In a previous article, I discussed how an ill-managed logistics department can lead to an unnecessary hemorrhage of cash. Procedures must be in place to conduct checks and balances to account for equipment issued and to justify use, cost and a comparison against clinical treatments delivered. For example, if an organization only responded to 100 cardiac arrests in a year, yet issued and expensed 200 sets of defibrillator pads, there is an obvious disconnect of provision, use and expenditure.
The Richmond Ambulance Authority (RAA) uses the Operative IQ system to track moving stores from arrival to issuance to a stock-controlled bin, which is then placed on the vehicle as part of the “make-ready” system. Resultant reports allow logistics staff and operational and clinical managers to conduct cross checks to ensure fast-moving or expensive items are being employed efficiently.
Soon after the bar-coding system went into action, a cross check of the use of intraosseous needles revealed more needles issued than eligible patients by a large margin. The ensuing investigation of what is a very expensive line item revealed that foul play was not to blame: It transpired that the first and second needles in the prepackaged equipment were so close together that when extracting one, providers contaminated the other, which was then cast aside as unusable. A simple fix involved moving the second needle into a separate bin. The annualized savings for RAA, which runs 60,000 calls for service in a year, amounted to a four-figure sum!
This is just one example of how an ordered systems approach can save money. The amount of kit and equipment on an average ambulance runs to hundreds of line items. While it is important to check equipment out, it is equally as important to check invoices in. Many items are contracted and locked in for large organizations on an agreed cost-per-item basis. Automated logistic systems—or, if those aren’t available, manual checks—should always ensure that the invoice delivered equates to the contract price. A few cents extra on a bandage may be something the eye misses, but if you take delivery of thousands of them it adds up. In the same vein, ALWAYS know when equipment contracts expire and plan ahead. With no contractual relationship, prices can rise and logistic managers (under most local procurement laws) must obtain quotes for everything. This affects another precious commodity—time.
Other Checks and Balances
Oxygen: Unless you are bottling your own, develop a minimum amount limit and don’t swap out until you reach that point of the tank. You could be returning “empty” tanks that are actually half full.
Sweat the small stuff: Who takes more ECG dots, tape and small expendable items out for patient use than are needed, only to discard them in the waste? You may have just thrown the cost of your merit raise out—enough said.
The harsh reality is that, dependent on payer mix or municipal budget, you may be expensing more on the patient in terms of equipment cost than you recoup from the insurance or payer. In the near future, reimbursement models for EMS will change as we claim our share of the bundle payment and of that, every logistic penny must be pinched.
Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA in 2008 to work with RAA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He is a graduate of the Royal Military Academy Sandhurst and served in the Royal Army Medical Corps. After a 22-year military career in many prehospital and evacuation leadership roles, Rob joined the National Health Service, initially as the Commissioner of Ambulance Services in the East of England. He later served with the East Anglian Ambulance Service as director of operations. He is also a member of the EMS World editorial advisory board.