3, in one embodiment of the
present method, supply bundles 50, 52, 54 and 56 which are intended
for use within respective care events 34, 36, 38 and 40, originate
with one or more manufacturers 30 and 32. At a first manufacturer's
30 location, one or more supply items, manufactured, assembled or
otherwise provided by the manufacturer, are unitized into a unit
58. This unit of medical supply items is placed in a container 60
which is releasably closed, as by a removable lid 62. Optionally,
and most commonly, this container and its contents are thereafter
transferred to the location of a distributor 44 where one or more
additional supply items are unitized into a further unit 64 and
placed in the container 60. The container with its contents of medical
supplies is referred to as a "supply bundle". The supply
items provided by the distributor commonly are products provided
by a second manufacturer 32 other than the first manufacturer, thereby,
requiring that either the distributor or the second manufacturer
cooperate in assigning to the supply items provided to a supply
bundle appropriate identifiers that are consistent with the identifier
protocol established between the medical care provider and the first
manufacturer, for example. This most commonly is accomplished by
the first manufacturer initially establishing an identifier for
each medical supply item to be included in a given bundle, plus
other appropriate identification elements, which the distributor
also uses. For example, the distributor may affix the appropriate
identifier which is provided by the manufacturer, to each supply
item which the distributor adds to the bundle.
The container with the two or more units of medical supplies contained
therein is releasably resealed by the distributor and transported
to the medical care facility, e.g. a hospital. As depicted in FIGS.
2 and 3, at the hospital, each supply bundle, comprising the container,
its lid, and one or more units of medical supply items, is delivered
to the location of that care event for which the supply bundle was
designed, for example, to the OR (operating room) when needed. As
noted above, the hospital, through its historical usage records
for its medical supplies for a given care event, can readily order
from a manufacturer, and the manufacturer (and distributor) can
readily deliver, in a timely fashion, those medical supplies which
are required for the given care event. Timing of the ordering and
delivery of a given supply bundle is further enhanced through the
use of the hospital's historical records relating to the frequency
of occurrence of a given care event within the hospital.
In accordance with another aspect of the present method, the inventors
have found that many care events, as defined in the clinical pathway
concept of providing patient care, even though taking place at different
levels of a given clinical pathway and/or even in the clinical pathway
for disparate illnesses (i.e. for different ICD-9 codes) call for
the use of common items of medical supplies. Therefore, based upon
a given hospital's historical occurrence rate of all (or many) of
its ICD-9s in combination with the hospital's usage rate for each
of its care events, irrespective of the ICD-9 with which the care
event may be associated, the inventors can project the total usage
by the hospital over time of each item of its medical supplies.
With this information in hand, a manufacturer of a variety of medical
supplies can anticipate the usage of those medical supplies which
it contemplates that it will provide to the supply bundle. The manufacturer,
therefore, can more efficiently control its ordering and inventorying
of raw materials, can better schedule its manufacturing operations,
and can reduce its inventories of finished goods. Because of this
capability, the medical supplies can be provided to the hospital
at a cost that permits the hospital to minimize its cost of providing
health care to its patients. These same benefits are available to
the distributor, the hospital, or any other entity in the supply
chain.
One feature of the present method provides for the generation of
the bill of materials at the outset, i.e. upon receipt by the manufacturer
of an order for a particular bundle. Since the bill of materials
as initially generated includes identification of the supply items
which are to be provided by each of the manufacturer, the distributor
and/or the hospital, a copy of the bill of materials provided to
each entity substantially immediately upon its completion provides
useful advance notice to the entities so notified that the order
has been received and is being processed. Importantly, this advance
notice also identifies to each entity the products which they are
expected to provide so that they can "preprocess" the
order by collecting and unitizing the supply items in anticipation
of receipt of a container from the entity ahead of them in the supply
chain. This feature shortens the time between placement of an order
and delivery of the product to the extent that the hospital can
rely on "just-in-time" type delivery of the needed supplies.
This results in less inventory of supplies at the hospital and reduced
costs. Like inventory cost savings are experienced by the distributor.
Still further, the present method, and its shortened delivery time
for specific medical supplies, permits the hospital to include patient-specific
items in a given bundle. For example, patient-sized items such as
endotracheal tubes and foley catheters commonly can not be specified
until the patient surgery (or other specific treatment) is scheduled.
Heretofore, the hospital and/or distributor had to keep on hand
inventories of such patient specific supplies. Because of the control
over inventory and short lead time afforded by the present method,
these items can be included in a specific bundle which is labeled
for a specific patient. Again, this permits the hospital to reduce
its level of inventory of the medical supplies and realize monetary
savings.
The unitizing of the medical supplies by a manufacturer may take
any appropriate form, but preferably includes collecting the medical
supply items and enclosing them in a protective cover, such as a
bag (which may be sealed) or a wrap of the type known in the art
as a sterile wrap. The function of the protective cover is two-fold
primarily. First, the cover protects the products from possible
contamination and from possible damage due to shifting or movement
during transit or handling. Second, the cover unitizes, that is
segregates, the collection of medical supplies so that the unit
can be readily identified. This identification includes identification
of the unit as a billable item for purposes of reimbursement accounting.
That is, the unit, through its unique identifier, provides both
the hospital and a third party payment provider, such as Medicare,
Medicaid or insurance company, with sufficient information to qualify
the unit of medical supplies as a valid reimbursable entity.
The container employed in the present method can be one of the
type which is disclosed in U.S. Pat. No. 5,235,795, for example,
which patent is incorporated herein in its entirety, by reference
thereto. This patent further describes a type of packaging of medical
supplies which is acceptable for use in the present method. Other
containers, including bags or conventional boxes may be employed.
Whereas specific description of various aspects of the present
invention have been described herein, it is intended that the invention
be limited only by the claims appended hereto. For example, the
specific composition of the identifier to be used need not be precisely
like that which is disclosed, but may include more, or in some instances,
less identifying indicia without departing from the essence of the
invention. Further, in certain instances, the supply chain may not
include a distributor, but rather the first provider may be the
manufacturer and the second provider to add supply items to the
bundle may be the hospital, itself.
Whereon specific description of various features of the invention
be limited only by the claims appended hereto. |