As the burden to pay for all or at least a portion of an ambulance transport or emergency room visit has increasingly been shifted to the patient, emergency medical services (EMS) agencies have been forced to look at reducing costs in whatever way possible to assuage losses from un-paid transports. Decreasing operational costs is just one way that could help alleviate the deficits from lost revenue.
Without making drastic personnel or apparatus changes, agencies could first look to their supply closet for answers on how to cut operational costs. Maintaining a full and compliant inventory of supplies is a struggle for many agencies, yet even a few simple adjustments related to inventory management could help not only reduce operational costs and address a pain point for many organizations, but these adjustments could also help address the supply shortages that currently plague the industry.
Protect Your Supplies
The ambulance presents a less-than stable working environment: it’s never known who will be in this “office,” and it’s even more unclear as to what cases will present themselves from day-to-day, hour-to-hour. A transport could be simple and routine, but it could involve multiple critical trauma patients. In the latter, the back of the rig tends to become a disaster zone itself. Cabinets are left ajar, first-in bags are left open and exposed, and random supplies are tossed to the side in a desperate attempt to get to the tools required to treat the patients.
Due to these unpredictabilities, it is key to protect your medical supplies. To avoid easy cross contamination during a chaotic run, agencies should attempt to store supplies in durable containers or baggies even if already in a first-in bag’s pocket or ambulance cabinet. This is especially critical for supplies that can easily be damaged or rendered unusable if they get wet from fluids: trauma pads, gauze, and so forth.
Implement Smart, Strategic Ordering
When it comes to ordering supplies, agencies must find the delicate balance of ordering just the right amount. You want enough to stock the ambulance per code, but you also want a reasonable back stock for restocking the rig. The key to finding this balance lies in tracking the most commonly used supplies and ordering per need. Ordering per need also includes knowing which supplies require a larger back stock. For example, gloves are used on every call and run out quickly. In contrast, an agency may not have used an obstetrical delivery kit in years. Thus, maybe only one is required in back stock.
What makes ordering even more complicated, aside from finding the balance, is the existence of expiration dates. Many medications have expirations dates, as do saline flushes and many airway tools such as nasal pharyngeal airways (NPAs) or suction catheters. If a medication has a short expiration date and is rarely used, you may want to consider ordering just the amount required by your state and forgoing a significant back stock. Due to recent shortages, the FDA has even approved extended expiration dates for certain medications. Review the announcement here before discarding these drugs.
Oftentimes, suppliers package items in conjunction that are frequently used together. For example, IV start kits come in one simple package and include all you need to initiate an intravenous (IV) line: gauze, a tourniquet, chloropreps, tape and a chux pad. If the IV was started ideally, the chux pad, extra chloroprep and gauze may not have been used. However, since the remainders cannot be put into the original package again, these supplies are discarded.
One solution to reducing waste and thus saving inventory costs is to recycle items that are not used and re-package them in an agency-created kit. Unused items in IV start kits, EKG electrode packs, airway kits and more can all be redistributed in a new container or water-safe baggies that helps the supplies maintain cleanliness and effectiveness for future use.
Maintain an Accurate and Organized Inventory
Having an inventory management system that works well for your agency is critical to helping reduce unnecessary operational costs. If your stock room is not well-maintained and supplies are difficult to find, items may be put on order unnecessarily. Employees may claim something is out of stock, but this may not be the case: the item may just not be in a readily-accessible location.
Not only should your agency strive for a well-organized stock room, but you should also consider implementation of an inventory management system. Accurately tracking supplies in stock is key to efficient ordering and operations. Unfortunately, supply tracking can be extremely difficult, especially for organizations without the funding for a digital inventory management system. Ideally, your organization would use a digital supply tracking solution that tracks usage of supplies based on the ePCR and alerts when back stock is depleting. For those that cannot afford such a system, Microsoft Excel or reliance on crew members may be viable options for management.
Due to Hurricane Harvey, Irma and Maria, hospitals and ambulance services alike have been struggling through a massive drug and saline solution shortage. Implementing some supply management strategies can help address this shortage while also helping streamline operational costs, something that is going to be ever more important as changes to the overall healthcare system will inevitably continue.