ED specific supply costs

[JustPeachyRN]

Hey everyone!

Newbie RN here. Started out straight from school in the ED 9 months ago and absolutely loving it. I've been reading posts for what feels like FOREVER on here, and just now finally joined!

I've recently been assigned a project involving cutting down on our department's supply costs. Prior to my taking on this project, a recent change we made was purchasing anesthesia tubing and trying to use that as often as possible vs. primary tubing (several dollars cheaper for anesthesia). We have started seeing a significant reduction in our monthly supply spending from that alone, which is great, but we need some more ideas!

One of our biggest problems is SpO2 probes going missing. We've tried zip-tying them to the cords in the monitor, and yet we still have to replace several a year at a cost of approx $250 per probe. Not sure what other solution there is to this, or if other EDs have encountered this problem as well.

I'm looking for suggestions or ideas that are used in other EDs for commonly used supplies. Has anyone taken on a project like this in their department? Any input or resources would be greatly appreciated!

[ChristineN, BSN, RN]

Has your ER looked into the cost of the disposable SpO2 probes? Also, in my hospital we have supply pyxises where we can charge materials used directly to the Pt's account.

[JustPeachyRN]

We have. We keep a few on hand for kiddos and miscellaneous situations when merited, but the cost of replacing after every patient would be astronomical. We're a smaller level 3 ED, but we see a TON of volume.

The idea of a supply pyxis has been discussed before with poor reception. I am unsure of the rational behind this. I am also interested in switching to disposable BP cuffs that would follow the patient when admitted to inpatient, but same problem for now unless a supply pyxis is implemented and pt's can be charged for their supplies. I am considering re-introducing the idea of a supply pyxis with some additional supportive arguments. Thanks for your input!

[Esme12, ASN, BSN, RN]

You can make the disposable probe a chargeable item. why do you need a supply pixis...is there a compliance issue with the staff charging for them?

Where do you think the real probes are going or what is happening to them..?

[JustPeachyRN]

I don't think they have ever tried making them a chargeable item. I brought up the same idea with disposable BP cuffs by trying to make them charged to the patient, and the response I got was basically 'we don't have a good way to do that right now.' Not sure what that means, or even what all it would entail to charge patient's for specific items used. I know that reimbursements are at an all time low right now, which may have something to do with not wanting to charge pt's for commonly used items (low reimbursement perhaps means even if we charged we wouldn't necessarily recoup the cost). Any thoughts on this, Esme12?

As far as where the real probes are going...that's anyone's guess I suppose. Some of the transport techs were historically bad about just unplugging the patient from the monitor and leaving the heart monitor leads, BP cuffs, and SpO2 probes all still attached to the pt. They have been reprimanded for this, but even when this was happening I never noticed pt's coming back with missing equipment.

Although SpO2 probes are a big problem, I'm also interested in hearing from anyone involved with supply ordering in their ED and any ways other departments have cut down on their supply expenditure. Thanks again for everyone's input so far, a lot of valid points have been brought up!

[Sassy5d]

Are they going up and being admitted with pt?

[Sassy5d]

As for the probes.. I would do some educating your transport team too. Who is taking them off and where are they going? Write ER on them? I'm not sure how they are being detached from your equipment?

[emmy27]

In our department we use the sticky disposable probes, charged to the patient, on anyone who needs continuous O2 monitoring (less likely to come off than the reusable ones) and staff carry pocket O2 sat monitors for spot checks on everyone else. We had the same problem with the reusable corded ones going missing in the past. I suspect a lot of it was pt theft. We had someone walk off with tele leads the other day.

Sigh. People are weird.

[Belle2013]

I work in a level 1 trauma ED. We have disposable/recycle Bp cuffs and pulse ox probes. We also have an omni cell where we charge supplies to the patient directly. This is done for pretty much everything.

[JustPeachyRN]

Hey y'all,

So I spoke with my manager the other day. We cannot bill pt's for items used. Based on way we currently bill, pt's get charged based on a level of acuity they are assigned by the Dr (i.e. level 3 may mean pt was on telemetry monitor, continuous SpO2 monitoring, cardiac workup...yada yada yada). Dr on billing sheet circles certain levels of acuity and procedures, say pt was level 2 and ortho procedure done, so pt gets billed for level 2 acuity and default ortho supplies charge. Hope that makes sense. Basically, if we charge pt's specifically for items used it's considered 'double dipping' and fraud for duplicate charging based on how our system is currently set up.

This is why we are on a project to try to reduce our supply expenditure since we only charge based on a defaulted level of acuity assigned by the Drs. Something else we now do is try to use ACE wraps when appropriate instead of knee immobilizers, air cast splints, leatherette wrist splints, etc. Sometimes you have to use the real deal, but there are many times total immobilization is not required. Thanks again everyone for your great input! Any additional thoughts or ideas are greatly appreciated!