Just in Time nelle mani del Chirurgo: ottimizzazione della logistica dei dispositivi specialistici nella Sala Operatoria di Chirurgia Generale del CTO di Napoli
Ilaria Barbato, Barbara Esposito, Virginia Cristiano
Introduction The handling of materials in the operating block is a critical one with a high degree of complexity. To this end, the Pharmacy and General Surgery developed a system to reduce stock inventory through the “Just in Time” method to get the product in quantity, place and time. On the basis of planned operating sessions, the objective was to define a monthly supply plane of devices required for the General Surgery Room, a minimum stock and a methodology for reintegrating the times and quantities needed to ensure operational continuity and low immobilization of stocks.
Materials and Methods We analyzed the medium weekly activities of General Surgery and then, we established the need for the intervention devices, their minimal stock and we resort to the Kanban model for device management and reinstatement. We studied the average delivery time per supplier by extracting 2016 delivery data from the drug management database and considering the production delay times. We positioned the Kanban tags in the warehouse by dividing the dedicated space into a part that contained the devices to use and one with those to be used during the lead time of supply. When the material contained in the first part of dedicated space was consumed, the card was sent to the Pharmacy for reintegration. In the Kanban label besides the name of the product are also shown the quantities to be ordered. Upon arrival of the new material, the dedicated space was filled and the card repositioned to its place in the shelf while waiting for its order.
Results Every week, an avarage of 3 Sleeve Gastrectomy, 3 Colecystectomy, 1 Appendicectomy, 1-2 Colon-rectal Resections, 1 Gastrectomy, 1-2 Hernia or Laparocele were performed. We worked out a “Device Manual” for each intervention. Following the timing of the interventions and the analysis of the evasion and delivery times data, we determined that the devices in stock were sufficient for one month and the minimum stock for reorder was for a week. Applying this procedure, the cost for devices related to the first nine months of 2017 amounted to € 476,496.87 in comparison with € 626,181.34 of the first nine months of 2016.
Conclusion The Process Government guarantees appropriateness, improves assistance, and reduces costs. By choosing the most cost-effective devices and improving logistics, the clinical pharmacist can participate in real practice by playing a key role in providing the best possible care for patients and rationalizing resources.
Key words: medical devices, logistics, Just in Time, Kanban model